Risk of Lyme disease low, Manitoba specialist says

While reports of tick sightings are up across many parts of Canada this year, the risk of contracting Lyme disease from a tick bite remains relatively low in Manitoba, according to a provincial specialist.

Dr. Stephen Goulet, an Internal Medicine Specialist and physician with Manitoba’s Tick Collaborative Care Service (TiCCS), said most people bitten by a blacklegged tick will not develop Lyme disease, even as the number of confirmed cases in the province has gradually increased since the early 2000s.

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted through the bite of an infected blacklegged tick. Southern Manitoba remains the province’s highest-risk region for exposure.

“The number of ticks carrying Lyme disease in Manitoba is still pretty low,” Goulet said, noting that infection following a tick bite remains uncommon.

For patients who continue to experience symptoms long after a suspected tick bite, Manitoba offers the Tick Collaborative Care Service, a physician referral program operated by Shared Health.

The service is intended for adults who have experienced symptoms associated with tick-borne disease for at least three months, have undergone standard testing or treatment, and remain ill. Patients must be referred by a primary care provider, nurse practitioner or physician assistant.

Under the program, specialists assess patients, review their symptoms and develop a treatment plan. Most patients are seen between one and three times before ongoing care is returned to their family physician.

“We are more for when it’s not clear,” Goulet said. “The idea is we see the consult, come up with a basic plan, and depending on how complicated things are, the plan will be for us to follow them for a few follow-ups and leave it in the hands of the family doctor.”

For more complex cases, TiCCS consults with specialists in areas such as rheumatology to help determine appropriate treatment.

Goulet said many people associate Lyme disease with the characteristic bullseye rash, but not everyone develops one.

Diagnosis relies on both clinical assessment and laboratory testing. Manitoba uses a two-tier blood test that detects antibodies, but Goulet said testing too soon after a tick bite can produce a false negative because it can take up to six weeks for antibodies to develop.

“If a physician suspects Lyme disease, it is better to start treatment than to wait for the test to be reported,” he said, adding Lyme disease is often a clinical diagnosis.

The standard treatment is a two- to three-week course of oral antibiotics, which Goulet said is effective for most patients.

If left untreated, Lyme disease can spread through the bloodstream and affect the joints, heart and nervous system.

Potential complications include Lyme arthritis, meningitis, nerve inflammation, Bell’s palsy and Lyme carditis, a rare condition that can affect the heart’s electrical system.

Goulet said patients experiencing severe headaches, light sensitivity or difficulty thinking should seek medical attention promptly, as these may be signs of neurological involvement.

A small percentage of patients, estimated at five to 10 per cent, develop post-treatment Lyme disease syndrome, in which symptoms persist or recur despite antibiotic treatment.

“Most people will recover, but it will take about a year to recover to sort of get back to where you were,” Goulet said. “For those who don’t recover in this manner, TiCCS will remain involved for a longer period of time.”

» Winnipeg Sun