Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada: a multicentre retrospective cohort study

Abstract

L yme disease, a multisystem infection primarily caused byBorrelia burgdorferi in North America and by Borrelia afzelii and Borrelia garinii in Europe and Asia, 1,2 progresses in 3 stages: early localized stage, early disseminated stage and late disseminated stage. 3 Cases of Lyme disease reported in Canada increased from 144 in 2009 to 992 in 2016, representing an increase from 0.4 to 2.7 per 100 000 population. 4 In Quebec, Lyme disease has been notifiable since November 2003, with the first locally acquired case reported in 2006. 5,6 Reported cases of Lyme disease and the proportion of cases with acquired infection have increased each year. 6 In 2017, 329 cases were declared to the public health authorities in Quebec, including 249 (76%) acquired in that province, particularly in Estrie (n = 138, 55% of Quebec-acquired cases) and Montérégie (n = 75, 30% of Quebec-acquired cases). 6 Despite the increase in cases, little is known about the management and clinical course of Lyme disease in Canada.Published evidence has focused on epidemiologic surveillance, risk of acquisition and clinical case characteristics. [7][8][9] We aimed to describe case management of Lyme disease in acute care facilities in Quebec and adherence to the 2006 guideline of the Infectious Diseases Society of America (IDSA). 3 We assessed the clinical course of patients treated in Quebec and temporal changes in case severity from 2004 to 2017.

Current and future burden from Lyme disease in Québec as a result of climate change

“…These reports present some results from epidemiological investigations of cases reported between 2016 and 2018 ((8– 11 , 23 , 24 )), such as stage and clinical signs, proportion of cases hospitalized and length of hospitalization. Data published by Musonera et al , (( 14 )), analyzing the medical records of cases reported and treated at a hospital in Estrie and Montérégie between 2004 and 2017 (n=272), were also considered in estimating some clinical criteria not available in the ND (proportion of cases by clinical stage, proportion of cases hospitalized and length of hospitalization).…”

“…To prepare a clinical portrait of cases reported during our study period, the data published by the DSPu ((8– 11 , 13 , 23 , 24 )) and by Musonera et al (( 14 , 42 )) for the Estrie, Montérégie and Montréal regions were used. The average percentages of cases by stage and clinical signs was estimated based on these data, and the percentages were related to all cases reported in Québec between 2015 and 2019 to estimate the number of cases by stage and clinical signs during our study period.…”

“…The initial treatment considered is the treatment recommended by INESSS (( 27 )). Two studies indicate that the prescribed treatment in Québec is appropriate in over 85% of cases (( 14 , 24 )). The cost of hospitalizations was estimated separately taking into account the average length and the cost of a stay.…”

“…To prepare a clinical portrait of the 1,473 cases, the data provided by the DSPu (n=405 cases) and Musonera et al , (( 14 )) (n=272 cases) were used. On average, 66% of cases of Lyme disease are at the localized stage, and 34% at the disseminated stage when reported (Table 2).…”

“…The demographic and geographic characteristics of cases are published annually by the Institut national de santé publique du Québec and the Ministère de la Santé et des Services sociaux (( 1 , 5 )). Several studies have described the clinical picture of Lyme disease, but only for some regions of Québec (( 6 – 14 )). Some costs associated with Lyme disease have been assessed in Ontario (( 15 )) and the United States (( 16 – 20 )), but their results cannot be transposed directly to Québec due to differences in healthcare systems.…”