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Research

Clinical presentation of Lyme disease in the higher-risk region of Quebec: a retrospective descriptive study

Audrey Charbonneau, Louis-Philippe Charette, Geneviève Rouleau, Mélissa Savary, Alexandra Wilson, Emily Heer, Karine Bériault and Alexandra de Pokomandy
March 27, 2018 6 (1) E139-E145; DOI: https://doi.org/10.9778/cmajo.20170084
Audrey Charbonneau
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Louis-Philippe Charette
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Geneviève Rouleau
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Mélissa Savary
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Alexandra Wilson
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Emily Heer
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Karine Bériault
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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Alexandra de Pokomandy
La Pommeraie Family Medicine Unit (Cowansville) (Charbonneau, Charette, Rouleau, Savary, Wilson, Bériault, de Pokomandy), Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Que.; Departments of Public Health (Heer) and Family Medicine (de Pokomandy), McGill University, Montréal, Que.
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  • Figure 1
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    Figure 1

    (A): Location of La Pommeraie local health and social service network in Quebec. (B): Location of municipalities within La Pommeraie network. Yellow cross indicates location of Brome-Missisquoi-Perkins Hospital. Source: ministère de la Santé et des Services sociaux du Québec (www.msss.gouv.qc.ca/statistiques/atlas/atlas/index.php). Reproduced with permission.

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    Figure 2

    Flow diagram showing identification of study cases. Note: EIA = enzyme immunoassay.

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    Figure 3

    Absolute number of patients for whom a request for serologic testing for Lyme disease was sent to the Brome-Missisquoi-Perkins Hospital, by year (A) and month (all years combined) (B). Note: EIA = enzyme immunoassay.

Tables

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    Table 1: Characteristics of patients with Lyme disease confirmed by laboratory diagnosis through 2-tiered testing, 2012 and 2015
    CharacteristicNo. (%) of patients
    IgM-positive or IgG-positive
    n = 59
    IgM-positive
    n = 50
    Age, yr
        ≤ 197 (12)5 (10)
        20-3921 (36)18 (36)
        40-5917 (29)14 (28)
        ≥ 6014 (24)13 (26)
    Male sex40 (68)34 68)
    Area of residence
        Brome Lake11 (19)9 (18)
        Bedford8 (14)8 (16)
        Cowansville16 (27)12 (24)
        Bromont19 (32)18 (36)
        Farnham2 (3)1 (2)
        Other3 (5)2 (4)
    Year of serologic testing
        20123 (5)2 (4)
        201319 (32)18 (36)
        201419 (32)17 (34)
        201518 (30)13 (26)
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    Table 2: Clinical presentation and history of patients with laboratory-confirmed Lyme disease
    CharacteristicNo. (%) of patients
    IgM-positive or IgG-positive
    n = 38
    IgM-positive
    n = 29
    Sign/symptom
    Systemic
        Any30 (79)25 (86)
    Fever (reported or objective)20 (53)17 (59)
        Fatigue18 (47)14 (48)
        Headaches12 (32)10 (34)
        Anorexia5 (13)5 (17)
        Lymphadenopathy3 (8)3 (10)
        Malaise9 (24)7 (24)
        Lethargy2 (5)1 (3)
    Cutaneous
        Any27 (71)23 (79)
        Erythema migrans15 (39)14 (48)
        Cellulitis2 (5)2 (7)
    Other10 (26)7 (24)
    Musculoskeletal
        Any20 (53)13 (45)
        Myalgia15 (39)12 (41)
        Arthralgia7 (18)4 (14)
        Migratory pains3 (8)3 (10)
        Arthritis4 (10)1 (3)
    Neurological
        Any7 (18)5 (17)
        Nuchal rigidity2 (5)1 (3)
        Facial paralysis4 (10)3 (10)
        Polyradiculopathy1 (3)1 (3)
    Cardiac
        Any2 (5)2 (7)
        Atrioventricular block2 (5)2 (7)
    Ophthalmic
        Any1 (3)1 (3)
        Conjunctivitis1 (3)1 (3)
    History
    Reported travel in New England3 (8)3 (10)
    Tick bite reported*12 (32)11 (38)

    *No ticks were brought for analysis.

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    1 Jan 2018
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    Clinical presentation of Lyme disease in the higher-risk region of Quebec: a retrospective descriptive study
    Audrey Charbonneau, Louis-Philippe Charette, Geneviève Rouleau, Mélissa Savary, Alexandra Wilson, Emily Heer, Karine Bériault, Alexandra de Pokomandy
    Jan 2018, 6 (1) E139-E145; DOI: 10.9778/cmajo.20170084

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    Clinical presentation of Lyme disease in the higher-risk region of Quebec: a retrospective descriptive study
    Audrey Charbonneau, Louis-Philippe Charette, Geneviève Rouleau, Mélissa Savary, Alexandra Wilson, Emily Heer, Karine Bériault, Alexandra de Pokomandy
    Jan 2018, 6 (1) E139-E145; DOI: 10.9778/cmajo.20170084
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