How serious is Lyme disease?

According to the Government of Canada, cases of Lyme disease in Canada have skyrocketed from a low of 143 in 2010 to a high of 3,147 in 2021 as climate change, animal migration, and continued land use have expanded ticks’ habitat. Given the number of unreported cases and the individuals who don’t realize they’re infected, these numbers likely understate the full extent of the problem.

The data clearly shows that tick exposure is increasing across the country. And, given the potential for their bites to cause Lyme disease, Canadians should be aware and prepared.

But what exactly is Lyme disease, and what should you do if you or a loved one become infected? Here are helpful tips about Lyme disease treatment, symptoms, and prevention.

What is Lyme disease, and which ticks carry it?

Lyme disease is an infection caused by a bacteria species called Borrelia burgdorferi (B. burgdorferi). Initial symptoms of the disease can vary, but often include a “bullseye” rash, along with flu-like symptoms such as fever, chills, fatigue, loss of appetite, headache, stiff neck, joint and muscle aches, and swollen lymph nodes.

B. burgdorferi lives primarily in white-footed mice, chipmunks, and deer, which ticks feed on. When a tick bites an animal infected with B. burgdorferi, the bacteria migrate into the gut. If the infected tick bites a human, it can take between 36-72 hours to transmit the bacteria, causing Lyme disease.

Safely removing a tick before this timeframe (before 24 hours) has been shown to prevent transmission. The tricky part is that full-sized ticks are roughly the size of sesame seeds, while nymphs (immature ticks) are about the size of poppy seeds. This can make them difficult to notice.

Additionally, more than 40 species of ticks call Canada home, which can make it difficult to tell if your tick encounter has put you at risk of Lyme disease. In North America, two different kinds of tick — the black-legged tick, or deer tick, and the western black-legged tick — are adapted to carry B. burgdorferi.

Moreover, all kinds of ticks can carry other bacteria, viruses, or parasites that can cause Lyme disease-like infections like in people. For example, Rocky Mountain Spotted Fever (RMSF), is a treatable — but potentially lethal — tick-borne illness that can present with similar nonspecific Lyme disease-like symptoms such as fever, headache, and rash. This makes it important to be vigilant with all tick bites, regardless of species.

You’re most likely to encounter a black-legged tick or western black-legged tick in the southern parts of British Columbia, Manitoba, Ontario, Quebec, and Nova Scotia during the spring, summer, and fall. However, ticks can become active anytime the temperature is consistently above 0°C.

While ticks aren’t endemic to places like Newfoundland, climate change and migratory birds may allow them to reach areas they haven’t previously. Since ticks tend to be most active along trails or in areas with tall grasses, low shrubs, and woods, it’s a good idea to check yourself for ticks after visiting any of these environments, even if it’s not a well-known area for ticks.

Is Lyme disease contagious?

While Lyme disease is transmissible through ticks, it’s not contagious through person-to-person or animal-to-person contact. However, since the disease can cross the placental barrier, a pregnant woman infected with Lyme disease can transmit it to her child in utero, which makes it crucial to speak to your healthcare provider right away if you’ve been bitten.

And, while you can’t get Lyme disease through animal-to-person contact, if an infected tick falls off your dog in the house, it can bite and infect you. This makes it imperative to regularly check yourself and your pets for ticks after an outdoor adventure, especially between March and November, or anytime the weather is consistently above freezing.

How to check yourself for ticks

• Find good lighting and a mirror
• If you can, get someone else to help, since ticks can be hard to spot
• Inspect every part of your body, including your hair, inside your belly button, and your joints (like your knees and armpits)

What to do if you find a tick

• Put on gloves and use a pair of tweezers to grasp it at the closest part to your skin (the tick’s mouth), and slowly pull it out
• If the tick’s mouth breaks while pulling, remove it afterwards
• Wash your hands
• Apply rubbing alcohol or antiseptic to the area
• Dispose of the tick by placing it in a container with rubbing alcohol or freezing it for several days, and placing it in your household garbage. It might be tempting to squash it, but infection can enter through small breaks in your skin.
• Finally, you should speak with a doctor if you are pregnant, still have concerns after being bitten, are experiencing Lyme disease symptoms, can’t remove the tick because it’s buried deep in the skin, or aren’t comfortable removing it yourself.

How to check your pet for ticks

Your pet is also susceptible to ticks that can carry Lyme disease, so it’s important to check them as soon as you’re home for a walk, or they return from the outdoors. Here’s how to thoroughly check your pet for ticks.

• Use good lighting
• If you can, get someone else to help, since ticks can be hard to spot
• Run your fingers through their fur, including around their tail and between their toes, using gentle pressure to feel for any small bumps

What to do if you find a tick on your pet

• If you find a tick, put on gloves and get a pair of clean tweezers
• Grasp the tick close to your pet’s skin without squeezing, and pull it out slowly to avoid leaving anything behind that could cause an infection
• Wash your hands
• Clean the area with antiseptic, and disinfect your tweezers as well
• Dispose of the tick as mentioned above

What does Lyme disease look like in dogs?

Only about 5% of dogs that are exposed to a Lyme-infected tick go on to develop clinical signs of Lyme disease. In the dogs that do develop it, symptoms may take between two to five months to manifest. Like humans, dogs can present with a wide range of Lyme disease symptoms, including:

• Fever
• Loss of appetite
• Lethargy
• Sudden lameness that may shift from one leg to another
• Vomiting
• Swollen joints

In later stages of the disease, you may see more serious effects. Certain breeds such as Labradors and Golden Retrievers may be more prone to these symptoms which can include:

• Glomerulonephritis, or inflammation and damage to the filtering part of the kidneys
• Lyme nephritis, a potentially deadly kidney inflammation
• Protein-losing nephropathy, a kidney disease that causes an excessive loss of protein in the urine

How is Lyme disease diagnosed?

A bullseye rash, known as erythema migrans, is the most recognizable sign of Lyme disease. This, or presenting with other symptoms (such as fever, chills, headache, and swollen lymph nodes) in conjunction with a history of tick exposure, is usually sufficient for your healthcare provider to diagnose the disease.

However, in some cases, diagnosing it may be more complex. Not everyone who’s bitten by an infected tick develops a bullseye rash. Moreover, not everyone who was bitten knows they’ve been bitten, especially if it’s from a smaller, immature tick. Furthering the complexity is that not everyone with Lyme disease presents with symptoms initially.

So, how do you test for Lyme disease without important clues? The most popular way is through an antibody test known as an enzyme-linked immunosorbent assay (ELISA). This should be followed by a second antibody screening test known as a Western blot test to confirm the diagnosis. These antibody screening tests analyze a sample of your blood for antibodies to B. burgdorferi.

While these tests are accurate, testing alone can’t diagnose (or rule out) Lyme disease. Sometimes, a provider can make a clinical diagnosis without requiring any testing. In other cases, testing can help support a diagnosis. However, it can take your body a while to make antibodies after infection. This means that an antibody screening test may miss an active infection in its early stages. For this reason, providers sometimes prescribe antibiotics if Lyme disease symptoms, the bullseye rash, or recent evidence of a tick bite is present, regardless of antibody test results.

How to prevent Lyme disease

There’s no approved vaccination for Lyme disease for humans in Canada yet, so preventing it comes down to planning ahead before your next outdoor trip. Ticks prefer shady areas with tall grasses and low shrubs to cling to while they wait for a warm body to pass by. Often, this means they lurk along trails and in wooded areas.

Despite this, it’s still possible to enjoy the outdoors even if you’re spending time in an area known to have ticks. For starters, consider wearing light-coloured pants can help you spot ticks more easily. You may also consider tucking your pants into your socks.

To help repel ticks and other biting bugs, insect repellents with DEET are the most effective options. However, if you do go this route, check guidelines before applying them to children and babies.

While you shouldn’t use an insect repellent for children under the age of six months, you can apply repellent with a solution of up to 10% DEET once a day on children between six months and two years. And, as long as they’re not using DEET products on a daily basis for more than a month, you can apply the same concentration up to three times a day on children between the ages of two and twelve.

For adults and children over the age of 12, you may use an insect repellent with a 30% DEET concentration as needed.

Whether you use a DEET repellent or not, it’s imperative you check yourself and any loved ones for ticks upon your return. Because they’re quite small — about the size of a poppyseed — you’ll likely need someone to help you check your own body too. Pay special attention to hard-to-see places like inside the belly button, on the scalp, in or behind your ears, and under your arms.

And, since a case-controlled study found bathing within two hours of exposure provided protection against Lyme by washing away any unattached ticks, consider taking a bath after spending time outdoors.

What are the stages of Lyme disease?

Lyme disease has three distinct stages. The first, known as the early or localized stage, takes place up to 30 days following the tick bite. This is the time you’re likely to see the bullseye rash that often accompanies a bite from an infected tick.

However, the bullseye rash doesn’t show up for everyone, so don’t discount other symptoms or circumstances. Some individuals may not have any noticeable symptoms initially, while others may have a solid red rash at the bite sight. In all cases, you may also experience flu-like symptoms such as:

• Fever
• Chills
• Fatigue
• Loss of appetite
• Headache
• Neck stiffness
• Joint and muscle aches
• Swollen lymph nodes

The second stage of the disease, called early disseminated Lyme disease, presents within the first three months after the bite. During this stage, the bacteria begin to spread throughout the body. This can cause a wide variety of symptoms including:

1. Cutaneous symptoms (affecting the skin)

Multiple erythema migrans — these tend to be smaller than the initial rash at the bite site

2. Neurological symptoms

A classic presenting triad includes meningitis, cranial neuropathy, and motor or sensory radiculoneuropathy. In other words, brain inflammation or nerve damage that can result in headaches, light sensitivity, fever, stiff neck, visual disturbances, numbness, pain or tingling in the arms or legs, and cranial nerve palsies involving one or both sides of the face.

3. Cardiac symptoms

A cluster of cardiac symptoms caused by the presence of B. burgdorferi bacteria in heart tissue. These include atrioventricular (heart) blocks or myopericarditis.

The third stage of the disease develops in the months or years following the infection. This is known as late persistent Lyme disease. The long-term effects of Lyme disease are rare even in untreated cases but can be quite serious, and you may experience:

• Pain and swelling in one or more joints and sometimes the tendons and bursa in early attacks. Later, this can morph into chronic arthritis involving cartilage and bone in more than one joint, most often affecting the knees
• Mild brain injury (encephalopathy) resulting in multifocal central nervous system signs such as memory and concentration difficulties, hearing loss, fatigue, and depression
• Axonal sensorimotor polyradiculoneuropathy, a type of nerve damage that can precipitate a range of symptoms including muscle weakness, numbness, tingling, nerve pain, swallowing or breathing difficulties, and movement issues

How is Lyme disease treated?

The earlier Lyme disease is treated, the better. Canadian Lyme disease treatment guidelines indicate that a 21-day course of antibiotics, when the disease is in its earliest stages, yields the best outcomes. As a result, healthcare providers will usually prescribe a three-week dose of doxycycline for Lyme disease treatment. Antibiotic alternatives include amoxicillin and azithromycin among others.

While antibiotic treatment effectively addresses the disease’s symptoms at all stages, the longer you go without treatment, the higher your risk of complications. It’s also possible to develop a serious condition known as Lyme carditis, which can be fatal.

The result of B. burgdorferi bacteria entering heart tissue, Lyme carditis can disrupt the electrical impulses of your heart, which is known as a “heart block.” Patients who receive prompt antibiotic treatment generally recover from this condition.

Can Lyme disease come back years later?

While Lyme disease can be cured with antibiotics, around 10% of infected individuals continue to experience symptoms even after treatment. This is known as post-Lyme disease syndrome or what some refer to as chronic Lyme disease — although it’s not believed to be a permanent condition.

Post-Lyme disease syndrome most often manifests in non-specific complaints such as fatigue, joint pain, and brain fog that linger after treatment ends. It’s not clear why certain people develop it, but scientists think it may have to do with immune dysregulation as the result of inflammation, or with hidden reserves of B. burgdorferi in the body.

Symptoms typically resolve without the need for additional treatment, although it may take a few months. If you do find yourself experiencing these long-term effects after treatment, you should speak to a doctor to discuss your options for symptom management.

How Maple can help with Lyme disease

While concerning, Lyme disease can be cured with proper treatment. However, early diagnosis and treatment are necessary to minimize the possibility of more intense complications.

Maple is a virtual healthcare platform that connects you with Canadian-licensed doctors, 24/7. Doctors on Maple can provide prescriptions, as necessary, that can be sent to the pharmacy of your choice for pickup or delivered to your front door. This ensures you can begin treatment immediately.

Time is of the essence when it comes to Lyme disease. With Maple, you don’t need to wait for a doctor’s appointment or sit at a walk-in clinic. You can upload any images regarding your concern and begin your consultation with a doctor online in minutes, no matter where you are.

This blog was developed by our team and reviewed by a medical professional.