Lyme disease is a multisystem illness caused by Borrelia burgdorferi, a spirochete transmitted by certain species of Ixodes ticks. The Public Health Agency of Canada (the Agency), in partnership with provincial and territorial public health authorities, conducts surveillance for Lyme disease in Canada and studies show that the incidence of this disease is on the rise in Canada.
The Agency encourages health professionals to learn about Lyme disease in Canada; how to identify the symptoms and prescribe proper treatment if a patient is diagnosed with the disease; and how to report cases of Lyme through appropriate channels.
The following information replicates what is currently captured in medical literature. The Agency acknowledges that there is more to learn about the epidemiology of Lyme disease and other tick-borne diseases in Canada. As well, clinical questions remain, such as why some individuals have persistent symptoms after treatment of their infection and how can we optimally diagnose re-infection. The Agency is committed to exploring new science and research to better detect, diagnose and treat Lyme disease.
Lyme disease is a multisystem illness caused by B. burgdorferi, a spirochete transmitted by certain species of Ixodes ticks, specifically the blacklegged tick and the western blacklegged tick (Ogden et al. 2009). Ticks become infected by feeding on infected wild animal hosts, such as rodents and birds, and can then transmit the bacterium to humans. Infection with B. burgdorferi causes what is known as Lyme disease in humans.
Lyme disease is the most commonly reported vector-borne disease in the northern temperate zone. It became a nationally notifiable disease in December 2009. As such, all healthcare professionals are to report cases of Lyme disease to the Agency via their provincial public health system. The Agency posts information on notifiable diseases on its website.
The Agency currently has data for Lyme disease cases reported between 2009-2013*:
The incidence of Lyme disease peaks in children between 5-9 years and adults between 55-59 years (Source: Bacon et al, 2008).
Post-treatment re-infection is possible, especially when a person is re-infected with different strains of B. burgdorferi.
The clinical manifestations of Lyme disease largely reflect the biology of B. burgdorferi as it replicates in the skin (early, localized Lyme disease, which sometimes presents as erythema migrans) and then disseminates (early and late disseminated Lyme disease) via the bloodstream to other body sites where the bacterium provokes damage to body tissues (Bockenstedt, p. 283, 2008). Symptoms appear, sometimes in overlapping stages, as early localized disease, early disseminated infection, or late disease.
Know the clinical manifestations and epidemiological risk factors, and consider Lyme disease as part of your differential diagnosis in a patient who presents with compatible symptoms and signs. Accurate diagnosis is one of the key factors to successfully manage Lyme disease.
Early Localized Disease
It is important to note that some people with Lyme disease may have no or minimal symptoms, yet others may suffer severe symptoms. As well, some people may not develop symptoms until weeks after the initial bite and, as such, may not remember the tick bite or associate the illness with the bite. Because the blacklegged tick is so small, some people may not even know that they had a tick bite.
A typical symptom of early non-disseminated Lyme disease is an expanding rash called erythema migrans (pathognomonic for Lyme disease). Such a rash can occur at the site of the infective tick bite within 1-2 weeks post infection (in as many as 70% - 80% of infected people) and can persist up to eight weeks.
However, it is important to note that a rash is not manifested in all cases, and does not necessarily resemble the image noted above. It is therefore important to watch out for other symptoms of the disease, including low-grade fever, fatigue, headache, and arthralgia in order to inform a diagnosis.
Early disseminated disease:
If untreated, this stage of the disease can last up to several months and could include the following symptoms:
Late Lyme disease
If it remains untreated, late Lyme disease can last months to years with symptoms that can include:
Symptomatic infection of the heart is rare in Lyme disease cases, but three sudden cardiac deaths associated with Lyme carditis were reported in the United States in 2012 (MMWR, CDC, Vol. 62, No. 29, 2013).
In general, the diagnosis of Lyme disease is principally clinical, supported by a history of potential tick exposure in an area where it is known or suspected that blacklegged ticks have become established, and informed by laboratory testing if indicated. However, as tick populations are expanding, it is possible that Lyme disease can be acquired outside the currently identified areas and this should be considered when assessing patients. Detection of antibodies against B. burgdorferi using the two-tiered serological method described below is an additional diagnostic tool; however patients with clear symptoms of early localized Lyme disease (erythema migrans) should be diagnosed and treated without laboratory confirmation, as false negative test results are common during the early stage of Lyme disease.
If initial results from the laboratory tests come back negative, alternative diagnoses or re-testing a few weeks later should be considered to confirm/rule out the disease.
Serological testing has a valid role to play in supporting the clinical impression of early and late disseminated Lyme disease.
Two-tiered testing method
The Agency’s National Microbiology Laboratory (NML) and some provincial laboratories assist clinicians to diagnose Lyme disease using a two-tiered serological testing approach that includes an EIA screening test followed by a confirmatory Western blot test.
According to the Agency, the United States Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control, use of the two-tiered method is based on credible scientific evidence.
Notes on serologic tests
Canadian laboratory diagnostic guidelines for Lyme disease are consistent with those followed by public health authorities in the United States and Europe and meet current international standards.
Public health professionals in these countries have concerns regarding reports from laboratories that may not be using properly validated tests or recommended standards for interpreting test results (CDC, MMWR, 2005). Further research is required to enhance current knowledge on new Borrelia species, and strains of other tick-borne pathogens to inform development of diagnostic methods that can reliably identify emerging pathogens.
Treatment regimens listed in the following table are for localized (early) Lyme disease. Treatment guidelines for patients with disseminated (early and late) Lyme disease are outlined in the reference below (Wormser, et al., 2006).
These regimens are guidelines only and may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, pregnancy status or allergies. Consult an infectious disease specialist, as needed for the most current treatment guidelines or for individual patient treatment decisions.
|Age Category||Drug||Dosage||Maximum||Duration in Days(Range)|
|Adults||Doxycycline||100 mg, p.o., q 12 h.||N/A||14 (14-21)|
|Cefuroxime axetil||500 mg, p.o., q 12 h||N/A||14 (14-21)|
|Amoxicillin||500 mg, p.o., q 8 h||N/A||14 (14-21)|
|Children||Amoxicillin||50 mg/kg per day p.o., divided in 3 doses||500 mg per dose||14 (14-21)|
|Doxycycline||4 mg/kg per day p.o., divided into 2 doses||100 mg per dose||14 (14-21)|
|Cefuroxime axetil||30 mg/kg per day p.o., divided into 2 doses||500 mg per dose||14 (14-21)|
Although timely treatment with a recommended 14-21 day course of antibiotics is effective to treat Lyme disease in most cases, some Lyme disease patients have persistent symptoms following treatment. Research continues into the causes of these persistent symptoms and methods of treatment. There is no evidence that persistent symptoms represent ongoing infection. Post-infectious inflammation, due to damage from the infectious process, will respond to anti-inflammatory drugs.
A few early case reports of pregnant women with untreated Lyme disease described adverse outcomes, with babies stillborn or dying within 48 hours of birth, but no set pattern of abnormality was found. Subsequent large population studies showed no increased risks of adverse outcomes of pregnancies in women with Lyme disease who received appropriate treatment. A comparison of pregnancy outcomes, in areas where Lyme disease was highly endemic as well as non-endemic areas, showed no excess of adverse outcomes in the highly endemic areas (O’Connell, 2011).
There is no consensus on post-exposure prophylaxis. Some experts recommend that doxycycline can be offered as a single dose of 200 mg (or 4.4 mg/kg for people weighing less than 45 kg, to a maximum dose of 200 mg) for people ≥ 8 years of age who have been bitten in an area with hyper endemic infection. Prophylaxis can be started within 72 hours after removal of a feeding blacklegged tick, even if it's been attached for ≥ 36 hours. There is no data on the use of amoxicillin as an alternate prophylactic antibiotic in younger children.
In Canada, such prophylaxis should be considered in the ‘known endemic’ areas. The Public Health Agency of Canada continues to monitor the distribution and prevalence of infected ticks and cases of Lyme disease. Endemic areas may change in the future.
There is currently no vaccine available for Lyme disease. The best way to avoid Lyme disease is to protect against tick bites. Health professionals should advise their patients to take the following measures:
The Agency is engaged in two forms of surveillance for Lyme disease: surveillance for ticks and surveillance of human cases. The Agency works with the provinces, health authorities and other experts to define and monitor the occurrence of the ticks that carry B. burgdorferi.
In Canada, the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus) are the species that transmit this disease-causing agent. These ticks can also carry other less common infectious agents.
Other tick species are known to transmit the bacterium that causes Lyme disease in nature, but these ticks live in the nests and burrows of their wild animal hosts and rarely bite humans. The greatest risk of Lyme disease in Canada occurs where populations of blacklegged ticks are established. These locations are termed ‘Lyme endemic areas’ when their presence is confirmed by multiple years of surveillance (Health Canada 1991). However, surveillance shows that the ticks have become established over a much wider area than these highly studied locations (Lyme disease risk areas: Ogden et al. 2014a, b). Knowledge of a patient’s exposure to Lyme disease risk areas (Fig 1) is an important parameter for Lyme disease diagnosis. Knowledge of where known endemic areas occur (Table 1 and Fig 1) is important when reporting Lyme disease cases. However, as tick populations are expanding, it is possible that Lyme disease can be acquired outside the currently identified areas. This should be considered when diagnosing patients.
Our current knowledge of the occurrence of established tick vectors, based on active surveillance in the field, is detailed in Table 1 and Figure 1. Known endemic areas have a very limited distribution, but field surveillance suggests that Lyme disease risk areas occur over a much wider geographic area. Surveillance also indicates that established populations of blacklegged ticks are spreading their geographic scope, and are increasing in number, in Canada. The potential expansion of localized tick populations makes it difficult to precisely define the geographic limits of any given population; however people living or visiting areas adjacent to established tick populations may have a greater chance of contact with blacklegged ticks.
|Lyme disease risk where the western blacklegged tick is the vector|
|British Columbia||Southern mainland, Vancouver Island||Known endemic in some areas, suspected over a wider region|
|Lyme disease risk where the blacklegged tick is the vector|
|Manitoba||The ”South East Corner” population comprising an area adjoining the western shore of Lake of the Woods, including Moose Lake Provincial Park.||Known endemic|
|The “Pembina” population within an area along the Pembina valley and Pembina escarpment extending from the American border to South Norfolk in the north and west to Killarney. This includes Pembina Valley Provincial Park.||Known endemic|
|The “Vita/Arbakka” population within which ticks occur in small and isolated forests, particularly along the Roseau River.||Suspect area|
|The “Eastern Assiniboine” population extending from Beaudry Provincial Park westward along the Assiniboine River as far as Poplar Point.||Suspect area|
|The “St. Malo” population comprising two groups, one in the Kleefeld area, west of Steinbach and the other in the St. Malo/Roseau River area.||Suspect area|
|The “Richer/Ste. Genevieve Population” adjacent to the Agassiz and Sandilands provincial forests.||Suspect area|
|Ontario||Point Pelee National Park||Known endemic|
|Rondeau Provincial Park||Known endemic|
|Turkey Point Provincial Park||Known endemic|
|Locations in the Rainy River region of Northwestern Ontario||Known endemic|
|Long Point peninsula including Long Point Provincial Park and the National Wildlife area||Known endemic|
|Wainfleet bog region near Welland||Known endemic|
|Prince Edward Point||Known endemic|
|Parts of the Thousand Islands National Park||Known endemic|
|Quebec||Montérégie||Five known endemic areas|
|New Brunswick||Millidgeville area of Saint John||Known endemic|
|North Head, Grand Manan Island||Known endemic|
|Nova Scotia||Areas of Lunenburg County||Known endemic|
|Areas of Halifax Regional Municipality||Known endemic|
|Areas of Shelburne County||Known endemic|
|Areas of Yarmouth County||Known endemic|
|Areas of Pictou County||Known endemic|
|Areas of Queens County||Known endemic|
The establishment of new tick populations is an ongoing process, so it is desirable to continue surveillance to continuously update knowledge of where Lyme disease risk occurs in Canada. With this information, public health professionals can target preventive and treatment advice as well as control efforts to the people who may be particularly at risk from Lyme disease, due to their geographic location and/or occupation (e.g. forester, park worker) or choice of leisure activity (camping, golfing, etc.).
In addition, knowledge of where known Lyme disease endemic areas and Lyme disease risk areas occur in Canada is useful to health care professionals when they are considering a diagnosis of Lyme disease in their patients.
Note that the Agency recommends that Lyme disease is diagnosed primarily on clinical criteria, with support, where indicated, from diagnostic testing, using the two-tiered serological approach.
Figure 1 shows the locations where the current risk from tick bites and Lyme disease is known to occur. Locations where ticks and Lyme disease risk are known are called ‘endemic areas’ (‘known’ endemic areas if ticks and Lyme disease risk have been confirmed over several years of field study or by the occurrence of multiple human cases, otherwise they are called ‘suspect’ endemic areas). Also shown are Lyme disease risk areas (the hatched areas) where surveillance and research studies suggest ticks and possible Lyme disease risk have begun to become established.
Visitors to the United States (US) should note that there are extensive areas with established blacklegged tick populations, particularly in the northeast and upper Midwest regions. More information on Lyme in the US can be found on the USA can be found on the Centers for Disease Control and Prevention web site. Lyme disease also occurs in Europe and some parts of Asia.
The proportion of ticks in a geographic area that are infected with the bacterium causing Lyme disease varies. The proportion of infected ticks is typically higher in adult ticks compared to the other stages (nymphs and larvae). However, people are most likely to acquire Lyme disease from a nymph because this stage is so small (see Figure 4), and thus more likely to go unnoticed, allowing it to feed for a sufficient amount of time for the Lyme disease bacterium to be transmitted (over 36 hours). The proportion of infected ticks is often greater where tick populations have been established for long periods of time (such as Long Point), compared to areas with newly established tick populations. Based on surveillance data, as many as 60% of the adult ticks at Long Point are infected; however, infection rates in adult ticks are more often between 10 and 25% at the other localities where ticks are established. Partly because of differences in the types of hosts that they feed upon, the proportion of I. pacificus ticks that are infected with the Lyme disease agent is usually much lower (1-3%) than the proportion of I. scapularis ticks that are infected.
While there is a higher risk of coming in contact with infected blacklegged ticks in areas where populations are established, there is also a low risk of Lyme disease being contracted almost anywhere in Canada because migratory birds transport infected ticks over large geographic distances.
Cases of Lyme disease in Canadians
Since December 2009, Lyme disease has been a nationally notifiable disease in Canada. This means that all cases that fit the surveillance case definition criteria should be notified by healthcare professionals to the local medical officer of health. The current case definitions for confirmed and probable classifications are:
The Agency currently has data for Lyme disease cases reported between 2009-2013Footnote *:
Although the Agency conducts surveillance both on ticks carrying the bacteria that cause Lyme disease and on human cases of Lyme disease, surveillance detects only a portion of the Lyme disease cases in Canada. The true number of Lyme disease infections in Canada is likely greater.
This is also true in the United States (US). Each year, approximately 30,000 cases of Lyme disease are reported by the Centers for Disease Control and Prevention (CDC); however this number does not reflect every case of Lyme disease. The CDC estimates that approximately 300,000 people are diagnosed with Lyme disease each year in the US. For additional information, please visit the CDC’s website.
The Agency relies on the provinces and territories to report the number of Lyme disease cases occurring in their jurisdictions on an annual basis. In order to most accurately reflect the occurrence of Lyme disease cases in Canada each year, healthcare professionals need to remain vigilant in diagnosing Lyme disease and promptly reporting cases to their public health regional authorities.
The Agency, with provincial and territorial public health organizations, performs surveillance to identify Lyme disease risk areas so that Lyme disease cases are prevented.
‘Passive’ surveillance involves the voluntary submission of ticks found on humans and domestic animals, by veterinarians and healthcare professionals (Ogden et al., 2006; 2010). This method can raise the suspicion of areas where ticks are establishing.
‘Active’ field surveillance involves collecting ticks and/or wild animal hosts to determine whether populations of vector ticks and endemic cycles of Borrelia burgdorferi transmission have become established. These methods are used to identify where tick populations are becoming established (Lyme disease risk areas), and, when multiple visits to the same site are possible, to confirm the occurrence of a Lyme disease endemic area (Health Canada 1991).
A confirmed Lyme disease endemic area is defined as a locality where active surveillance has detected i) reproducing populations of the tick vector as confirmed by the presence of all three stages (larva, nymph and adult) on resident animals or in the environment for at least 2 consecutive years; and ii) the agent of Lyme disease (B. burgdorferi) has been detected in ticks and/or wild animal hosts collected from the locality by culture, molecular methods (specific PCR), or immunofluorescent antibody staining (IFA).
A suspected Lyme disease endemic area is a locality where active field surveillance has revealed the presence of multiple ticks at one or more visits, suggesting that the tick vector is becoming established, and where B. burgdorferi has been detected in ticks or animals collected from the site.
A Lyme disease risk area is an area where tick vectors of Lyme disease have been detected by collection of ticks from the environment or from resident animals, whether or not B. burgdorferi has been detected in tick or animal samples (Ogden et al. 2014a).
Field surveillance for ticks cannot cover the whole of Canada because of the immensity of our country, and because of the practical difficulties in performing surveillance in remote areas and on privately held land. But, tick populations are expanding across the country and as such, Lyme disease can be acquired outside the currently identified areas. The Agency is enhancing its LD surveillance to better predict new and emerging areas of risk. In collaboration with provincial, public and animal health organizations, and with Canadian universities, the Agency developed a map (Figure 2) to show areas predicted to be at risk of becoming Lyme endemic. The objectives of this map are to help guide surveillance and preventative efforts and to provide a resource for those working and participating in leisure activities outdoors. The map is constructed using the Agency’s current knowledge of the biology of the blacklegged tick and of the environmental factors that limit its survival (Ogden et al., 2008), and has performed well in field validation to date (Ogden et al., 2008; 2010).
Please click here for a risk map produced by the British Columbia Centre for Disease Control for the occurrence of Lyme endemic areas in British Columbia (Mak et al., 2010).
Text equivalent for figure 2 A map showing areas predicted to be at risk for emergence of Lyme endemic areas in eastern and (inset) central Canada. A map showing areas predicted to be at risk for emergence of Lyme endemic areas in eastern and (inset) central Canada.
Larger version of Figure 2 A map showing areas predicted to be at risk for emergence of Lyme endemic areas in eastern and (inset) central Canada. A map showing areas predicted to be at risk for emergence of Lyme endemic areas in eastern and (inset) central Canada.
The coloured zones on the map indicate current predictions for regions where Lyme endemic areas are most likely to emerge, provided that a suitable woodland habitat for the blacklegged tick exists. The green zone indicates the main extent of locations where Lyme endemic areas may emerge. The orange and red zones indicate areas with increasingly high risk for emergence of new Lyme endemic areas. The grey zone indicates areas where, in general, the risk of Lyme endemic area emergence is predicted to be very low and risk of Lyme disease is mostly restricted to that posed by ‘adventitious’ ticks dispersed by migratory birds from Lyme endemic areas in Canada and the US. Even so, in some localized areas of the grey risk zone, local environmental conditions may be suitable for Lyme endemic areas to emerge.
Both the blacklegged tick and western blacklegged tick can transmit pathogens other than the agent of Lyme disease. These pathogens are all zoonoses (i.e. infections of animals that can cause disease in humans) for which the natural hosts are wild animals. Of importance are the bacterium Anaplasma phagocytophilum, which causes Human Granulocytic Anaplasmosis (HGA: Wormser et al., 2006), the protozoal parasite Babesia microti, which causes human babesiosis, and Powassan encephalitis virus (POWV) including the deer tick virus lineage, both of which can cause encephalitis. Other bacteria carried by these ticks include Borrelia bissettii, B. carolinensis and B. kurtenbachii although whether these bacterium cause disease in humans in North America is unknown. The bacterium B. miyamotoi occurs at low prevalence in blacklegged ticks and, recently, human cases (mostly suffering influenza-like illnesses) associated with B. miyamotoi have been discovered in the United States. Vigilance by physicians for cases associated with this bacterium is recommended (Dibernardo et al 2014).
Tick-borne diseases transmitted by other tick species also occur in Canada and include Rocky Mountain Spotted Fever (caused by Rickettsia rickettsii), transmitted primarily by the Rocky Mountain wood tick (Dermacentor andersoni) and tularaemia (caused by the bacterium Francisella tularensis), transmitted by the American dog tick (Dermacentor variabilis Figure 3). Powassan encephalitis is caused by Powassan virus (POWV), transmitted by Ixodes cookei ticks and relapsing fever (caused by the bacterium Borrelia hermsii) is transmitted by soft bodied (Argasid) ticks in southern British Columbia. Tick-borne diseases carried by the ‘Lone Star tick’ Amblyomma americanum, which include Human Monocytic Ehrlichiosis caused by the bacterium Ehrlichia chaffeensis, could also occur in Canada, but are rare. These diseases are associated with ticks dispersed from the US by migratory birds.
A toxin in the saliva of adult female Rocky Mountain wood ticks (RMWT) can cause paralysis in humans and animals, on which these ticks feed. Paralysis ascends beginning in the legs and spreads to other muscles during the period the tick is feeding. Paralysis can extend to muscles important for respiration, and if not diagnosed and treated early, the paralysis can result in death. Simple removal of the feeding ticks is usually sufficient for recovery (Gregson, 1973). Rocky Mountain wood ticks are found from central Saskatchewan to British Columbia, although RMWT in the Canadian prairies may be genetically incapable of causing paralysis (Lysyk, 2010). Other tick species endemic to Canada, such as American dog ticks and blacklegged ticks, have been linked to cases of tick paralysis, but not in Canada (Gregson 1973).
Blacklegged ticks are considerably smaller than the more common American dog tick (often called the wood tick), Dermacentor variabilis. Adults of the blacklegged ticks lack the white marking seen on the dorsum of adult dog ticks (Figure 3). Before feeding, blacklegged adult females are approximately 3-5 mm in length and red and dark brown in colour. The pre-adult stages (larvae and nymph) are much smaller and lighter in colour (Figure 4). All stages except adult males increase in size and change colour as they feed upon a host. For example, it is not uncommon for adult females to reach the size of a small grape and they typically go through a change in colour from whitish as they start feeding to dark gray to nearly black when fully fed (Figure 5). Larvae and nymphs also increase proportionally in size and go through a similar change in colour (Figure 6).
Text equivalent for figure 3 Unfed adult blacklegged ticks (top row) and adult American dog (wood) ticks (bottom row). Note the difference in colour patterns and relative size.Text equivalent for figure 3 Unfed adult blacklegged ticks (top row) and adult American dog (wood) ticks (bottom row). Note the difference in colour patterns and relative size.
Text equivalent for figure 4 Life stages of the blacklegged tick (1-larva, 2-nymph, 3-adult male, 4-adult female). Sizes presented in relation to underlying 10-cent coin.Text equivalent for figure 4 Life stages of the blacklegged tick (1-larva, 2-nymph, 3-adult male, 4-adult female). Sizes presented in relation to underlying 10-cent coin.
Text equivalent for figure 5 Female blacklegged ticks in various stages of feeding. Note the change in size and colour. Text equivalent for figure 5 Female blacklegged ticks in various stages of feeding. Note the change in size and colour.
Text equivalent for figure 6 Unfed, partially fed and fully engorged nymphs of the blacklegged tick. Note the change in size and colour. Text equivalent for figure 6 Unfed, partially fed and fully engorged nymphs of the blacklegged tick. Note the change in size and colour.
To remove ticks that are embedded in skin, use tweezers to carefully grasp the tick as close to the skin as possible and pull slowly upward, avoiding twisting or crushing the tick. If members of the public are concerned about removing a tick from themselves or a member of their family, the Agency recommends that they ask for assistance from a healthcare professional who can also advise on possible symptoms of tick-borne diseases to permit early recognition of infection and prompt treatment. In messaging to the General Public, the Agency has advised that patients keep any ticks they remove themselves in a ziplock bag or pill vial and note the location and date of the bite. They are then advised to watch for symptoms, and to see their healthcare professional immediately, should symptoms appear. Note: the Agency recommends patients take the tick with them to their medical appointment, to support healthcare professionals in their clinical assessment of potential causes for the onset of illness.
When possible, ticks should be sent to provincial collaborators who will identify the tick and then forward only the blacklegged ticks to the Agency's National Microbiology Laboratory (NML). Staff at the NML will conduct testing for the Lyme disease agent as well as several other disease-causing agents. It should be remembered that this tick testing program is designed specifically for surveillance to gain a better understanding of the distribution of blacklegged ticks and their associated pathogens. Tick testing has very limited practical use for clinical diagnostic purposes (i.e., to determine whether to treat or not) and there are established guidelines for prophylactic treatment of patients with documented exposure to blacklegged ticks (Wormser et al. 2006). For information on where to send tick specimens in your area, contact the NML through phone or email at:
National Microbiology Laboratory
Phone: (204) 789-2000
Please note that it usually takes at least two weeks for ticks submitted to the NML to be identified, tested, and for results to be reported to the original submitter. During the peak periods of adult activity (October to December), the processing time at the NML can extend to 4-6 weeks because of the large volume of tick samples received.
How to download PDF documents:
Please download the document by right clicking on the link below and choose: "Save Target As" or "Save Link As"
Please follow the guidelines for handling and shipping ticks and complete and attach a Tick Submission Form (PDF Document - 766 KB - 1 page) with the submission.If you do not have PDF reading software, you can download a free PDF reader from the Adobe® Web site.
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