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Monday, February 20, 2017

Lyme disease: a tiny tick can pack a huge punch


Lack of awareness in Ireland means illness is under reported, and often left untreated


Many of us are familiar with airborne viral or bacterial infections that cause coughs, colds and flus. But bacterial diseases caused by insect bites are often less understood by the general public and many doctors.

Take Lyme disease for instance, an illness caused by the bite of an infected tick that results in flu-like symptoms such as headache, fever and joint pains. If untreated with antibiotics, a range of other symptoms occur which are similar to those experienced in chronic fatigue syndrome, fibromyalgia, arthritis and multiple sclerosis.

That many of the symptoms of undiagnosed and untreated Lyme disease are so similar to these chronic conditions means it is often not considered at all in assessing a patient, according to Dr John Lambert, a specialist in infectious diseases at the Mater Hospital in Dublin.

His view concurs with a Health & Family reader who contacted us about three people who had been misdiagnosed before Lyme disease was discovered. “Doctors in Ireland seem to be in denial about Lyme disease. My father was first diagnosed with arthritis, a friend was diagnosed with multiple sclerosis and another person I know was first diagnosed with Parkinson’s disease,” she says.

Prevalent in Ireland
Dr Paul McKeon, a specialist in public health medicine with the Health Protection Surveillance Centre (HPSC), says “the ticks that carry Lyme disease are prevalent in Ireland but most of the population is rural. Ramblers, campers and those who work in woodlands or moorlands are at greatest risk. Dogs can carry ticks home which can go on to bite family members, so checking for ticks after a trip to the countryside is very important.”
The HSE website states that there are between 50-100 cases of so-called early Lyme disease cases annually in Ireland. The most extreme form – neuroborreliosis – is a notifiable disease in Ireland. This means GPs and hospital doctors must notify their nearest public health centre if a patient is diagnosed with it. However in 2016, 19 cases were reported, eight of which were in Kerry and Cork. The HPSC says these figures may be lower following verification.


Dr Lambert is adamant that the figures for Lyme disease and other co-infections from tick bites are much higher. “I have about 100 patients in my clinic at any one time and I see four new patients each week with Lyme disease or other co-infections from tick bites,” he says.
His patients vary in age and symptoms. “I have young adults with chronic pain, marathon runners who can barely get out of bed and patients with numbness and tingling all over their bodies. I am not saying the Lyme disease is very common in Ireland but Irish people travel all over the world and can be bitten by an infected tick, return home sick and not be diagnosed with Lyme disease,” says Dr Lambert.

Checking for tick bites
Years ago, and in many parts of the world still, people would thoroughly examine their bodies for tick bites after spending time in the countryside, particularly woodlands or mountains. Lyme disease is spread by infected ticks in deer, sheep, dogs and birds and is common in Germany, eastern European and Scandinavian countries and parts of thenUnited States. The tick population is highest in late spring and early summer due to breeding patterns.

Wearing long-sleeved tops and long trousers tucked into socks is the best way to avoid being bitten. Walking in the middle of the path and avoiding sitting on logs are other ways of avoiding ticks. Removing the tick from your body within 12 hours of being bitten means an infected tick won’t have had enough time to spread the bacteria into your body.

However, here in Ireland the lack of awareness of Lyme disease and other bacterial infections carried by ticks means most people don’t check themselves. “We need warning signs of possible infections by ticks in public parks and we would like to see all stages of Lyme disease become notifiable, not just neuroborreliosis,” says Ann Maher from Tick Talk Ireland, the support group for those with Lyme disease.
The National Parks and Wildlife Service said it might consider placing warning signs in its nature reserves, following a call from Kerry County Council.
Dr Lambert says if a patient presents with headache, fever and joint pains after spending extended time outdoors, they should be treated with antibiotics for Lyme disease even before testing for the presence of the bacteria. “The bull’s eye rash (whose medical name is erythema migrans) only appears in about 50 per cent of cases, so treatment with antibiotics should be based on clinical symptoms if the person has spent extended time in a park or in the countryside,” he says.

Chronic illness
False positive or negative results from some of the standard blood tests to confirm diagnosis of Lyme disease further complicate the picture. The Elisa and Western Blot tests rely on finding antibodies to the bacteria, borrelia burgdorferi (the strain most commonly found in the United States) but Dr Lambert says co-infections by other bacteria from the infected tick won’t be picked up by these tests. He is researching the bacterial strains that cause tick-borne infections in Ireland.
A recent documentary, Living With Lyme Disease highlighted the suffering of people with chronic Lyme disease. Those interviewed include the former Co Kerry footballer, Anthony Morris, who is currently receiving treatment in the United States.

James Pembroke, the producer of the documentary, was infected with Lyme disease from a tick bite in Kerry in 2013. “I was very ill for 12 months and was suspected to have rheumatoid arthritis. I couldn’t walk. My joints had stiffened up. I had terrible chills and night sweats,” he explains. Pembroke was eventually diagnosed with Lyme disease, following tests at the Armin laboratory in Germany. “I was put on medication 12 months after I got the illness and I improved almost immediately.”

Dr Armin Schwarzbach who runs the Armin lab was interviewed on Living With Lyme Disease. Dr Schwarzbach is also one of the speakers at Tick Talk Ireland’s conference on Lyme disease in March. “Lyme disease is often misdiagnosed and under-reported. And yet it is one of the fastest growing vector borne diseases in the western world,” he says.

LYME DISEASE: Q&A
What is Lyme disease?
Lyme disease is a bacterial infection, caused by the bite of a tick infected by the bacteria borrelia burgdorferi.

What are the symptoms?
The symptoms often begin with a raised bull’s eye type rash on the skin known as erythema migrans (EM). Within a week, flu-like symptoms such as chills, fever and headache will follow.

How is it diagnosed?
Lyme disease can be clinically diagnosed by symptoms alone if the person has spent time in the countryside. There are a variety of blood tests used to confirm diagnosis.

How is it treated?
Antibiotics are the only treatment for Lyme disease. When it is caught in the early stages, treatment is shorter but some experts suggest antibiotic treatments up to one year for chronic cases of Lyme disease and other bacterial co-infections from tick bites.
How can I avoid being bitten?
Wear long-sleeved tops and long trousers when outdoors in the warmer months of the year. Insect repellents containing Deet will also deter ticks.

Sylvia Thomson