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The flawed interpretation of the Westmead study that NSW Health states is the proof Lyme disease  is not here - see fact sheet below

Lyme Disease Australia

December 28th 2010 is the start of this treatise. I hope to work with other collaborators on this matter.

NSW Health quotes a study done on over 12000 ticks as their justification for not recognising Lyme disease here in Australia.

Firstly here is the scientific paper itself published in 1994  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271457/pdf/epidinfect00044-0139.pdf

If you go to the trouble of reading this you will find the following statements are true (if you are kind enough to believe what I say here instead of wading through it then your trust will not be abused)

The study states:

bulletOver 12000 ticks were collected in coastal regions from the Queensland Border to the Victorian border in all seasons over a three year period. These were dissected for the MID GUT CONTENTS and these were analysed by microscopy and serological tests for the Borrelia spirochaete. All ticks collected had not had a blood meal. In other words they looked in the wrong place. The serology was directed against only OspA OspB and flagellin proteins (thus missing several that a  Western Blot detects).
bullet1038 ticks were examined by PCR. Guess what! They used part of the above mid gut sample from each and every tick
bulletOf these 1038 ticks only 570 were Ixodes Holocyclus (that's the common Eastern Coast paralysis tick that represents the great majority of human tick bites.
bulletand the study's discussion states at its conclusion a better marker is needed to elucidate the enigma viz:

Confirmation of clinically suspected cases of Lyme disease in Australia, based on
positive serology from IFAT and ELISA, should thus continue to be questioned.
Unfortunately, a 'more sophisticated' technique such as Western immunoblot
testing may be no more helpful because of the lack of specificity of protein
'markers' such as the 41 kDa flagella protein and the outer surface proteins (such
as OspA) which are known to be heterogeneous in North American and European
borrelia [32-35]. Until more specific markers are defined for a causative agent for
the Australian syndrome, preferably following isolation and characterization of an
organism from a local patient, the exact nature of 'Lyme disease' in Australia will
remain an enigma.

SO.............how many positive PCR's (tissue or blood) do we have to come up with to defeat this study. looks like the answer is 571 unless they want to bend a little at a lower number.

Was the original study accurate in only examining gut contents. It would seem to me as a clinician the more likely area of anatomy to find spirochaetes is the salivary gland structure of the tick as would also be the case with the co-infections we see transmitted with Lyme disease.

Is NSW health speaking for all Australia? Take a look at this map showing the distribution of this tick on this continent http://en.wikipedia.org/wiki/File:Ixodes_holocyclus_distribtion_map.png

Does NSW health even want to have a policy to cover those who contract Lyme disease overseas? The clear answer to this at this stage is NO. I personally await their advice on this as I have 5 such patients now.

Their current fact sheet is at http://www.health.nsw.gov.au/factsheets/infectious/lyme_disease.html

I reproduce it here and invite NSW Health to notify me of any changes. Take notice at how strenuously they state it is not here, and by the way, don't bring it back from overseas because we wouldn't have any advice for you. We don't collect data on that. It further states tick bites cause "allergies". This is not so. These reactions are misdiagnosed Queensland tick typhus or erythema migrans the infection that subsequently causes Lyme disease. 

NSW Department of Health

Infectious Disease Factsheet
Lyme disease is caused by the bacterium Borrelia burgdorferi.
Typical symptoms include fever, headache, fatigue, sore muscles and joints, and a characteristic skin rash called erythema migrans. 

Lyme disease


Last updated: 23 July 2010


What is the disease

 

bulletLyme disease is caused by the bacterium called Borrelia.
bulletThe first symptom is usually a characteristic pink or red rash that starts as a small red spot that gradually spreads in a much larger circle with a characteristic bulls-eye appearance. This normally happens between 3 and 32 days after being bitten by an infected tick. Not everyone with Lyme disease gets the rash.
bulletThere may also be fever, headaches, tiredness and joint pains.
bulletIn later stages of Lyme disease the infection spreads through the bloodstream and can cause infection in the brain and membranes surrounding the brain (meningoencephalitis) and infection in or around the heart (endocarditis, myocarditis or pericarditis). The disease can also cause inflammation of joints and cause joint pain and long-term neurological involvement.

 

How is Lyme disease spread?

 

bulletLyme disease is transmitted following the bite of a tick that is infected with the Borrelia bacterium.
bulletOnly some species of ticks are capable of being infected by the Borrelia bacteria and only these infected ticks can pass the infection on to humans. This group of ticks is found in Asia, Europe and North America, but not in Australia.
bulletTicks with Borrelia infection live in temperate forested areas of northern Asia and Europe (especially central and eastern Europe) and the United States (especially north-eastern, north central and Pacific coastal USA).
bulletIn the 1990s, 12,000 ticks were collected from different parts of NSW and were tested for Borrelia bacteria. No evidence of Borrelia infection could be found in any of the ticks collected.
bulletLyme disease is not spread from person-to-person.

 

How is Lyme disease diagnosed?

 

bulletLyme disease is diagnosed based on symptoms, physical findings (e.g., a characteristic rash), and the possibility of exposure to infected ticks. Laboratory testing is helpful in the later stages of disease.
bulletDiagnosis of any infectious disease requires a combination of clinical experience and assessment by the doctor and understanding of the lab tests and their limitations. Lab tests are rarely definitive and all tests have a proportion of results which are false positive (test indicates disease in someone without the disease) and false negative (test indicates that there is no disease in someone with the disease). When tests are done in places where a disease is rare or absent (for example, Lyme disease in Australia), many positive tests will be falsely positive.
bulletThe tests to diagnose Lyme disease are technically complex and require specialist expertise. It is important for people who want to be tested to make sure the laboratory that performs the test has accreditation with National Association of Testing Authorities (NATA).
bulletLyme disease is most commonly diagnosed by a screening test called ELISA and this is then confirmed using a western blot test. Both of these tests detect antibodies that are produced by the immune system of someone with Lyme disease.
bulletLyme disease can also be diagnosed by culturing the bacterium from tissue specimens or by finding the bacterial DNA using a PCR test. These tests are not readily available in NSW laboratories.
bulletOccasionally, tests performed in Australia for Lyme disease show evidence of an infection. When these cases have been followed up in the past, the cases have been found to have acquired the infection while overseas.
bulletTests for Lyme disease should only be done by laboratories that have current accreditation with National Association of Testing Authorities (NATA).

 

How is Lyme disease treated?

 

bulletMost cases of Lyme disease can be treated successfully with a few weeks of antibiotics

 

Can ticks in NSW transmit infections?

 

bulletA species of paralysis tick called Ixodes holocyclus can be found along Australia's east coast and can cause tick paralysis, tick typhus and allergic reactions.
bulletWhile there is little evidence that Lyme disease is caused by Australian ticks, there may be other infections carried by Australian ticks which may cause an infection which is similar to Lyme disease. These infections remain poorly characterised.

 

How to prevent tick bites

 

bulletTicks tend to live in coastal areas in NSW.
bulletWear appropriate clothing when outdoors in tick areas including long sleeved shirts, long pants tucked into socks and a wide brimmed hat. Ticks are more easily detected on light coloured clothing.
bulletSpray clothes and hats with an insect repellent and wear a repellent that contains DEET or Picaridin.
bulletWhen returning from an area known to have ticks, remove clothing and search for ticks, especially behind the ears, on the back of the head, groin, armpits and back of knees. Be careful where clothes are placed as they may introduce ticks to inside the house. Don't forget to check children and pets.
bulletTicks in the nymph stage are tiny (eg. as big as a poppy seed) but can still transmit infections so it's important to have a very close look at your skin in good light to see any small ticks that may be feeding. People are sometimes not aware that they have been bitten by a tick.
bulletIn tick-infected areas, mow grass in the backyard and keep mulch and leaf litter away from the main entrance to the house. Trim shrubs overhanging paths and play areas.
bulletWhen walking in tick-infested areas try to keep to the centre of cleared paths as much as possible and try to avoid brushing up against plants and grasses as you walk.
bulletIn the Northern Hemisphere the risks of tick bites and Lyme disease is greatest in late spring, summer and early autumn when the nymph ticks are more abundant and when people visit habitats where ticks live such as forests and other densely vegetated areas, especially areas with high grass and lots of leaf litter. Lyme disease is more likely to affect people participating in outdoor activities such as hiking or mountain biking in tick-infested areas.

 

What to do if bitten by a tick

 

bulletRemove a tick as soon as possible after locating it.
bulletUse fine pointed tweezers and grasp the tick as close to the skin as possible. Gently pull the tick straight out with steady pressure. If you have difficulty, seek medical attention.
bulletDo not try to kill the tick with methylated spirits or any other chemicals as this will cause the tick to inject more toxins. If you have a severe infestation by larval stage ticks (often referred to as grass ticks) take a bath for 30 minutes with 1 cup of bicarbonate of soda.

 

What is the public health response?

Lyme disease is not notifiable in NSW.


 

 

 

 

 

 
Last update 30th April 2012