The consensus statement is the joint summary of opinion of all participants and as such stands on its own. Consensus conferences do not often have further updates to them and there has been no update to the Lyme disease conference. However there has been some addition information published in the Canada Communicable Disease Report on the identification of British Columbia as an endemic area for Lyme disease in Canada.
In addition isolation of the Lyme disease bacterium from ticks collected near Thunder Bay, Ontario and Alberta has been reported in the Canada Communicable Disease Report and isolation of the Lyme disease bacterium from ticks in Prince Edward Island has been reported in an international journal as well as at an international borreliosis conference in Vancouver organized by the Vancouver, B.C. Lyme Borreliosis Society.
These latter reports do not provide evidence that Lyme disease is endemic in Alberta, Northern Ontario or Prince Edward Island since the currently recognized relevant tick vectors have not been shown to be endemic in these regions but they serve to show that there may be a low level of risk for humans to contract Lyme disease in these areas.
There has been no update on the topic of symptoms but the concensus conference statements are still basically applicable. As noted in the concensus conference statement, Lyme disease is an illness with dermatological, neurological, cardiac and/or rheumatological features. There may be localized manifestations of Lyme disease which relate to the erythema migrans rash, an expanding, erythematous skin lesion commonly seen at the site of the tick bite of many patients. In addition disseminated Lyme disease may include neurological forms of disease such as Bell's palsy, cardiac manifestations and arthritic involvement characterized by recurrent, brief attacks of large joint swelling in one or a few joints.
Recommendations for the treatment of Lyme disease do change with time but the basic recommendations for treatment involve the use of various beta-lactam-pencillin family-and tetracycline antibiotics. Treatment regimes will vary depending on factors such as the stage of Lyme disease, the age of the patient, and the specific clinical manifestations of the patient. The topics of methods of diagnosis and antibiotic treatment have been further addressed by the Canadian Paediatric Society which published a position paper in the Canadian Medical Association Journal Volume 147 pages 169-172, 1992.
Question No. 213-