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Evolving Perspectives on Lyme Borreliosis in Canada

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      Abstract

      With cases now documented in every province, Lyme borreliosis (LB) is emerging as a serious public health risk in Canada. Controversy over the contribution of LB to the burden of chronic disease is maintained by difficulty in capturing accurate Canadian statistics, especially early clinical cases of LB. The use of dogs as sentinel species demon-strates that potential contact with Borrelia burgdorferi spirochetes, as detected by C6 peptide, extends across the country. Dissemination of infected ticks by migratory birds and rapid establishment of significant levels of infection have been well described. Canadian public health response has focused on identification of established populations of the tick vectors, Ixodes scapularis and I. pacificus, on the assumption that these are the only important vectors of the disease across Canada. Strains of B. burgdorferi circulating in Canada and the full range of their reservoir species and coinfections remain to be explored. Ongoing surveys and historical records demonstrate that Borrelia-positive Ixodes species are regu-larly present in regions of Canada that have previously been considered to be outside of the ranges of these species in re-cent modeling efforts. We present data demonstrating that human cases of LB are found across the nation. Consequently, physician education and better early diagnoses are needed to prevent long term sequelae. An international perspective will be paramount for developing improved Canadian guidelines that recognize the complexity and diversity of Lyme borreliosis.

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      Most cited references 82

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      The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

      Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.
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        Measurement of in situ activities of nonphotosynthetic microorganisms in aquatic and terrestrial habitats.

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          EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.

          Lyme neuroborreliosis (LNB) is a nervous system infection caused by Borrelia burgdorferi sensu lato (Bb). To present evidence-based recommendations for diagnosis and treatment. Data were analysed according to levels of evidence as suggested by EFNS. The following three criteria should be fulfilled for definite LNB, and two of them for possible LNB: (i) neurological symptoms; (ii) cerebrospinal fluid (CSF) pleocytosis; (iii) Bb-specific antibodies produced intrathecally. PCR and CSF culture may be corroborative if symptom duration is 6 months) for 3 weeks (good practice points). Children should be treated as adults, except that doxycycline is contraindicated under 8 years of age (nine in some countries). If symptoms persist for more than 6 months after standard treatment, the condition is often termed post-Lyme disease syndrome (PLDS). Antibiotic therapy has no impact on PLDS (level A).
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            Author and article information

            Affiliations
            [1 ]Department of Biological Sciences, University of Alberta, Edmonton, Canada
            [2 ]Canadian Lyme Disease Foundation, West Kelowna, British Columbia, Canada
            [3 ]Department of Family Medicine, University of Alberta, Edmonton, Canada
            Author notes
            [* ]Address correspondence to this author at the Department of Biological Sciences, University of Alberta, Edmonton, Alberta, T6G 2E9 Canada; Tel: 1-780-492-3991;Fax: (780) 492-9234; E-mail: felix.sperling@ 123456ualberta.ca
            Journal
            Open Neurol J
            Open Neurol J
            TONEUJ
            The Open Neurology Journal
            Bentham Open
            1874-205X
            5 October 2012
            2012
            : 6
            : 94-103
            23091570
            3474999
            TONEUJ-6-94
            10.2174/1874205X01206010094
            © Sperling et al.; Licensee Bentham Open.

            This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

            Categories
            Article
            Suppl 1

            Neurology

            borrelia burgdorferi, zoonotic disease., public health, chronic disease, ixodes

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