Lyme disease: A growing risk for both leisure and occupational travellers

Author(s):  Dr Sherilyn Houle

Lyme disease is the most common arthropod-borne disease in the Northern hemisphere, transmitted by various species of Ixodes ticks.¹ Lyme disease presentation typically spans 3 stages:¹

• Early localized stage: In days to weeks after infection, characterized by erythema migrans (a skin lesion present in 70-80% of cases that begins with redness at the bite site and expands to a ‘bulls-eye’ rash with central clearing)²
• Early disseminated disease: In weeks to months after infection, characterized by two or more erythema migrans lesions with possible neurologic or cardiac effects
• Late disseminated disease: In weeks to months after infection, characterized by arthritis or chronic skin manifestations

Even with antibiotics, up to 20% of treated patients may experience Post-Treatment Lyme Disease Syndrome (PTLDS) with symptoms lasting 6 months or more including fatigue, cognitive impairment, and musculoskeletal pain.³ The pathophysiology of PTLDS is poorly understood, with genetic studies seeking to identify polymorphisms that may impact its likelihood of developing and to identify potential treatment strategies.³

It's important that the prevention of Lyme disease be on clinicians’ radar for travellers to affected destinations, with both leisure and occupational travellers (especially forestry and agricultural workers)⁴ at risk. Prevention strategies include wearing long clothing treated with permethrin, use of repellent on exposed skin, avoiding areas with tall grass and leaf litter, performing daily tick checks and removing ticks appropriately (pull by the head, wash bite with soap and water and apply alcohol or antiseptic), and seeking medical attention if a rash develops.⁵

An increase in the incidence and geographic distribution of tick-vectored disease is anticipated, with an estimated 30,000 cases reported annually in the United States and Canada, and 85,000 cases in Europe, although these case counts are likely significantly underestimated.⁶

Counselling of travellers to regions with potential for Lyme disease on prevention measures and awareness to seek medical care should not be overlooked as an important strategy to support traveller health and improve disease surveillance.

References

[1].  Bridging the gap: Insights in the immunopathology of Lyme borreliosis.  Snik ME, Stouthamer NEIM, Hovius JW, van Gool MMJ ‐ Eur J Immunol 2024;54(12):e2451063 [link]
[2].  Lyme disease.  DermNet [link]
[3].  A comparison of genome-wide association analyses of persistent symptoms after Lyme disease, fibromyalgia, and myalgic encephalomyelitis - chronic fatigue syndrome.  Hirsch AG, Justice AE, Poissant A, Nordberg CM, Josyula NS, Aucott J, Rebman AW, Schwartz BS ‐ BMC Infect Dis 2025;25(1):265 [link]
[4].  Occupational Lyme Disease: A Systematic Review and Meta-Analysis.  Magnavita N, Capitanelli I, Ilesanmi O, Chirico F ‐ Diagnostics 2022;12(2):296 [link]
[5].  Lyme Disease Prevention, Tick Removal, & Health and Wellness Tips.  Johns Hopkins Medicine Lyme Disease Research Center [link]
[6].  Brave New Worlds: The Expanding Universe of Lyme Disease.  Stone BL, Tourand Y, Brissette CA ‐ Vector Borne Zoonotic Dis 2017;17(9):619-629 [link]