Lyme Disease in Canada: Symptoms, Neurologic Cases, and Regional Trends
Neurologic Lyme disease cases increased over time.
Bell’s palsy and arthritis affected both children and adults.
Regional differences emerged across Canada.
Lyme disease in Canada presents with a broad range of symptoms, including erythema migrans rashes, neurologic complications, Lyme arthritis, and cardiac involvement, according to Canadian surveillance data.
Researchers analyzed cases reported through the Canadian Lyme disease enhanced surveillance system to better understand symptom patterns, age distribution, and regional trends across Canada.
The findings were described by Murison and colleagues in their report “Epidemiology and clinical manifestations of reported Lyme disease cases: Data from the Canadian Lyme disease enhanced surveillance system.”
According to the authors, the analysis “describe[s] the clinical manifestations associated with Canadian Lyme disease cases” and demonstrates changing trends over time across multiple provinces.
Common Lyme Disease Manifestations in Canada
A single erythema migrans (EM) rash was the most commonly reported manifestation, occurring in 76% of patients.
Lyme arthritis was the second most common manifestation, reported in 32% of cases.
Cardiac complications occurred less frequently but were more common in specific adult age groups, including:
- 25–39 years
- 60–64 years
- 70–74 years
The authors noted that fatal cardiac manifestations were rare, similar to reports from the United States.
There was a significant decrease in late disseminated Lyme disease cases reported after 2016.
Investigators suggested this may reflect improvements in earlier recognition and treatment of Lyme disease.
However, cases of late disseminated Lyme disease continued to occur more often in Canada’s Central region.
Neurologic Lyme Disease in Canada
Neurologic manifestations were reported across multiple age groups and regions.
Bell’s palsy peaked in:
- Children ages 5–14
- Adults ages 60–64
Other neurologic manifestations peaked in:
- Children ages 10–14
- Adults ages 55–74
Reports of neurologic manifestations increased from 15% (2009–2015) to 20% (2016–2019).
The increase in neurologic cases highlights the importance of recognizing symptoms beyond the classic rash presentation.
Related: Neurologic Lyme Disease
Lyme Disease Manifestations by Age
Researchers observed different symptom patterns across age groups.
Single and multiple EM rashes were more commonly seen in:
- Children ages 5–9
- Adults ages 55–79
Lyme arthritis was most frequently reported in:
- Children ages 5–14
- Adults ages 60–74
Cardiac symptoms were distributed more evenly across adult age groups, with lower incidence in children.
Regional Differences Across Canada
The majority of cases reported in:
- New Brunswick (67%)
- Nova Scotia (63%)
were associated with early localized Lyme disease.
Ontario, however, reported a greater proportion of late disseminated Lyme disease cases.
These findings suggest regional differences in exposure patterns, recognition, and disease stage at diagnosis.
Clinical Perspective
This Canadian surveillance study highlights the wide range of Lyme disease manifestations seen across different provinces and age groups.
The findings reinforce several important clinical themes:
- Neurologic Lyme disease occurs in both children and adults
- Bell’s palsy remains an important presentation
- Lyme arthritis continues to be common
- Regional differences may affect diagnosis patterns
- Earlier recognition may reduce late disseminated disease
The increase in neurologic manifestations over time also emphasizes the importance of recognizing symptoms beyond erythema migrans alone.
Frequently Asked Questions
Is Lyme disease common in Canada?
Yes. Lyme disease has been increasingly reported across several Canadian provinces, particularly in regions where Ixodes ticks are established.
Can Lyme disease cause neurologic symptoms?
Yes. Canadian surveillance data identified Bell’s palsy and other neurologic manifestations in both children and adults.
Which Lyme disease symptoms are most common in Canada?
Erythema migrans rash was the most commonly reported manifestation, followed by Lyme arthritis and neurologic symptoms.
Is Lyme disease increasing in Canada?
Canadian surveillance studies suggest that Lyme disease cases and recognition of neurologic manifestations have increased over time.
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References:
- 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 Dec 15;18(12):e0295909. doi:10.1371/journal.pone.0295909. PMID: 38100405; PMCID: PMC10723709.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I got Lyme Disease after I was bitten by a tick in France. My rash was not the typical one for Canada and the nearby USA. It was an oval expanding rash. I got neurological Lyme. No arthritic pain. I delayed treatment because I didn’t recognize my rash as a Lyme Disease rash. I did not have any treatment in time so I have been on antibiotics to keep the Lyme under control for several years now.
The implication from the paper is that complex disseminated Lyme is a recognized treatable condition in Canada but in practice 100% of physicians treating beyond the IDSA guidelines are at risk of being investigated and charged with overprescribing antibiotics, poor record keeping or anything else of their choosing. One investigator might sit in the waiting area and tell patients that their physician is under investigation and the other will sit in with the doctor and patient. Investigators will ask the doctor how long they expect to stay in business? Canadian physicians are afraid to talk to each other about Lyme and many are now too afraid to treat. [1]
Canada along with many other countries agreed to support the CDC and follow its lead on Lyme disease. The CDC gave control of Lyme and all the procedures around it to the private 13,000 member IDSA society. The Association of Medical Microbiologists and Infectious Disease [AMMI] Canada owes its allegiance and takes its direction from the IDSA. AMMI Canada have a death grip on this disease. There is only a handful of ILADS trained physicians left in the country although there are a few ILADS trained naturopaths and a couple of NP’s.
The Canadian courts have already ruled “A doctor need not follow the procedures adopted by a unanimous majority of doctors. If a doctor follows a procedure adopted by a reputable minority of practitioners, it will suffice to disprove any inference of negligence. This principle has been expounded by the Ontario courts since 1878. Currently Canadian judges invariably rule in favour of eminence over evidence and Lyme patients and their treating physicians usually lose.
Unlike the U.S. where there are figures from insurance companies there is no second source of Lyme data in Canada. Officials only count those cases that they are absolutely sure of. All we can know from the official case numbers is that these are the absolute minimum. There is consensus that cases are under-detected but no consensus on what multiplier to use. Estimates range from 12.1 to 58.2-fold (1.7% to 8.3% of all cases detected). Lloyd/Hawkins 2018 [1]
A two-part ELISA is used in Canada that misses at least one third of those that truly do have the disease. [2] Journalists faithfully report the low official figures they obtain from the official Public Health Agency of Canada [PHAC] website. Canadians keep asking how do they get away with reporting such low numbers when every 2nd or 3rd person on their street has been bitten?
Physicians haven’t been told the test and the guidelines are flawed. In fact in 2014 I sat in on a webinar given by Canada’s two leading self-appointed Lyme experts who neither see or treat patients with complex disseminated Lyme or Lyme+. Attendees were told that if your patient doesn’t pass the test then they surely don’t have Lyme and that patients get better even if they aren’t treated. Dr. Todd Hatchette is one of the lead authors of this paper and leading self-appointed Lyme expert. Dr. Gerald Evans, another key author and AMMI member, is a vociferous Lyme denialist. My physician commented that he was tired of learning about the disease from his patients. The response was an equivocal “yes”.
Physicians are told to treat their patients nicely and if they are still complaining after treatment they should refer them to who ever will make them feel better like the physiotherapist, but not to prescribe more antibiotics as that has been proven to be of no benefit.
The insurance industry understands that it can control medicine if it can control the guidelines. This is regulatory capture of our publicly funded Canadian medical system.
Canada’s Associate Chief Public Health Officer, Dr. Howard Njoo is the kingpin in this operation, both he and the Chief Public Health Officer are infectious disease doctors with probable close ties to AMMI, IDSA, CDC and WHO. Both have the ear of the Minister and any attempts to contact the Minister are efficiently triaged by Dr. Njoo and his staff. [3]
References:
1.) Lyme disease is steeped in controversy. Now some doctors are too afraid
to treat patients, Teotonio I, thespec.com 2018-12-14:
https://www.thespec.com/living-story/9082958-lyme-disease-is-steeped-in-controversy-now-some-doctors-are-too-afraid-to-treat-patients/
2.) Under-Detection of Lyme Disease in Canada, Lloyd VK, Hawkins R, Healthcare 6 [4], 125; 2018-10-04: https://doi.org/10.3390/healthcare6040125
3.) Dr. Ralph Hawkins explains the challenges of detecting Lyme disease through testing, Looking at Lyme, S1 E7, CanLyme 2020-09-01: https://www.lookingatlyme.ca/2020/09/dr-ralph-hawkins-explains-the-challenges-of-detecting-lyme-disease-through-testing/
4.) “Small Wins” for those with Lyme Disease in Canada: Patients in an Embodied Health Movement, Cox M, Levesque M, Zoonotic Dis. 4[1], 22-36; 2024-01-22: https://www.mdpi.com/2813-0227/4/1/4
In Canada, officials only count the cases they are absolutely sure of. All you really know is the absolute minimum number of cases. There is consensus that cases are under-detected but not consensus on what multiplier to use. You can safely multiply whatever number they report by 10 and still be under estimating the true number. The estimated under-detection ranges from 12.1 to 58.2-fold [1.7% to 8.3%] under-detection. Lloyd/Hawkins 2018. Journalists unfailingly report only the official numbers posted by PHAC website and fail to note any limitations or discrepancies which PHAC fails to disclose. Canada doesn’t have a second source of data similar to that of the U.S. insurance industry that showed there are at least half a million new cases a year not the 50,000 officially reported.
The CDC in a recent report made incremental changes but are still reliant on the flawed serology that got us into all this trouble. Currently there is no test that can rule out Lyme disease. The original problem was that they defined the test too narrowly by a flawed test that misses at least a third of those that are truly positive in Canada. The worst thing you can do for a patient is give them a false negative test result. The test for Lyme is based on the original strain of Borrelia found on the Eastern U.S. Seaboard. Strains vary across Canada while new ones are still being discovered. The test doesn’t detect Borrelia miyamotoi which is found in all provinces. Physicians haven’t been told that the test and guidelines they used are flawed and should be scrapped.
IDSA/ AMMI Definition: “Lyme borreliosis is caused by the spirochete Borrelia burgdorferi [strain B- 31] and is transmitted by deer ticks [Ixodes scapularis].”
CanLyme definition: “Lyme disease is a tick-borne zoonosis caused by several genospecies of the spirochete Borrelia burgdorferi sensu lato.” [In the broad
sense]
More important, one shouldn’t “define” a disease in terms of a single bacterial species, let alone a single strain of that species. One should acknowledge the well-known diversity of agents [in this case a spirochete] that causes a disease.
“It’s like defining a dog bite as that of a German shepherd when you have been bitten by a pit bull”. They are choosing to define the disease by the diagnostic. That’s what they can detect, so that’s what they consider the disease. This makes no sense but politics rarely does. We have different strains of the bacteria across Canada and the test won’t detect all of them. AMMI [Canada] have moved serology to the top of the hierarchy when this is a clinical disease and tests were only meant to help the physician confirm the diagnoses.
Many physicians will mistakenly defer to the PHAC case definition of Lyme disease in making a diagnosis. These clinicians require that patients meet these strict and narrow criteria in order to be diagnosed with the disease. However, this definition was designed as a surveillance-monitoring tool to track the number of Lyme disease cases throughout the country. It was not meant to be used in making a clinical diagnosis. Still, even when patients meet the PHAC criteria, there can be a delay in diagnosis; a delay that can have long-lasting consequences for the patient.
Rob Murray [DDS retired]
Board member Canadian Lyme Disease Foundation [www.CanLyme.org]
I understand the usefulness of Elisa tests over time decreases and drops off after 2 years. Do you have a link to a reference on this phenomenon or topic? Perhaps the immune system becomes exhausted and all the antibodies are bound up with the Borrelia. The test doesn’t appear to work for those that have late neurological Lyme or Lyme encephalomyelitis.