F.A.Q.
If you don’t find the answers to your questions on this page, you can always write to us at: info@aqml.ca
General
Regions and environment
Co-infections
Symptoms
Treatments
Case studies
1. Quoi faire au stade localisé?
- Wear light-coloured pants and a long-sleeved shirt to spot ticks more easily.
- Tuck your sweater into your pants and the bottom of your pants into your socks.
- Wear closed shoes
- Use mosquito repellent containing DEET or icaridin on clothing and exposed skin (always follow label instructions)
- Wear permethrin-treated clothing (always follow label instructions)
- Walk on open trails or paths
- Make sure that children and pets stay on the trail.
- Avoid using trails created by animals (such as deer and moose), as ticks are often found in the grass and plants along these trails.
- Check for ticks:
- On yourself (Check for ticks all over your body (hair, armpits, inner thighs, navel, back of knees, etc.)
- Your pets
- Your clothes
- Your outdoor equipment, such as back packs.
- Take a shower or bath as soon as possible, as this can help you find ticks that haven’t yet latched on. If you’re not showering or bathing, check your whole body and that of your children for ticks.
- If you find a tick clinging to your skin, remove it as quickly as possible.
- To kill any loose ticks on your clothes, put dry clothes in a dryer on high heat for at least 10 minutes. If your clothes are damp, they may take longer to dry.
- If you wash your clothes, use hot water and dry at a high temperature. Ticks can survive a cold or lukewarm wash cycle.
- Immediately remove the tick using a tick remover (available at the pharmacy). If you don’t have your own, use fine-tipped tweezers. Make sure not to rotate the tick. Don’t crush the tick’s abdomen to avoid transmitting the bacteria present in the tick to the person bitten. Do not attempt to remove the tick using nail polish, petroleum jelly or heat;
- Wash the bite area with soap and water and disinfect the wound with an alcohol-based hand sanitizer;
- Store the tick in a sealed container and write the date of the bite. Ticks can be stored for up to 10 days in the refrigerator if alive, or in the freezer if dead;
- Make an appointment at a medical clinic as soon as possible;
- Bring the container to your medical appointment to help diagnose Lyme Disease;
- Watch for the appearance of erythema migrans (a sore that appears on your body and then disappears after a while).
If you were bitten and develop erythema migrans, it is important to consult a doctor as soon as possible. The latter should follow the recommendations of INESSS (2021): the presence of erythema migrans is sufficient to obtain a prescription for antibiotic treatment. In this case, it can be administered without a serological diagnosis of Lyme Disease. Here’s a simple table taken from the INESS document explaining the clinical approach to bites and erythema migrans.
*Please note that the INESSS document is a good reference, but the actual treatment choice remains at the clinician’s discretion.
The INESS also recommends monitoring the onset of symptoms (neurological, arthritic, cardiac, etc.) of the disease during the observation period, during and after treatment. The appearance of systemic symptoms may influence the choice of treatment. The patient is advised to use the following file: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Biologie_medicale/Lyme_PPE/Lyme_Feuille-de-suivi.pdf
Please note the following points:
- Patients may take an antipyretic/analgesic (e.g. acetaminophen, ibuprofen) in conjunction with their antibiotic treatment to relieve pain and general systemic symptoms.
- A reaction called the Jarisch-Herxheimer reaction may occur following the start of antibiotic therapy. This systemic inflammatory reaction may occur during the treatment of spirochaete infections such as those caused by Borrelia burgdorferi.
Elle est généralement associée à la mort des bactéries. It is generally associated with the death of bacteria. However, it should not lead to discontinuation of the antibiotic, and you should notify a healthcare professional if in doubt.
*For tips on how to reduce this “Herx” reaction, you can rely on the AQML guide.
Erythema migrans are usually in the form of a target (red outline, white interior, approx. 5 cm in diameter). Its characteristics (size, shape and appearance) and its duration can vary considerably from one individual to another. Please note that certain sores caused by tick bites do not resemble classic erythema migrans. Smaller or atypical sores must be given the same attention as larger erythema migrans. The following illustrations will give you a better idea of what erythema migrans looks like.
Even if you’re not sure, we strongly recommend that you seek medical attention. The INESS guidelines suggest that if a patient has skin involvement without other manifestations suggestive of the disseminated́ stage, the physician should favour treatment covering both pathologies (e.g. cefuroxime axetil) if there is hesitation between the diagnosis of infectious cellulitis and erythema migrans.
Erythema migrans is one of the first signs of Lyme Disease, but is absent in 20% of cases, and often goes unnoticed. In Québec, post-exposure prophylaxis (PEP) is available for asymptomatic people recently bitten by a blacklegged tick to prevent Lyme Disease. According to INESSS, PEP is recommended when erythema migrans is not present and all the following criteria are met:
- The bite occurred in a geographical area covered by the application of the PPE
- The tick remained attached to the skin for a period of 24 hours or more
- The time between tick removal and initiation of PEP treatment is less than 72 hours
- If all these criteria are met, single-dose doxycycline PEP can be offered, in the absence of contraindications.
The geographical sectors covered by the application of the PPE are:
- Municipalities in the Estrie health and social services region;
- Municipalities in the Lanaudière health and social services region;
- Municipalities in the Montérégie health and social services region;
- Municipalities in the Outaouais health and social services region;
- Municipalities in the Montréal health and social services region;
- Municipalities in the Mauricie-et-du-Centre health and social services region of Québec
Here is a more comprehensive list provided by the MSSS: https://www.msss.gouv.qc.ca/professionnels/documents/maladie-lyme/liste-municipalites-PPE_Lyme-2023.pdf
For more information on the PPE, please refer to the following document:
https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Biologie_medicale/Lyme_PPE/Outil_aide_decision_PPE.pdf We also recommend that you keep track of your symptoms using this monitoring sheet:
Should symptoms suggestive of the disease appear, clinical evaluation is essential in order to initiate the appropriate treatment.
Our position: The AQML would like these criteria to be abolished, and for anyone bitten by a tick to be able to receive preventive treatment, regardless of the area of acquisition or length of exposure.