Perspective: Incidence of Clinician-Diagnosed Lyme Disease in Manitoba, Canada 2009–2018
Richard RuskSalima GasmiAnnie‐Claude BourgeoisMandy WhitlockGilles R. DetillieuxKelly K. StimpertDavid L. BuckeridgeJules K. Koffi
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Abstract:
Lyme disease (LD) surveillance yields useful information to monitor the disease trends and spatial distribution. However, due to several factors, the Manitoba Health surveillance system, as with other systems, could be subject to underreporting.Keywords:
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Objective: Patients and families searching the Internet about Lyme disease may find conflicting information. Our purpose was to review the accuracy of information on Lyme disease easily available on the Internet. Methods: We used 15 search engines to find general information about Lyme disease. We found 251 Lyme disease websites, which we reviewed. Of these 251 websites, 19 gave general Lyme disease information and were analyzed. We evaluated the accuracy of information concerning 8 Lyme disease topics. Results: Ten of the 19 websites gave accurate information and 9 of the 19 websites provided inaccurate information. There were 8 websites with the word "Lyme" in the domain name, and 7 of the 8 sites gave inaccurate information. There were 2 ".gov" websites, and both gave accurate information. Conclusions: Patients and families searching the Internet for medical information about Lyme disease may encounter inaccurate information.
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Background. The commercially-available C6 Lyme enzyme immunoassay (EIA) has been approved to replace the standard whole-cell sonicate EIA as a first-tier test for the diagnosis of Lyme disease and has been suggested as a stand-alone diagnostic. However, the C6 EIA has not been extensively studied in pediatric patients undergoing evaluation for Lyme disease. Methods. We collected discarded serum samples from children and adolescents (aged ≤21 years) undergoing conventional 2-tiered testing for Lyme disease at a single hospital-based clinical laboratory located in an area endemic for Lyme disease. We performed a C6 EIA on all collected specimens, followed by a supplemental immunoblot if the C6 EIA result was positive but the whole-cell sonicate EIA result was negative. We defined a case of Lyme disease as either a clinician-diagnosed erythema migrans lesion or a positive standard 2-tiered serologic result in a patient with symptoms compatible with Lyme disease. We then compared the performance of the C6 EIA alone and as a first-tier test followed by immunoblot, with that of standard 2-tiered serology for the diagnosis of Lyme disease. Results. Of the 944 specimens collected, 114 (12%) were from patients with Lyme disease. The C6 EIA alone had sensitivity similar to that of standard 2-tiered testing (79.8% vs 81.6% for standard 2-tiered testing; P = .71) with slightly lower specificity (94.2% vs 98.8% 2; P < .002). Addition of a supplemental immunoblot improved the specificity of the C6 EIA to 98.6%. Conclusions. For children and adolescents undergoing evaluation for Lyme disease, the C6 EIA could guide initial clinical decision making, although a supplemental immunoblot should still be performed.
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By using a Lyme enzyme-linked immunosorbent assay (ELISA), we demonstrated that high ELISA index values are strongly predictive of Lyme disease. In children with clinical presentations consistent with Lyme disease, ELISA index values ≥3.0 had a positive predictive value of 99.4% (95% confidence interval: 98.1–99.8%) for Lyme disease, making a supplemental Western immunoblot potentially unnecessary.
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We conducted a matched case-control study to assess the effectiveness of Lyme vaccine (LYMErix) as it was used in clinical practice. We found ≥3 doses to be 71% effective against Lyme disease. This is the first study to show that the Lyme vaccine is effective in a real-world setting.
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Abstract Background Controversy and confusion surround the terminology for patients who have persistent symptoms after treatment for Lyme disease (LD) or may have been misdiagnosed with Lyme disease. While Infectious Diseases (ID) use the term Post treatment Lyme disease syndrome (PTLDS), patients tend to use the term Chronic Lyme disease (CLD) to describe the syndrome associated with persistent symptoms post treatment of LD. Many ID physicians are reluctant to see patients who identify themselves as having “Chronic Lyme” disease in some part due to reluctance to prescribe repeated courses of antibiotics. The purpose of this inquiry was to assess belief regarding Lyme disease and treatment. Methods Patients at the Integrated Lyme Program at the University of Maryland completed clinical intake forms which included questions on their familiarity and beliefs surrounding Lyme disease. Results We evaluated 146 patient records from our Lyme Program Registry which began in December 2018. There were 57 (34.5%) males and 108 (65.5%)females with mean age of 51 years. Forty seven percentage of patients were referred by a physician and 53 % were self-referred. Approximately 50% (71/146) were treated with less 30 days of antibiotics, 37% (54/146) were treated with 1-6 months of antibiotics and 11.6% (17/146) were treated with >6months of antibiotics prior to their initial evaluation in our Lyme program. Sixty eight percentage of patients were familiar with the term CLD but only 44% percentage were familiar with term PTLDS. Approximately half of the patients ( 52%) believed that they currently had Lyme disease and 63% believed that their current symptoms were due to Lyme disease. Despite this only 18% believed that they needed antibiotics for Lyme disease at the time completing the form. Conclusion Patient referred to our Lyme center were more familiar with term CLD vs PTLDS. Many of them believed that they currently had LD and their symptoms were due to Lyme disease. Despite this, the majority did not feel that they needed antibiotics for Lyme Disease at the time of their clinical visit. More research is needed to better understand patient beliefs and understanding regarding Lyme disease. Disclosures All Authors: No reported disclosures
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The summer brings physicians an onslaught of tick-related questions, especially in Lyme-endemic areas where antibiotic prophylaxis is sometimes instituted after a bite. This study may help estimate the risk for Lyme disease in susceptible patients and determine if prophylaxis is warranted. …
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To know the real incidence of tuberculosis in Galicia and its epidemiological characteristics.Study of data recorded in the "Galician Programme for Tuberculosis Control and Prevention", where an active epidemiological survey of every diagnosis of tuberculosis is carried out in every part of Galicia.1995 cases were included in this study, with an incidence of 72.7/100,000 inhabitants. 58% of the cases were detected by the epidemiological survey. 92% of the cases were newly diagnosed cases, being the remain relapses. The highest incidence were localized in the areas of A Coruña and Vigo. The mean age was 40.5 years with 57% being between 15 and 44 years. Male incidence was 92.8/100,000 and female incidence was 54.0/100,000 (RR = 1.72; CI 95%: 1.57-1.88). 18.1% of the patients had at least one of the following risk factors associated: HIV infection (9.1%), alcoholism (8.4%) or injecting drug use (7.3%). Other risk factors for tuberculosis were very unusual. Pulmonary localization was the most frequent form with 1389 cases (incidence: 50.6/100,000). 742 patients were considered to be bacilliferous (incidence: 27/100,000).The incidence of tuberculosis in Galicia is high. Its epidemiological characteristics suggest a historical lack of measures of tuberculosis control.
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Lyme disease is caused by a bacteria belonging to the Borreliaceae family. Wooded forests and terrains are affected, including those in the Northeastern United States. Teenage ticks are most commonly discovered on humans as those ticks need to satisfy their nutritional requirements for growth. They bite warm, moist areas of the body and take 24 to 48 hours to transmit the Borrelia Burgdorferi infection. Lyme disease manifests as a multisystem disorder in humans, and is known for its dermatological, neurological and rheumatological findings. For the primary care provider, Lyme disease should be on the differential in multisystem diseases. Our case is a 63 year old gentleman who presented with unilateral knee pain for the last 3 months. He initially visited the outpatient orthopedic outpatient office for this arthritic pain. Before moving forward with knee replacement he was eventually tested for Lyme Serology IgG and IgM tests. His positive results warranted Lyme Western Blot testing which confirmed the suspicion of lyme arthritis secondary to Borrelia Burgdorferi. He was treated with a 14 day course of doxycycline, which resulted in significant improvement of knee pain and return to baseline functionality without surgical intervention. The purpose of this report is to stress the importance of beginning doxycycline as soon as possible to avoid progression into other organ systems such as worsening rheumatologic arthritis, central nervous system neuropathies, peripheral nervous system palsies, or cardiac atrioventricular blocks. The optimal treatment is obtained with thorough history taking and physical examination.
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