1
|
Donovan A, Quilty R, Joy BK, Seddigh S, Coatsworth H, Gauthier L, Comeau JL, Lang B, Leblanc J, Hatchette T, Stringer E. Retrospective validation of a rapid Lyme fluorescent immunoassay in differentiating Lyme arthritis from other musculoskeletal presentations in children in a Lyme-endemic region. Microbiol Spectr 2024; 12:e0359323. [PMID: 38682930 DOI: 10.1128/spectrum.03593-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Lyme arthritis can present similarly to other causes of joint pain and swelling including septic arthritis and other acute and chronic arthropathies of childhood. Septic arthritis, although rare, constitutes an orthopedic emergency and requires early surgical intervention to reduce the risk of permanent joint damage. Currently, results of standard serologic tests to diagnose Lyme disease take days to weeks, which is unhelpful in acute clinical decision-making. Thus, some children with Lyme arthritis are treated empirically for septic arthritis undergoing unnecessary invasive procedures and hospital admission while on inappropriate antibiotic therapy. We retrospectively validated the Quidel Sofia Lyme Fluorescent Immunoassay, a rapid serologic assay that can detect IgG and/or IgM antibodies to Borrelia burgdorferi in 10 minutes, in residual serum samples collected from 51 children who had Lyme arthritis and 55 children with musculoskeletal presentations who were Lyme negative. The sensitivity and specificity of the Sofia IgG to identify cases of Lyme arthritis in children were 100% (95% confidence interval [CI] of 93.0%-100%) and 96.4% (95% CI: 87.5%-99.6%), respectively. The positive likelihood ratio (LR) was 27.5 (95% CI 7-107), and the negative LR was 0.00 (95% LR 0.00-0.15). We propose that the Sofia IgG, a rapid method for identifying Lyme arthritis, may be useful in differentiating Lyme arthritis from other forms of arthritis. Used in conjunction with readily available clinical and laboratory variables, it could help to rapidly identify children who are at low risk of septic arthritis in Lyme-endemic regions. IMPORTANCE Lyme arthritis is a common manifestation of Lyme disease in children, with clinical features overlapping with other causes of acute and chronic joint pain/swelling in children. We have demonstrated that the Sofia IgG is a reliable test to rule in and rule out the diagnosis of Lyme arthritis in children with musculoskeletal presentations in a Lyme-endemic region. When used in conjunction with clinical and laboratory variables routinely considered when differentiating Lyme arthritis from other diagnoses, the Sofia IgG has the potential to fill an important gap in care, especially when acute decision-making is necessary. The Sofia IgG should be included in prospective research studies examining clinical prediction tools to identify children at low risk of septic arthritis.
Collapse
Affiliation(s)
| | - Rebecca Quilty
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryn K Joy
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shahriar Seddigh
- Division of Orthopedic Surgery, Nova Scotia Health, Halifax, Canada
| | - Heather Coatsworth
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Luke Gauthier
- Division of Orthopedic Surgery, IWK Health, Halifax, Nova Scotia, Canada
| | - Jeannette L Comeau
- Division of Pediatric Infectious Diseases, IWK Health, Halifax, Nova Scotia, Canada
| | - Bianca Lang
- Division of Pediatric Rheumatology, IWK Health, Halifax, Nova Scotia, Canada
| | - Jason Leblanc
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Todd Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Elizabeth Stringer
- Division of Pediatric Rheumatology, IWK Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
2
|
Murison K, Wilson CH, Clow KM, Gasmi S, Hatchette TF, Bourgeois AC, Evans GA, Koffi JK. Epidemiology and clinical manifestations of reported Lyme disease cases: Data from the Canadian Lyme disease enhanced surveillance system. PLoS One 2023; 18:e0295909. [PMID: 38100405 PMCID: PMC10723709 DOI: 10.1371/journal.pone.0295909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada.
Collapse
Affiliation(s)
- Kiera Murison
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christy H. Wilson
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Katie M. Clow
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Salima Gasmi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Departments of Pathology, Immunology and Microbiology, Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annie-Claude Bourgeois
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Gerald A. Evans
- Infection Prevention & Control, Kingston Health Sciences Centre, Biomedical & Molecular Sciences and Pathology & Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jules K. Koffi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| |
Collapse
|
3
|
Sanderson VP, Miller JC, Bamm VV, Tilak M, Lloyd VK, Singh-Ranger G, Wills MKB. Profiling disease burden and Borrelia seroprevalence in Canadians with complex and chronic illness. PLoS One 2023; 18:e0291382. [PMID: 37939060 PMCID: PMC10631674 DOI: 10.1371/journal.pone.0291382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/25/2023] [Indexed: 11/10/2023] Open
Abstract
Lyme disease, caused by vector-borne Borrelia bacteria, can present with diverse multi-system symptoms that resemble other conditions. The objective of this study was to evaluate disease presentations and Borrelia seroreactivity in individuals experiencing a spectrum of chronic and complex illnesses. We recruited 157 participants from Eastern Canada who reported one or more diagnoses of Lyme disease, neurological, rheumatic, autoimmune, inflammatory, gastrointestinal, or cardiovascular illnesses, or were asymptomatic and presumed healthy. Intake categories were used to classify participants based on their perceived proximity to Lyme disease, distinguishing between those with a disclosed history of Borrelia infection, those with lookalike conditions (e.g. fibromyalgia syndrome), and those with unrelated ailments (e.g. intestinal polyps). Participants completed three questionnaires, the SF-36 v1, SIQR, and HMQ, to capture symptoms and functional burden, and provided blood serum for analysis at an accredited diagnostic lab. Two-tiered IgG and IgM serological assessments (whole cell ELISA and Western blot) were performed in a blinded fashion on all samples. The pattern of symptoms and functional burden were similarly profound in the presumptive Lyme and Lyme-like disease categories. Borrelia seroprevalence across the study cohort was 10% for each of IgG and IgM, and occurred within and beyond the Lyme disease intake category. Western blot positivity in the absence of reactive ELISA was also substantial. Fibromyalgia was the most common individual diagnostic tag disclosed by two-tier IgG-positive participants who did not report a history of Lyme disease. Within the IgG seropositive cohort, the presence of antibodies against the 31 kDa Outer Surface Protein A (OspA) was associated with significantly better health outcomes. Previously, this marker has been linked to treatment-refractory Lyme arthritis. Overall, our findings support prior observations of phenotypic overlap between Lyme and other diseases. Seropositivity associated with non-specific symptoms and functional impairment warrants further mechanistic investigation and therapeutic optimization.
Collapse
Affiliation(s)
- Victoria P. Sanderson
- G. Magnotta Lyme Disease Research Lab, Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Jennifer C. Miller
- Galaxy Diagnostics, Research Triangle Park, North Carolina, Raleigh, United States of America
| | - Vladimir V. Bamm
- G. Magnotta Lyme Disease Research Lab, Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Manali Tilak
- G. Magnotta Lyme Disease Research Lab, Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Vett K. Lloyd
- Department of Biology, Mount Allison University, Sackville, New Brunswick, Canada
| | - Gurpreet Singh-Ranger
- Upper River Valley Hospital, Horizon Health Network, Waterville, New Brunswick, Canada
| | - Melanie K. B. Wills
- G. Magnotta Lyme Disease Research Lab, Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
4
|
Bolotin S, Osman S, Halperin S, Severini A, Ward BJ, Sadarangani M, Hatchette T, Pebody R, Winter A, De Melker H, Wheeler AR, Brown D, Tunis M, Crowcroft N. Immunity of Canadians and risk of epidemics workshop - Conference report. Vaccine 2023; 41:6775-6781. [PMID: 37827968 DOI: 10.1016/j.vaccine.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 10/14/2023]
Abstract
On November 18-19, 2019, the Immunity of Canadians and Risk of Epidemics (iCARE) Network convened a workshop in Toronto, Ontario, Canada. The objectives of the workshop were to raise the profile of sero-epidemiology in Canada, discuss best practice and methodological innovations, and strategize on the future direction of sero-epidemiology work in Canada. In this conference report, we describe the presentations and discussions from the workshop, and comment on the impact of the COVID-19 pandemic on serosurveillance initiatives, both in Canada and abroad.
Collapse
Affiliation(s)
- Shelly Bolotin
- Centre for Vaccine Preventable Diseases, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada.
| | | | - Scott Halperin
- Canadian Center for Vaccinology, Dalhousie University, Halifax, NS, Canada; Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | - Alberto Severini
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MN, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Todd Hatchette
- Canadian Center for Vaccinology, Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, NS, Canada
| | | | - Amy Winter
- University of Georgia, Athens, GA, United States
| | - Hester De Melker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Aaron R Wheeler
- Department of Chemistry, University of Toronto, Toronto, Ontario M5S 3H6, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada; Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario M5S 3E1, Canada
| | - David Brown
- Virus Reference Department, UK Health Security Agency, London, United Kingdom; Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Matthew Tunis
- National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Natasha Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
| |
Collapse
|
5
|
Khan F, Allehebi Z, Shabi Y, Davis I, LeBlanc J, Lindsay R, Hatchette T. Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease. Open Forum Infect Dis 2022; 9:ofac272. [PMID: 35873285 PMCID: PMC9297310 DOI: 10.1093/ofid/ofac272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
Abstract
The modified 2-tier testing algorithm (MTTT) for Lyme disease (LD) has been approved by the US Food and Drug Administration. In this study, we show that the MTTT detected 28% more cases of early infection compared with the standard 2-tier algorithm while retaining high specificity in a region with a high incidence of LD.
Collapse
Affiliation(s)
- Farhan Khan
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| | - Ziyad Allehebi
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| | - Yahya Shabi
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| | - Ian Davis
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| | - Jason LeBlanc
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| | - Robbin Lindsay
- National Microbiology Laboratory , Winnipeg, Manitoba, Canada
| | - Todd Hatchette
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre , Halifax, NS, Canada
- Dalhousie University , Halifax, NS, Canada
| |
Collapse
|
6
|
Dong Y, Zhou G, Cao W, Xu X, Zhang Y, Ji Z, Yang J, Chen J, Liu M, Fan Y, Kong J, Wen S, Li B, Yue P, Liu A, Bao F. Global seroprevalence and sociodemographic characteristics of Borrelia burgdorferi sensu lato in human populations: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-007744. [PMID: 35697507 PMCID: PMC9185477 DOI: 10.1136/bmjgh-2021-007744] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Borrelia burgdorferi sensu lato (Bb) infection, the most frequent tick-transmitted disease, is distributed worldwide. This study aimed to describe the global seroprevalence and sociodemographic characteristics of Bb in human populations. Methods We searched PubMed, Embase, Web of Science and other sources for relevant studies of all study designs through 30 December 2021 with the following keywords: ‘Borrelia burgdorferi sensu lato’ AND ‘infection rate’; and observational studies were included if the results of human Bb antibody seroprevalence surveys were reported, the laboratory serological detection method reported and be published in a peer-reviewed journal. We screened titles/abstracts and full texts of papers and appraised the risk of bias using the Cochrane Collaboration-endorsed Newcastle-Ottawa Quality Assessment Scale. Data were synthesised narratively, stratified by different types of outcomes. We also conducted random effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO (CRD42021261362). Results Of 4196 studies, 137 were eligible for full-text screening, and 89 (158 287 individuals) were included in meta-analyses. The reported estimated global Bb seroprevalence was 14.5% (95% CI 12.8% to 16.3%), and the top three regions of Bb seroprevalence were Central Europe (20.7%, 95% CI 13.8% to 28.6%), Eastern Asia (15.9%, 95% CI 6.6% to 28.3%) and Western Europe (13.5%, 95% CI 9.5% to 18.0%). Meta-regression analysis showed that after eliminating confounding risk factors, the methods lacked western blotting (WB) confirmation and increased the risk of false-positive Bb antibody detection compared with the methods using WB confirmation (OR 1.9, 95% CI 1.6 to 2.2). Other factors associated with Bb seropositivity include age ≥50 years (12.6%, 95% CI 8.0% to 18.1%), men (7.8%, 95% CI 4.6% to 11.9%), residence of rural area (8.4%, 95% CI 5.0% to 12.6%) and suffering tick bites (18.8%, 95% CI 10.1% to 29.4%). Conclusion The reported estimated global Bb seropositivity is relatively high, with the top three regions as Central Europe, Western Europe and Eastern Asia. Using the WB to confirm Bb serological results could significantly improve the accuracy. More studies are needed to improve the accuracy of global Lyme borreliosis burden estimates. PROSPERO registration number CRD42021261362.
Collapse
Affiliation(s)
- Yan Dong
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Guozhong Zhou
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Xin Xu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Yu Zhang
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jiaru Yang
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Meixiao Liu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jing Kong
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Bingxue Li
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China.,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Peng Yue
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Aihua Liu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Fukai Bao
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| |
Collapse
|
7
|
Gasmi S, Koffi JK, Nelder MP, Russell C, Graham-Derham S, Lachance L, Adhikari B, Badcock J, Baidoobonso S, Billard BA, Halfyard B, Jodoin S, Singal M, Bourgeois AC. Surveillance for Lyme disease in Canada, 2009-2019. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:219-227. [PMID: 38105769 PMCID: PMC10723632 DOI: 10.14745/ccdr.v48i05a05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Lyme disease (LD) is a multisystem infection that can affect the skin, heart, joints and nervous system. In Canada, the incidence of LD cases has increased over the past decade making this a disease of public health concern. The objective of this study is to summarize the epidemiology of LD cases reported in Canada from 2009 through 2019. Methods Incidence over time, case classification (confirmed and probable), seasonal and geographic distribution, demographic and clinical characteristics of reported LD cases were determined. Logistic regression was used to explore potential demographic risk factors for the occurrence of LD. Results During 2009-2019, a total of 10,150 LD cases were reported by the provinces to the Public Health Agency of Canada, of which 7,242 (71.3%) were confirmed and 2,908 (28.7%) were probable cases. The annual count increased from 144 in 2009 to 2,634 in 2019, mainly due to an increase in locally acquired infections, from 65.3% to 93.6%, respectively. The majority of cases (92.1%) were reported from three provinces: Ontario (46.0%); Nova Scotia (28.0%); and Québec (18.1%). Most of the locally acquired cases (74.0%) were reported in the summer months of June (20.0%), July (35.4%) and August (18.6%). The highest incidence rates (cases per 100,000 population) were in children aged 5-9 years (45.0) and in adults aged 65-69 years (74.3), with 57.3% of all reported cases occurring among males. The most common presenting symptoms were single erythema migrans rash (75.1%) and arthritis (34.1%). The frequency of reported clinical manifestations varied among age groups and seasons with erythema migrans and arthritis at presentation reported more frequently in children than older patients. Conclusion The results of this report highlight the continued emergence of LD in Canada and the need for further development and implementation of targeted awareness campaigns designed to minimize the burden of LD.
Collapse
Affiliation(s)
- Salima Gasmi
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Saint-Hyacinthe, QC
| | - Jules K Koffi
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Saint-Hyacinthe, QC
| | - Mark P Nelder
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - Curtis Russell
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - Scott Graham-Derham
- Communicable Disease Control Branch, Manitoba Health and Seniors Care, Winnipeg, MB
| | - Lisa Lachance
- Health and Wellness Promotion Branch, Public Health and Compliance Division, Alberta Health, Edmonton, AB
| | - Bijay Adhikari
- Population Health Branch, Ministry of Health, Regina, SK
| | - Jacqueline Badcock
- Office of the Chief Medical Officer of Health, New Brunswick Department of Health, Fredericton, NB
| | - Shamara Baidoobonso
- Prince Edward Island Department of Health and Wellness, Population Health Assessment & Surveillance Unit, Charlottetown, PE
| | - Beverly A Billard
- Public Health Branch, Nova Scotia Department of Health and Wellness, Halifax, NS
| | - Beth Halfyard
- Health and Community Services, Population Health Branch, St. John’s, NL
| | - Stéphanie Jodoin
- Direction générale adjointe de la protection de la santé publique, Ministère de la Santé et des Services sociaux, Québec, QC
| | - Mayank Singal
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver, BC
| | - Annie-Claude Bourgeois
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| |
Collapse
|
8
|
Musonera JB, Valiquette L, Baron G, Milord F, Marcoux D, Thivierge K, Bedard-Dallaire S, Pelletier AA, Lachance R, Bourget J, Simard C, Cantin E, Abbasi F, Haraoui LP, Carignan A. Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada: a multicentre retrospective cohort study. CMAJ Open 2022; 10:E570-E576. [PMID: 35764331 PMCID: PMC9241544 DOI: 10.9778/cmajo.20210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite increases in cases of Lyme disease, little is known about the management and clinical course of the disease in Canada. We aimed to describe the management and clinical course of Lyme disease in patients treated in acute care facilities in Quebec and to assess adherence to the 2006 Infectious Diseases Society of America (IDSA) guideline. METHODS This retrospective multicentre cohort study included pediatric and adult patients with serologically confirmed Lyme disease treated in acute care facilities (12 community hospitals and 2 tertiary care centres) of 2 endemic regions of Quebec (Estrie and Montérégie), from 2004 to 2017. We considered drug choice, prescribed dose and treatment duration in assessing adherence of prescriptions to the 2006 IDSA guideline. The main outcome was complete resolution of symptoms at 3 months after the initiation of treatment. RESULTS We included 272 patients from 14 institutions (age range 3-87 yr). Early disseminated Lyme disease (140 patients [51%]) was predominant. Adherence to the IDSA guideline was observed in 235 (90%) of the 261 cases with complete information, and adherence was stable over time (2004-2013: 57/64 [89%]; 2014-2015: 64/71 [90%]; 2016-2017: 114/126 [90%]; p = 0.8). Non-adherence to the guideline (n = 26) was predominantly due to longer-than-recommended treatment duration (16/26 [62%]). Resolution of objective signs at 3 months after treatment initiation occurred in 265 (99%) of 267 patients, whereas post-treatment Lyme disease syndrome was observed in 27 patients (10%) with increasing incidence over time (2004-2013: 3/65 [5%]; 2014-2015: 4/73 [5%]; 2016-2017: 20/129 [16%]; p = 0.02). INTERPRETATION We observed clinical resolution of Lyme disease in 99% of the patients, and most treatments (90%) complied with the 2006 IDSA guideline. The incidence of post-treatment Lyme disease syndrome increased over the study period, warranting further prospective studies.
Collapse
Affiliation(s)
- Jean B Musonera
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Geneviève Baron
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - François Milord
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Dominique Marcoux
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Karine Thivierge
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Samuel Bedard-Dallaire
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Andrée A Pelletier
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Raphaël Lachance
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Jeremy Bourget
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Catherine Simard
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Emmanuelle Cantin
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Farhad Abbasi
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Louis-Patrick Haraoui
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases (Musonera, Valiquette, Marcoux, Bedard-Dallaire, Pelletier, Haraoui, Carignan), Department of Community Health Sciences (Baron, Milord) and Faculté de médecine et des Sciences de la santé (Lachance, Bourget, Cantin, Abbasi), Université de Sherbrooke, Sherbrooke, Que.; Laboratoire de santé publique du Québec (Thivierge), Montréal, Que.; Université Laval (Simard), Québec, Que.
| |
Collapse
|
9
|
Abstract
Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms. It may result in a range of clinical manifestations involving different organ systems, and can lead to persistent sequelae in a subset of cases. The pathogenesis of Lyme borreliosis is incompletely understood, and laboratory diagnosis, the focus of this review, requires considerable understanding to interpret the results correctly. Direct detection of the infectious agent is usually not possible or practical, necessitating a continued reliance on serologic testing. Still, some important advances have been made in the area of diagnostics, and there are many promising ideas for future assay development. This review summarizes the state of the art in laboratory diagnostics for Lyme borreliosis, provides guidance in test selection and interpretation, and highlights future directions.
Collapse
|
10
|
Performance of a Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease in Nova Scotia. J Clin Microbiol 2020; 58:JCM.01841-19. [PMID: 32321781 DOI: 10.1128/jcm.01841-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/07/2020] [Indexed: 12/25/2022] Open
Abstract
Compared to the standard two-tiered testing (STTT) algorithm for Lyme disease serology using an enzyme immunoassay (EIA) followed by Western blotting, data from the United States suggest that a modified two-tiered testing (MTTT) algorithm employing two EIAs has improved sensitivity to detect early localized Borrelia burgdorferi infections without compromising specificity. From 2011 to 2014, in the Canadian province of Nova Scotia, where Lyme disease is hyperendemic, sera submitted for Lyme disease testing were subjected to a whole-cell EIA, followed by C6 EIA and subsequently IgM and/or IgG immunoblots on sera with EIA-positive or equivocal results. Here, we evaluate the effectiveness of the MTTT algorithm compared to the STTT approach in a Nova Scotian population. Retrospective chart reviews were performed on patients testing positive with the whole-cell and C6 EIAs (i.e., the MTTT algorithm). Patients were classified as having Lyme disease if they had a positive STTT result, a negative STTT result but symptoms consistent with Lyme disease, or evidence of seroconversion on paired specimens. Of the 10,253 specimens tested for Lyme disease serology, 9,806 (95.6%) were negative. Of 447 patients who tested positive, 271 charts were available for review, and 227 were classified as patients with Lyme disease. The MTTT algorithm detected 25% more early infections with a specificity of 99.56% (99.41 to 99.68%) compared to the STTT. These are the first Canadian data to show that serology using a whole-cell sonicate EIA followed by a C6 EIA (MTTT) had improved sensitivity for detecting early B. burgdorferi infection with specificity similar to that of two-tiered testing using Western blots.
Collapse
|
11
|
Ogden NH, Bouchard C, Badcock J, Drebot MA, Elias SP, Hatchette TF, Koffi JK, Leighton PA, Lindsay LR, Lubelczyk CB, Peregrine AS, Smith RP, Webster D. What is the real number of Lyme disease cases in Canada? BMC Public Health 2019; 19:849. [PMID: 31253135 PMCID: PMC6599318 DOI: 10.1186/s12889-019-7219-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lyme disease is emerging in Canada due to expansion of the range of the tick vector Ixodes scapularis from the United States. National surveillance for human Lyme disease cases began in Canada in 2009. Reported numbers of cases increased from 144 cases in 2009 to 2025 in 2017. It has been claimed that few (< 10%) Lyme disease cases are reported associated with i) supposed under-diagnosis resulting from perceived inadequacies of serological testing for Lyme disease, ii) expectation that incidence in Canadian provinces and neighbouring US states should be similar, and iii) analysis of serological responses of dogs to the agent of Lyme disease, Borrelia burgdorferi. We argue that performance of serological testing for Lyme disease is well studied, and variations in test performance at different disease stages are accounted for in clinical diagnosis of Lyme disease, and in surveillance case definitions. Extensive surveillance for tick vectors has taken place in Canada providing a clear picture of the emergence of risk in the Canadian environment. This surveillance shows that the geographic scope of I. scapularis populations and Lyme disease risk is limited but increasing in Canada. The reported incidence of Lyme disease in Canada is consistent with this pattern of environmental risk, and the differences in Lyme disease incidence between US states and neighbouring Canadian provinces are consistent with geographic differences in environmental risk. Data on serological responses in dogs from Canada and the US are consistent with known differences in environmental risk, and in numbers of reported Lyme disease cases, between the US and Canada. CONCLUSION The high level of consistency in data from human case and tick surveillance, and data on serological responses in dogs, suggests that a high degree of under-reporting in Canada is unlikely. We speculate that approximately one third of cases are reported in regions of emergence of Lyme disease, although prospective studies are needed to fully quantify under-reporting. In the meantime, surveillance continues to identify and track the ongoing emergence of Lyme disease, and the risk to the public, in Canada.
Collapse
Affiliation(s)
- N. H. Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, Canada
| | - C. Bouchard
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, Canada
| | - J. Badcock
- Office of the Chief Medical Officer of Health, New Brunswick Department of Health, Fredericton, Canada
| | - M. A. Drebot
- Zoonotic Diseases and Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - S. P. Elias
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - T. F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, NS Canada
| | - J. K. Koffi
- Policy Integration and Zoonoses Division, Centre for Food-Borne, Environmental and Zoonotic Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - P. A. Leighton
- Département de pathologie et microbiologie, and Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada
| | - L. R. Lindsay
- Zoonotic Diseases and Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - C. B. Lubelczyk
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - A. S. Peregrine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - R. P. Smith
- Maine Medical Center Research Institute, Scarborough, ME USA
| | - D. Webster
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, Saint John Regional Hospital, Dalhousie University, Saint John, New Brunswick Canada
| |
Collapse
|
12
|
AKAR N, ÇALIŞKAN E, ÖZTÜRK CE, ANKARALI H, KILINÇEL Ö, ÖKSÜZ Ş, ŞAHİN İ. Seroprevalence of hantavirus and Borrelia burgdorferi in Düzce (Turkey) forest villages
and the relationship with sociodemographic features. Turk J Med Sci 2019; 49:483-489. [PMID: 30862151 PMCID: PMC7018355 DOI: 10.3906/sag-1807-160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Hantavirus and Borrelia burgdorferi are two zoonotic agents that pose a great risk especially for people living in forest
areas. This study aimed to investigate the seroprevalence of hantavirus and B. burgdorferi in forest villages of Düzce and its relationship
with sociodemographic features. Materials and methods The presence of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against hantavirus and
B. burgdorferi in serum samples was investigated via enzyme-linked immunosorbent assay (ELISA). Hantavirus IgG and B. burgdorferi
IgM and IgG positivity was then validated by western blot (WB) method. Results During the analyses, 193 serum samples were tested. Eleven (6%) cases of hantavirus IgM was found positive by ELISA. Six
(3%) cases of hantavirus IgG, 3 (2%) cases of B. burgdorferi IgM, and 12 (6%) cases of B. burgdorferi IgG were found positive by WB.
Borrelia burgdorferi IgG positivity was found to be higher in the 46–70 age group and it was seen that the positivity was the highest
among those who lived in mud-brick houses. Conclusion This study was the first to determine the frequency of hantavirus in the study region and it includes current data for B.
burgdorferi. Consequently, it is recommended that similar studies be carried out on rodents in all the regions at risk.
Collapse
Affiliation(s)
- Nida AKAR
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Emel ÇALIŞKAN
- Department of Medical Microbiology, Faculty of Medicine, Düzce University, DüzceTurkey
| | - Cihadiye Elif ÖZTÜRK
- Department of Medical Microbiology, Faculty of Medicine, Düzce University, DüzceTurkey
| | - Handan ANKARALI
- Department of Biostatistics and Medical Science, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
| | - Özge KILINÇEL
- Medical Microbiology Laboratory, Düzce Atatürk State Hospital, DüzceTurkey
| | - Şükrü ÖKSÜZ
- Department of Medical Microbiology, Faculty of Medicine, Düzce University, DüzceTurkey
| | - İdris ŞAHİN
- Department of Medical Microbiology, Faculty of Medicine, Düzce University, DüzceTurkey
| |
Collapse
|
13
|
Lloyd VK, Hawkins RG. Under-Detection of Lyme Disease in Canada. Healthcare (Basel) 2018; 6:E125. [PMID: 30326576 PMCID: PMC6315539 DOI: 10.3390/healthcare6040125] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022] Open
Abstract
Lyme disease arises from infection with pathogenic Borrelia species. In Canada, current case definition for confirmed Lyme disease requires serological confirmation by both a positive first tier ELISA and confirmatory second tier immunoblot (western blot). For surveillance and research initiatives, this requirement is intentionally conservative to exclude false positive results. Consequently, this approach is prone to false negative results that lead to underestimation of the number of people with Lyme disease. The province of New Brunswick (NB), Canada, can be used to quantify under-detection of the disease as three independent data sets are available to generate an estimate of the true human disease prevalence and incidence. First, detailed human disease incidence is available for the US states and counties bordering Canada, which can be compared with Canadian disease incidence. Second, published national serology results and well-described sensitivity and specificity values for these tests are available and deductive reasoning can be used to query for discrepancies. Third, high-density tick and canine surveillance data are available for the province, which can be used to predict expected human Lyme prevalence. Comparison of cross-border disease incidence suggests a minimum of 10.2 to 28-fold under-detection of Lyme disease (3.6% to 9.8% cases detected). Analysis of serological testing predicts the surveillance criteria generate 10.4-fold under-diagnosis (9.6% cases detected) in New Brunswick for 2014 due to serology alone. Calculation of expected human Lyme disease cases based on tick and canine infections in New Brunswick indicates a minimum of 12.1 to 58.2-fold underestimation (1.7% to 8.3% cases detected). All of these considerations apply generally across the country and strongly suggest that public health information is significantly under-detecting and under-reporting human Lyme cases across Canada. Causes of the discrepancies between reported cases and predicted actual cases may include undetected genetic diversity of Borrelia in Canada leading to failed serological detection of infection, failure to consider and initiate serological testing of patients, and failure to report clinically diagnosed acute cases. As these surveillance criteria are used to inform clinical and public health decisions, this under-detection will impact diagnosis and treatment of Canadian Lyme disease patients.
Collapse
Affiliation(s)
- Vett K Lloyd
- Department Biology, Mt. Allison University, Sackville, NB E4L 1E2, Canada.
| | - Ralph G Hawkins
- Division of General Internal Medicine, University of Calgary, South Health Campus, Calgary, AB T3M 1M4, Canada.
| |
Collapse
|
14
|
Patriquin G, Drebot M, Cole T, Lindsay R, Schleihauf E, Johnston BL, Dimitrova K, Traykova-Andonova M, Mask A, Haldane D, Hatchette TF. High Seroprevalence of Jamestown Canyon Virus among Deer and Humans, Nova Scotia, Canada. Emerg Infect Dis 2018; 24:118-121. [PMID: 29260667 PMCID: PMC5749476 DOI: 10.3201/eid2401.170484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Using residual serum samples from Nova Scotia, Canada, we found that 87.8% of tested deer and an estimated 20.6% of the human population were infected with Jamestown Canyon virus. Human seropositivity reached 48.2% in 1 region. This virus may be an underrecognized cause of disease in Nova Scotia.
Collapse
|
15
|
Clinical manifestations of reported Lyme disease cases in Ontario, Canada: 2005-2014. PLoS One 2018; 13:e0198509. [PMID: 29856831 PMCID: PMC5983483 DOI: 10.1371/journal.pone.0198509] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/21/2018] [Indexed: 01/29/2023] Open
Abstract
Lyme disease (LD) is the most common vector-borne disease in Ontario, Canada. We describe the epidemiology and clinical manifestations of LD in Ontario and examine trends in the incidence of non-disseminated and disseminated LD. LD surveillance data from the integrated Public Health Information System (iPHIS) from 2005–2014 were mapped to symptoms according to syndrome groups (erythema migrans (EM), flu-like, cardiac, neurologic or arthritic) and disease stages (early localized, early disseminated or late disseminated). During the study period, 1,230 cases due to Borrelia burgdoferi were reported in Ontario with annual incidence rates ranging from 0.32 (2006) to 2.16 (2013) cases per 100,000 population. Seventy percent of cases had EM and the proportion of cases with EM increased over time. Other clinical manifestations included flu-like (75%), arthritic (42%), neurologic (41%) and cardiac (6%) symptoms. Early localized disease (n = 415) manifested with EM (87%) and flu-like (57%) symptoms; early disseminated disease (n = 216) manifested with neurologic (94%), cardiac (10%) and EM (63%) symptoms; and late disseminated disease (n = 475) manifested with EM (62%), neurologic (55%), cardiac (9%), and arthritic symptoms (i.e., arthralgia (93%) and arthritis (7%)). Early localized and early disseminated cases (88% each) occurred primarily from May through September, compared to late disseminated cases (81%). The proportion of cases reported to public health within 30 days of illness onset increased during the study period, while the proportion of cases reported within 1–3 months and >3 months decreased. Geographical variations characterized by higher incidence of early localized disease and earlier public health notification (within 30 days of illness onset) occurred in regions with established or recently established LD risk areas, while later public health notification (>3 months after illness onset) was reported more frequently in regions with recently established or no identified risk areas. This is the first study to describe the clinical manifestations of LD in Ontario, Canada. The observed geographical variations in the epidemiology of LD in Ontario reinforce the need for regionally focused public health strategies aimed at increasing awareness, promoting earlier recognition and reporting, and encouraging greater uptake of preventive measures.
Collapse
|
16
|
Herrin BH, Peregrine AS, Goring J, Beall MJ, Little SE. Canine infection with Borrelia burgdorferi, Dirofilaria immitis, Anaplasma spp. and Ehrlichia spp. in Canada, 2013-2014. Parasit Vectors 2017; 10:244. [PMID: 28526093 PMCID: PMC5437676 DOI: 10.1186/s13071-017-2184-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/10/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Canine test results generated by veterinarians throughout Canada from 2013-2014 were evaluated to assess the geographical distribution of canine infection with Borrelia burgdorferi, Dirofilaria immitis, Ehrlichia spp., and Anaplasma spp. METHODS The percent positive test results of 115,636 SNAP® 4Dx® Plus tests from dogs tested were collated by province and municipality to determine the distribution of these vector-borne infections in Canada. RESULTS A total of 2,844/115,636 (2.5%) dogs tested positive for antibody to B. burgdorferi. In contrast, positive test results for D. immitis antigen and antibodies to Ehrlichia spp. and Anaplasma spp. were low, with less than 0.5% of dogs testing positive for any one of these three agents nationwide. Provincial seroprevalence for antibodies to B. burgdorferi ranged from 0.5% (Saskatchewan)-15.7% (Nova Scotia); the areas of highest percent positive test results were in proximity to regions in the USA considered endemic for Lyme borreliosis, including Nova Scotia (15.7%) and Eastern Ontario (5.1%). These high endemic foci, which had significantly higher percent positive test results than the rest of the nation (P < 0.0001), were surrounded by areas of moderate to low seroprevalence in New Brunswick (3.7%), Quebec (2.8%), and the rest of Ontario (0.9%), as well as northward and westward through Manitoba (2.4%) and Saskatchewan (0.5%). Insufficient results were available from the westernmost provinces, including Alberta and British Columbia, to allow analysis. CONCLUSION Increased surveillance of these vector-borne disease agents, especially B. burgdorferi, is important as climate, vector range, and habitat continues to change throughout Canada. Using dogs as sentinels for these pathogens can aid in recognition of the public and veterinary health threat that each pose.
Collapse
Affiliation(s)
- Brian H Herrin
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA.
| | - Andrew S Peregrine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | | | - Susan E Little
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| |
Collapse
|
17
|
Ogden NH, Arsenault J, Hatchette TF, Mechai S, Lindsay LR. Antibody responses to Borrelia burgdorferi detected by western blot vary geographically in Canada. PLoS One 2017; 12:e0171731. [PMID: 28182723 PMCID: PMC5300191 DOI: 10.1371/journal.pone.0171731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/23/2017] [Indexed: 02/03/2023] Open
Abstract
Lyme disease is emerging in eastern and central Canada, and most cases are diagnosed using the two-tier serological test (Enzyme Immuno Assay [EIA] followed by Western blot [WB]). Simplification of this algorithm would be advantageous unless it impacts test performance. In this study, accuracy of individual proteins of the IgG WB algorithm in predicting the overall test result in samples from Canadians was assessed. Because Borrelia burgdorferi strains vary geographically in Canada, geographic variations in serological responses were also explored. Metrics of relative sensitivity, specificity and the kappa statistic measure of concordance were used to assess the capacity of responses to individual proteins to predict the overall IgG WB result of 2524 EIA (C6)-positive samples from across Canada. Geographic and interannual variations in proportions of samples testing positive were explored by logistic regression. No one protein was highly concordant with the IgG WB result. Significant variations were found amongst years and geographic regions in the prevalence of samples testing positive using the overall IgG WB algorithm, and for individual proteins of the algorithm. In most cases the prevalence of samples testing positive were highest in Nova Scotia, and lower in samples from Manitoba westwards. These findings suggest that the current two tier test may not be simplified and continued use of the current two-tier test method and interpretation is recommended. Geographic and interannual variations in the prevalence of samples testing positive may be consistent with B. burgdorferi strain variation in Canada, and further studies are needed to explore this.
Collapse
Affiliation(s)
- Nicholas H. Ogden
- National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- * E-mail:
| | - Julie Arsenault
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samir Mechai
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - L. Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| |
Collapse
|
18
|
Lindsay LR. Present state of common vector-borne diseases in Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:200-201. [PMID: 29769979 PMCID: PMC5757706 DOI: 10.14745/ccdr.v42i10a03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- LR Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
- Correspondence:
| |
Collapse
|
19
|
Rahman S, Shering M, Ogden NH, Lindsay R, Badawi A. Toll-like receptor cascade and gene polymorphism in host-pathogen interaction in Lyme disease. J Inflamm Res 2016; 9:91-102. [PMID: 27330321 PMCID: PMC4898433 DOI: 10.2147/jir.s104790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Lyme disease (LD) risk occurs in North America and Europe where the tick vectors of the causal agent Borrelia burgdorferi sensu lato are found. It is associated with local and systemic manifestations, and has persistent posttreatment health complications in some individuals. The innate immune system likely plays a critical role in both host defense against B. burgdorferi and disease severity. Recognition of B. burgdorferi, activation of the innate immune system, production of proinflammatory cytokines, and modulation of the host adaptive responses are all initiated by Toll-like receptors (TLRs). A number of Borrelia outer-surface proteins (eg, OspA and OspB) are recognized by TLRs. Specifically, TLR1 and TLR2 were identified as the receptors most relevant to LD. Several functional single-nucleotide polymorphisms have been identified in TLR genes, and are associated with varying cytokines types and synthesis levels, altered pathogen recognition, and disruption of the downstream signaling cascade. These single-nucleotide polymorphism-related functional alterations are postulated to be linked to disease development and posttreatment persistent illness. Elucidating the role of TLRs in LD may facilitate a better understanding of disease pathogenesis and can provide an insight into novel therapeutic targets during active disease or postinfection and posttreatment stages.
Collapse
Affiliation(s)
- Shusmita Rahman
- National Microbiology Laboratory, Public Health Agency of Canada, Toronto, ON, Canada
| | - Maria Shering
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Nicholas H Ogden
- National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, QC, Canada
| | - Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Alaa Badawi
- National Microbiology Laboratory, Public Health Agency of Canada, Toronto, ON, Canada
| |
Collapse
|