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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:
 | Over 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). |
 | 1038 ticks were examined by PCR. Guess what!
They used part of the above mid gut sample from each and every tick |
 | Of 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. |
 | and 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.
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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.
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Lyme
disease
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Last
updated: 23
July 2010
What
is the disease
 | Lyme
disease is caused by the bacterium called Borrelia. |
 | The
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. |
 | There
may also be fever, headaches, tiredness and joint pains. |
 | In
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?
 | Lyme
disease is transmitted following the bite of a tick that is
infected with the Borrelia bacterium. |
 | Only
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. |
 | Ticks
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). |
 | In
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. |
 | Lyme
disease is not spread from person-to-person. |
How
is Lyme disease diagnosed?
 | Lyme
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. |
 | Diagnosis
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. |
 | The
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). |
 | Lyme
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. |
 | Lyme
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. |
 | Occasionally,
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. |
 | Tests
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?
 | Most
cases of Lyme disease can be treated successfully with a few weeks
of antibiotics |
Can
ticks in NSW transmit infections?
 | A
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. |
 | While
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
 | Ticks
tend to live in coastal areas in NSW. |
 | Wear
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. |
 | Spray
clothes and hats with an insect repellent and wear a repellent
that contains DEET or Picaridin. |
 | When
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. |
 | Ticks
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. |
 | In
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. |
 | When
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. |
 | In
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
 | Remove
a tick as soon as possible after locating it. |
 | Use
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. |
 | Do
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.
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