Lyme Disease

Lyme disease is named after the small town in Connecticut where an explosion of rheumatoid arthritis cases was observed in a large number hundreds of children in 1975. It was only seven years later that we when it was confirmed that these cases were due to a bacterium – Borrelia burgdorferi – transmitted by a single species of tick: the black-legged tick, also known as the deer tick.

The black-legged tick is found in areas with an abundance of white-tailed deer and white-footed mice, the two main reservoirs of B. burgdorferi. The tick's territory, initially concentrated in Montérégie, Estrie and southern Ontario, is now expanding northwards at a rate of 33 to 55 km per year (1). Since these ticks can be carried by birds, the risk of contracting Lyme disease, which is currently rather low in other regions, will increase with global warming (2). Black-legged ticks are most active in the summer (June, July and August), although they can also infect people as soon as the temperature rises above 4°C (April to December).

About 20% to 25% of black-legged ticks are infected with B. burgdorferi but this rate can rise to 40% in regions where it is well established Therefore, not all bites from this tick will cause Lyme disease. In addition, for the bacterium to infect the human body, the tick must remain on the skin for more than 24 hours.

Some people will experience only very mild symptoms – or none at all – following an infection with the bacterium. But for others, the situation will be more worrisome. The most visible sign of an infection is redness on the skin, which grows day by day to reach a diameter of more than 5 cm. Called “erythema migrans,” this rash often takes the form of a bull’s-eye. It appears three to twenty days after a bite and is often accompanied by flu-like symptoms such as fever, fatigue, headaches, or muscle and joint pain.

If the infection is not treated, the consequences can be serious in the weeks and months that follow:

• Paralysis of facial nerves (Bell's palsy);
• Pain and numbness in the limbs;
• Stiffness in the neck;
• Cardiac rhythm disorders;
• Chronic damage to large joints (after several years).

According to healthcare professionals and observations made in several affected individuals, there is also another chronic form of Lyme disease of the same type as the one associated with Long COVID. This form could manifest itself several years after an untreated infection and result in chronic fatigue and muscle and joint pain. Although medical authorities recognize the existence of a post-treatment syndrome of Lyme disease in many people, the existence of a chronic form of the disease without initial diagnosis is the subject of much greater controversy. This debate is fuelled by the current difficulty in reliably detecting traces of the bacterium presence in the body after several years, and by the dangerous nature of the treatment- which involves administering highly potent broad-spectrum antibiotics such as - doxycycline - for several months. Research is ongoing to confirm whether hygromycin A, a recently “rediscovered” low-spectrum antibiotic (highly specific to B. Burgdorferi), could offer treatment with fewer undesirable side effects (3).

In the vast majority of cases (80%), the presence of an erythema migrans leads to a diagnosis of Lyme disease during the period of a few days to three weeks after the infection. If it also turns out that the person resided or stayed in an area infested with the black-legged tick, all doubts can be cleared. It is then justified to begin treatment with doxycycline without the need for laboratory confirmation of the presence of bacteria.

In the most severely affected regions, Public health authorities even recommend not waiting for the appearance of an erythema migrans before starting preventive treatment with doxycycline if the following conditions are met:

• Less than 72 hours have passed since the tick was removed;
• The tick has been attached for more than 24 hours;
• Treatment with doxycycline is not contraindicated for the person;
• The person was bitten in one of the geographical areas designated as higher risk.

If the situation is less clear, a diagnosis can be made by detecting the presence of antibodies produced against the bacterium in the blood. This approach is used if the person has not visited one of the higher-risk areas, does not have an erythema migrans rash, or if the illness has reached the later stages.

For laboratory diagnosis, the Quebec health authorities only allow the so-called two-tier approach, which, in the first stage, involves identifying antibodies in the blood using anti B. Burgdorferi, an enzyme immunoassay, followed by confirmation of a positive result using an immunoblot (western blot). Certain tests offered by American laboratories for the diagnosis of the chronic form of Lyme disease are strongly discouraged.

This revised edition reflects an updated version from the original version published on April 2nd, 2019, on our website. We have incorporated recent facts to offer you current and pertinent information.

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