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I see that this CMAJ article is mainly advocating against over-treating unconfirmed Lyme’s disease. However, I would also like to bring up the counterargument, in which clinicians hesitate to start Lyme disease prophylaxis that lead to adverse consequences to patients, such as arthritis and cranial nerve palsies. In the infectious disease consultation service at Ottawa, we receive calls from periphery institution clinicians who require help for their symptomatic patients who are tested positive for Lyme serology. We notice quite a number of the inquiring clinicians are unaware of the Lyme Diseases prophylaxis and treatment guidelines published jointly by the Ottawa Public Health and four local hospitals: http://www.ottawapublichealth.ca/en/professionals-and-partners/resources...
Although hindsight is 20/20, some of the disseminated Lyme disease cases are preventable if prophylaxis or treatment is started more promptly. I understand the difficulty to make a clinical diagnosis of Lyme disease since serology could be falsely negative in the first 4 weeks of infection. Therefore, I would like to raise awareness of this Ottawa Public Health Lyme Disease Algorithm, which may help both clinicians and patients to make a well-informed decision.