Clinical Resources

Lyme disease: Diagnosis and treatment

Lyme disease cases on the rise in Nova Scotia.

Incidence of Lyme disease (LD) spiked in 2013, causing  concern among Nova Scotians. From 2002-12, there were a total of 171 cases of Lyme disease reported in Nova Scotia. In 2013, there were 154 cases reported.

Nova Scotia has several infectious disease and medical microbiology experts who – along with their colleagues in rheumatology, neurology, and cardiology –  diagnose and treat LD.

Dr. Robert Strang, chief public health officer, said a recent case of 17 paediatric patients in Nova Scotia with arthritis as the presenting symptom of LD is a reminder of the variety of rheumatologic, neurologic, and cardiac manifestations of early disseminated and late LD.

Download June 10, 2014 letter to NS physicians from Dr. Robert Strang, chief public health officer

Six endemic areas

There are six areas/counties in the province where black-legged tickets carrying the bacteria that can cause LD are known to be endemic (i.e. have become established as part of the local ecology).

The endemic areas/counties are:

  • Queen’s
  • Yarmouth
  • Shelburne
  • Lunenburg
  • Halifax
  • Pictou

Map of endemic areas

Bacterial illness

LD is a bacterial illness that can be transmitted to humans through the bite of a black-legged tick, also known as deer tick. There are a number of tick species in Nova Scotia, but only the black-legged tick can carry the bacteria that can cause LD.

Not all black-legged ticks carry the bacteria and the risk of acquiring LD remains low in the province. LD is readily treatable with appropriate antibiotics.

LD response plan

The Department of Health and Wellness (DHW) has an LD response plan which includes an interdisciplinary committee that provides evidence-based advice and guidance to the provincial government on the control of LD. 

Nova Scotia has multiple infectious disease and medical microbiologist experts who deal with treatment and diagnosis of LD. The province also works closely with its federal partners at the Public Health Agency of Canada and the National Microbiology Laboratory which provides expert evidence-based recommendations for the prevention and surveillance of LD and ticks.

The DHW’s Infectious Diseases Expert Group has developed a Statement for Managing Lyme disease in Nova Scotia. It has been circulated to physicians in the province, and is based on current evidence and follows the guidelines endorsed by the Infectious Disease Society of America.

Notifiable disease

LD is a notifiable disease under the Health Protection Act in Nova Scotia. Health-care professionals are required to report clinical or laboratory-confirmed LD cases to Public Health. 

DHW regularly provides consistent, evidence-based information about LD and its prevention to the public, working closely with partners who disseminate information regarding LD to the public and stakeholders.

Laboratory testing for LD in Nova Scotia follows the guidelines established by the Public Health Agency of Canada, and the Centre for Disease Control and Prevention in the United States. The guidelines have been endorsed by the Canadian Public Health Laboratories Network and the Infectious Diseases Society of America. 

Treatment

The Department of Health and Wellness has developed an Outline for the Lyme Disease (LD) Management. The flowchart document outlines how to diagnose and treat LD, including:

  • information about symptoms for localized and disseminated LD
  • determining when testing and retesting is required for a diagnosis
  • best treatment practices
  • Public health contacts