Tick and Lyme Disease Clinicians Update
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Tick Collection and Lyme Disease
May 28, 2015
As the Windsor-Essex County Health Unit is starting to receive tick submissions for testing, I wanted to take this opportunity to provide you with information on tick collection and Lyme disease.
Southwestern Ontario is an established area for Lyme disease. Closer to home, Point Pelee National Park has been identified as an endemic area for blacklegged deer ticks and Lyme disease as well as the north shore of Lake Erie, particularly in areas around Long Point, Turkey Point, Rondeau Park and the St. Lawrence Islands National Park areas.
Important reminders for Health Care Providers:
- Not all tick bites will result in disease
- It is not the bite of the tick, but the bacteria (Borrelia burgdorferi) in the tick’s saliva that cause Lyme disease
- The tick must attach and feed on a human for at least 24 hours before the organism is transmitted
Diagnosis of Lyme disease generally is supported by a history of potential tick exposure in an area where it is known or suspected that blacklegged ticks have become established.
- Early localized disease presents with Erythema Migrans (EM) with or without flu-like symptoms without any GI or respiratory symptoms (usually within one month following the bite). About 1 in 5 patients lack this skin lesion, and the illness begins with flu-like symptoms or a later disease manifestation.
- Early disseminated disease presents as multiple EM lesions and/or neurologic and/or cardiac findings (occur weeks to months).
- Late Lyme disease is associated with intermittent or persistent arthritis involving one or few large joints, especially the knee, and/or certain rare neurologic problems, primarily a subtle encephalopathy or polyneuropathy (develops months to a few years after the initial infection).
Diagnosis is primarily based on clinical and epidemiological findings. Detection of antibodies against B. burgdorferi using the two-tiered serological method is an additional diagnostic tool; however patients with clear symptoms of early localized Lyme disease should be diagnosed and treated without laboratory confirmation, as false negative test results are common during the early stage of Lyme disease. (PHAC, 2015). Please note:
- Serologic tests are insensitive during the first few weeks of infection.
- Ontario Public Health Laboratory is available to consult on laboratory testing with health care providers for Lyme disease at toll free # 1-877-604-4567.
- All clinically diagnosed, suspected and confirmed Lyme disease cases must be reported to the Health Unit. During regular office hours, please call 519-258-2146 ext. 1471 and 1447 and after hours (weekends) please call 519-973-4510.
The Health Unit accepts ticks removed from humans to be sent to the Public Health Laboratory. Monday to Friday, 8:30am-4:30pm at all 3 of our office locations (Windsor, Essex and Leamington – addresses below). Ticks are tested for surveillance purposes and not for diagnostic and/or treatment purposes.
Suggested treatment for localized (early) Lyme disease. Consult an infectious disease specialist for the most current treatment guidelines or for individual patient treatment decisions.
Adults can be treated with Doxycycline (100mg, p.o., BID) or Amoxicillin (500mg TID) for 14 days (range 14-21). Other antibiotic choices (2nd and 3rd line) include Cefuroxime, Ceftriaxone, Cefotaxime, and Penicillin G.
Children can be treated with Amoxicillin (50mg/kg/day divided q8h) for 14 days (range 14-21). Other antibiotic choices (2nd and 3rd line) include Cefuroxime, Doxycycline, Ceftriaxone, Cefotaxime, and Penicillin G.
Health Care Providers Online Resources (Treatment Guidelines and Post-exposure antibiotic therapy):
- Windsor-Essex County Health Unit https://www.wechu.org/your-environment/ticks-and-lyme-disease
- Healthy Canadians (Government of Canada website) as they have posted information for health professionals on Lyme Disease
- Link to the Ontario Public Health Lyme Disease Infectious Disease Protocol/Management and Provincial Case Definition http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/lyme_disease_cd.pdf
Important instructions for your patients:
If they’ve been bitten by a tick, collect both nymphs and adult ticks safely. Instructions on how to properly remove a tick with a tick key or tweezers http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/lyme/ticks-removal-enlever-tiques-eng.php.
- The Health Unit accepts ticks removed from humans to be tested by Public Health Laboratory. Patients are advised to bring the tick to the Health Unit in a sealed container with a damp paper towel in it. Your patient will be required to have their health card with the tick submission.
- The Health Unit will notify the patient if the tick submitted was identified to be a blacklegged deer tick. This species of tick will be sent for further testing at the National Microbiology Lab. Results usually take up to 2 weeks but can take longer (depending on the season).
If you need further information on ticks or Lyme disease, I would be very happy to assist you.
Dr. Wajid Ahmed
Associate Medical Officer of Health (Acting)