^{The brochure, compiled and published by the LDAO, is a comprehensive brochure on the what, when, where and how of LD.}

^{The brochure starts by explaining that LD is caused by the bacterium “Borrelia burgdorferi” and is transmitted by the bite of a blacklegged tick, which is the common vector in Ontario. The life cycle of these ticks is reviewed, complete with their inter-reaction with host species. The tick bite and removal of ticks are explained, followed by LD testing procedures ( which are very unreliable), as well some preventive measures. The brochure ends with a thorough list of symptoms, complete with coloured pictures of various rashes associated with LD.}

^{Each brochure can be purchased at a cost of $1.50 a piece for 1 to 15 brochures; or for $1.40  a piece for 16 and more.}

^{You can pay by mailing a cheque to LDAO, P. O. Box 184 Campbellville Ontario, L0P 1B0}

^{You can also pay by credit card using the secure PayPal option available on the website.}

^{If you are interested in becoming a member of the LDAO, please see the membership application included on the website. The cost is $40.00 annually and can be paid by the two methods previously outlined.}

^{The LDAO has 4 meetings per year, publishes 3 to 4 newsletters, Lyme Alert, per year, which are included with your membership.}  

^{FACTS ABOUT LYME DISEASE}   

Lyme disease(Ld) is caused a bacterium, Borrelia burgdorferi (Bb), called a spirochete [spy’-ro-keet], which is typically transmitted by certain ticks to a wide range of birds, reptiles, and mammals including humans. Ld can cause a number of symptoms ranging from a relatively benign skin rash to severe arthritic, cardiac, gastrointestional, neurologic, and urogenital manifestations. Cognitive and psychiatric features may also develop. Ld was first described clinically in North America in a Wisconsin physician who was bitten locally by a tick in October 1969. Since 1988, Ld has been a reportable disease in Ontario.

CAUSAL ORGANISM

Bb has several forms: 1) spirochetes (elongated, helical-shaped); 2) atypical forms: ring-shaped, looped, rolled, blebs (budding vesicles), granules (ultra-microscopic grains), biofilm (cluster of spirochetes); and 3) cyst forms (spore-shaped, dormant, no cell wall). As a stealth pathogen, Bb has many strategies to evade the immune system. A biofilm consists of colony of spirochetes, coated by a gelatinous, protective membrane. They induce chronic infections by resisting antibiotics, anti-Lyme herbs, and escaping host immune response.

When an infected tick feeds on a host, it regurgitates spirochete-laden fluids into the host and, ultimately, Bb migrates through skin and connective tissue, and also moves via blood. Bb has different physical and biochemical characteristics depending on whether it is residing in a vector tick or present in a suitable warm-blooded host.

VECTORS

Ticks are neither “insects” nor “bugs;” they are arachnids (spider-like creatures). Ticks do not jump, fly, or drop out of trees. They wait on low vegetation to attach to suitable hosts.

The primary vector of Ld in Ontario is the blacklegged tick, Ixodes scapularis. This tick was first studied in 1972 in a breeding colony at Long Point on the north shore of Lake Erie and, in 1987, Bb was isolated from ticks and mice collected there. More recently, established populations of blacklegged ticks have been found at Point Pelee National Park, Rondeau Provincial Park*, Long Point (2 areas)*, Turkey Point Provincial Park*, Turkey Point lowlands*, Wainfleet Bog Conservation Area, Presqu’ile Provincial Park, Prince Edward Point National Area*, and St. Lawrence Islands National Park (3 areas)*, and Charleston Lake Provincial Park. [Key: *Ld endemic area confirmed.]

The life cycle of I. scapularis is 2-5 years, and consists of 4 life stages: egg, larva, nymph, and adult (Fig.1). The immature (larva, nymph) stages require a blood meal to molt to the next stage, and the female needs blood as nourishment to produce eggs. When the larva attaches, and becomes fully engorged, it drops off and molts to a nymph. As a nymph, it again quests for a host (i.e., mouse, chipmunk, songbird), and feeds for 3-5 days, drops off, and molts to an adult (male, female). In late spring, a fertile female lays 1000-3000 eggs in moist leaf litter. After 35 days, the eggs hatch into larvae, which promptly seek a host (i.e., white-footed mouse, deer mouse, songbird). While feeding on a Bb-infected host, the ticks can acquire spirochetes. Whenever the blacklegged tick becomes infected with Bb, it is infected for life. However, a gravid I. scapularis female does not pass Bb to her eggs.

Our 10-year tick-host study of blacklegged ticks in Ontario pinpoints this tick species as far north as the 50^th parallel, which transects Minaki in northwestern Ontario. All of the blacklegged ticks submitted by veterinarians and the public, were adults, with a 12.9% Bb infection rate (Fig. 2). These ticks had a wide geographic distribution province-wide, and were collected from people, domestic and wildlife hosts, which had no out-of-province travel. Blacklegged tick nymphs have been suggested as the principal vector of Ld; however, our study clearly show that females are the main mode of Bb transmission in Ontario.

Figure 1. In Lyme disease endemic areas, Bb cycles enzootically between vector ticks and reservoir hosts on a continuous basis.

HOSTS

Both mammals and birds play a vital role in the maintenance and dispersal of Lyme vector ticks. In North America, blacklegged ticks have been reported on at least 54 mammalian and 72 bird species. Rodents (e.g., mice, chipmunks) and shrews are primary reservoirs of Bb. Adult blacklegged ticks seek large hosts including people, and conduct host-seeking activity when the outdoor temperature is above 0˚C, peaking in May and, again, in October (Fig. 2). Blacklegged ticks have antifreeze-like compounds in their bodies, and overwinter successfully in the humus layer under an insulating blanket of snow. White-tailed deer, which act as amplifying hosts of all 3 motile stages of the blacklegged tick, play an important role in sustaining established tick populations. However, deer only play a minimal role in nonendemic areas because they do not transmit Bb to ticks, thus breaking the Ld cycle.

Songbirds act as short- and long-range dispersing hosts of larval and nymphal blacklegged ticks. During northward spring migration, songbirds make landfall at stopovers to refuel and replenish food reserves in Ld endemic areas and, while meandering through low-level vegetation, Bb-infected ticks attach and hitch a ride. Subsequently, these engorged ticks are carried hundreds of kilometres, and released across Canada. Our studies confirmed that songbirds carry Bb-infected ticks northward across the Canada-U.S. border and, likewise, from at least 23 established I. scapularis Canadian populations during spring migration. We have documented immature I. scapularis on songbirds from northern Alberta to Nova Scotia, some of which are infected with Bb. Some songbirds (i.e., American Robin, Song Sparrow) can harbour Bb, and act as reservoir hosts. Blacklegged ticks can be coinfected with several pathogens including: Anaplasma phagocytophilum (human granulocyctic anaplasmosis [HGA]), Babesia spp. (i.e., Babesia microti [human babesiosis]), Bartonella spp. (i.e., Bartonella henselae [cat scratch disease]), Mycoplasma fermentans (Chronic Fatigue), relapsing fever group spirochetes, deer tick virus, and multiple other viruses (i.e., HH-6, EBV, CMV). Recently, A. phagocytophilum was detected in ticks collected from songbirds in southern Canada. Because songbirds disperse ticks widely across Ontario, one does not have to go to an endemic area to contract Lyme disease.

TICK BITE

Ticks do not “burrow” in or under the skin. Instead, the tick attaches itself to the host with its hypostome (piercing mouthpart) (see front cover). This feeding structure has backward-pointing barbs, which provides a temporary steadfast grip while getting a blood meal. Before entry, the hypostome injects a painkiller, an antihistamine to anaesthetize the tissue, and anti-clotting chemicals to desensitize the bite site. After entry, the hypostome produces a cement-like compound, which holds the tick firmly attached. When engorgement is finished, the tick softens this substance, and releases itself from the host. Ticks often bite in nonconspicuous areas of the body. 85% do not remember a tick bite. Although Bb transmission normally takes 24-48 hours, anecdotal experience provides instance of transmission by I. scapularis adults in less than 6 hours. Other pathogens (i.e., HGA), which often are harboured by this tick species, can be transmitted in less than 24 hours.

TICK REMOVAL

Various “home remedies” for tick removal have not been proven effective. Under no circumstance should a flame, ointment, flammable liquid (gasoline, oil, lighter fluid, acetone, nail polish, etc.) or caustic material be used in removal attempts. A person who is bitten by a tick should go to a physician, and have it carefully removed with fine-pointed tweezers. Most tweezers are too blunt on the tips, and will cause an attached tick to regurgitate body fluids.

For removal yourself, place the tweezers snugly against the skin and, with a firm grip of the tick’s capitulum (head), gently pull the tick straight out with steady pressure. Do not twist the tick. A sterilized needle also works well for removal. It is important to remove the tick’s hypostome from the skin to reduce the chance of infection. Apply an antiseptic to the bite area, and wash your hands. Note in your medical records: date of removal, location on the body, and area of outdoor activity. Try to keep the tick live by placing it in a vial with a piece of moist Kleenex, and put vial in a ziplock bag with moist paper towel; keep at 10-20˚C. A dead tick can be PCR tested if it is not spoiled; put dead tick in tightly sealed vial of rubbing alcohol. Have the tick identified/tested by a lab, health department, or veterinarian. In Ontario, ticks from people can be sent by your doctor to the Parasitologist, Central Laboratory, 81 Resources Rd., Etobicoke, ON M9P 3T1. Instruction: Request that it be tested for Bb and other tick-borne pathogens, if it is a blacklegged tick.

PICTURE OF RASH

If a rash develops at the bite site, take a close-up colour picture of the rash in bright light. Place a ruler and also the date (on a piece of white paper) beside the rash to show the actual size. Record the measurements (length and width) of the rash.

ALTERNATE TRANSMISSION

During pregnancy, Bb can cross the placenta to the unborn child. Bb may also be transmitted during breastfeeding in the mother’s milk to the infant. Likewise, spirochetes can be transmitted to a person by drinking unpasturized, Bb-infected milk. Bb can be transmitted to the recipient during a blood transfusion. Sexual transmission in humans is probable among some couples; Bb has been noted in canine and human semen. Safe sex is advised.

LYME DISEASE TESTING

Routine Ld testing lacks complete reliability. Since it takes 4-6 weeks for Ld antibodies to develop against Bb to a “positive” level, serological (blood) testing should be delayed after the tick bite. Antibodies peak at 6-8 weeks after initial infection, and then subside to a lower level. By year 2, less than 50% of patients still have a strong antibody response. Serological tests (i.e., ELISA and Western blot) are commonly employed; however other screening tests are available. PCR testing may be used for tissue and certain body fluids (i.e., whole blood, synovial fluid, urine). Western blot, a qualitative test, is suggested initially because it is more specific in detecting IgM and IgG antibodies produced by the body in response to Bb infection. Ask your physician to specifically request a Western blot.

Preliminary serological screening tests (e.g., ELISA) measure the quantity of antibodies, and often show negative results; 4-65% accuracy has been reported. If the sample is obtained too early (e.g., within 4 weeks after tick bite), or the patient does not have a strong enough immune response, a false negative test can result. Since testing is not fully reliable, Ld remains a clinical diagnosis.

Note: Ld is a “great masquerader.” Physicians have been known to label Ld as other diseases/disorders like chronic fatigue, fibromyalia, stress, depression, mononucleosis, ADHD, autism, Q-fever, tularemia, scleroderma, Crohn’s disease, sarcoidosis, multiple chemical sensitivities, and psychiatric disorders. Ld mimics a litany of neurogenerative diseases (i.e., Alzheimer’s diseases, Parkinson’s disease, Lou Gehrig’s [ALS], multiple sclerosis) and connective-tissue diseases (e.i., systemic lupus erythematous, rheumatoid arthritis, nodular fasciitis, Parsonage-Turner syndrome). A U.S. researcher tested DNA from the brains of Alzheimers’ patients from the Harvard brain bank, and found 7 of 10 were positive for Bb. Other international research teams have found similar results.

Testing for other diseases is very important in determining the diagnosis. As a “stealth pathogen,” Bb sequesters and hides in the eye, bone, brain, and ligaments, and it is hard to detect and difficult to treat especially when established. If left undiagnosed and untreated, Ld can spread throughout the body and become a chronic, persistent infection.

Because Bb has different pleomorphic forms (i.e., spirochetes, cysts, biofilms), different antibiotic treatments are typically used. Chronic Ld usually requires therapeutic combinations for an extend period of time. After treatment, patients can have recurrence of symptoms months or years later. Alternative treatments show promise.

Early treatment of Lyme disease is paramount. Treatment delay can result in treatment failure, worse patient outcomes, unnecessary suffering, and increased medical expense. Ld may be acute, recurrent, or chronic; it can be fatal.

PREVENTATIVE MEASURES

Light-coloured clothing helps to spot ticks easier. Wear long-sleeve shirts and long pants. Tuck pant legs into socks, and shirts into pants. Fully closed shoes or boots hamper tick entry. Commercial repellants, such as DEET, act as a deterrent. A novel bio-friendly repellent, BioUD, is an efficacious alternative to DEET. Natural alternatives include a blend of: citronella, cedar, peppermint lemongrass, and geranium encapsulated in beeswax. After hiking, perform a full-body examination including armpits, hairline, neck, navel, groin, and behind knees. After doing a tick check, wash clothes promptly, and put clothes in the dryer on the “dry” cycle.

DO A TICK CHECK