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Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
Published on: February 4, 2018
Practices of Lyme disease diagnosis and treatment by general practitioners in Quebec, 2008-2015
Salima Gasmi1,2, Nicholas H Ogden3,4, Patrick A Leighton5
1Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045, chemin Sainte-Marie, Sainte-Anne-de-Bellevue, H9X 3R5, Canada.
Background:
Lyme disease (LD), a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto (B. burgdorferi), is the most reported vector-borne disease in North America, and by 2020, 80% of the population in central and eastern Canada could live in LD risk areas. Among the key factors for minimising the impact of LD are the accurate diagnosis and appropriate management of patients bitten by ticks. In this study, the practices of Quebec general practitioners (GPs) on LD diagnosis and management of patients bitten by infected ticks are described.
Methods:
Eight years (2008 to 2015) of retrospective demographic and clinical data on patients bitten by infected Ixodes scapularis (I. scapularis) ticks and on the management of suspected and confirmed LD cases by Quebec GPs were analysed.
Results:
Among 50 patients, all the antimicrobial treatments of LD clinical cases were appropriate according to current guidelines. However, more than half (62.8%) of erythema migrans (EM) were possibly misdiagnosed, 55.6%, (n = 27) of requested serologic tests were possibly unnecessary and the majority (96.5%, n = 57) of prophylactic antimicrobial treatments were not justified according to current guidelines.
Conclusions:
These observations underline the importance for public health to enhance the knowledge of GPs where LD is emerging, to minimise the impact of the disease on patients and the financial burden on the health system.
Insights
Lyme disease diagnosis and management by Quebec GPs show appropriate treatment for clinical cases but potential misdiagnosis of erythema migrans and unnecessary prophylactic treatments. Enhancing GP knowledge is crucial for public health in emerging Lyme disease areas.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Lyme disease (LD), caused by Borrelia burgdorferi, is North America's most reported vector-borne illness.
- Emerging LD risk in Canada necessitates accurate diagnosis and management of tick-bitten patients.
- General Practitioners (GPs) play a critical role in managing LD and tick exposures.
Purpose of the Study:
- To describe the diagnostic and management practices of Quebec GPs for patients bitten by infected ticks.
- To evaluate the appropriateness of LD diagnosis and treatment according to current guidelines.
- To identify areas for improvement in LD patient care.
Main Methods:
- Retrospective analysis of demographic and clinical data from 2008 to 2015.
- Inclusion of data on patients bitten by Ixodes scapularis ticks.
- Review of management for suspected and confirmed LD cases by Quebec GPs.
Main Results:
- Antimicrobial treatments for confirmed LD clinical cases were appropriate.
- Over 60% of erythema migrans (EM) cases were possibly misdiagnosed.
- A majority of prophylactic antimicrobial treatments were not justified by current guidelines.
Conclusions:
- There is a need to enhance GP knowledge regarding Lyme disease in emerging areas.
- Improving diagnostic accuracy and treatment justification can minimize patient impact.
- Optimizing LD management can reduce the financial burden on the healthcare system.
