Current debate about the existence of Lyme disease in Australia is controversial and animated, with differing and conflicting opinions from science, news, advocacy groups and public health agencies. Some might argue there is enough evidence to suggest Lyme disease is already here; others may posit further research is required. Indeed, if one were to step back, the debate about Lyme disease in Australia strikes similar parallels to the debate about climate change.
Whatever the case, globally at least, Lyme disease is real – it can cause long-term chronic health issues and if untreated its symptoms have been linked to death.
So, what does Lyme disease mean for us Outdoor Types? This article has been produced as an addendum alongside ‘Ticks and People in the Australian Bush’, published by The Outdoor Type in March 2011. It is a factsheet about Lyme disease for those working or playing outside, whether in Australia or abroad. The scope is not to answer the complex question about whether Lyme disease is in Australia, but more so, to present current facts with a view to raising awareness for Outdoor Types about Lyme disease and hopefully imbuing calmness and rationality about this ‘tricky ticky’ topic.
Ecology and Epidemiology
Lyme disease is transmitted to humans by ticks infected with the spirochaete bacterium Lyme borreliosis (Borrelia burgdorferi). Vectors involved in its transfer to humans are members of the I. persulcatus group of ticks including the deer tick or black-legged tick (I. scapularis) and the Western black-legged tick (I. pacificus) in North America, and the castor bean tick (I. ricinus) and taiga tick (I. persulcatus) of Europe and Eurasia respectively. These ticks live in temperate forests; some species have re-emerged in areas where re-forestation has occurred. They are not endemic to Australia .
Lyme disease, named after the Connecticut town where it was discovered, was first recognised in 1975 and has since become the most frequently reported tick-borne infection across the globe, particularly from North America, Europe and Asia . Ticks become infected with Lyme disease when they feed on a reservoir host between stages in their lifecycle. Known host animals include deer, mice, chipmunks, raccoons, squirrels, lizards and birds – up to 60 species in the northern hemisphere .
300,000 people are diagnosed with Lyme disease in America each year; these numbers have increased slightly over the period from 2003 to 2013 . In Europe the number of cases is increasing and tick vectors are expanding their range . While about 3,500 cases are reported in Asia; the numbers of actual cases may be significantly higher, however, mainly in China and Mongolia .
Stage 1: An expanding reddish rash known as erythema migrans occurs around the bite site of the majority of infected patients 3-30 days after infection. The redness can spread many centimeters, resembling a ‘bulls-eye’ with red and pale concentric circles.
In Australia a similar rash may appear as a reaction to a common paralysis tick Ixodes holocyclus . In America the appearance of such a rash can be considered sufficiently distinctive to allow clinical diagnosis in the absence of laboratory testing . Other symptoms include fever, fatigue, headaches, stiff joints, muscle pain and swollen lymph nodes, usually within 2-3 weeks of being bitten by an infected tick .
Stage 2: Inflammation of the heart, infection of the brain and brain membrane, long-term muscle and joint pain, and conjunctivitis – symptoms arise weeks or months after the initial bite .
Stage 3: Occurring months or years after infection – erosive arthritis of the joints, particularly the knees (Nth America); chronic reoccurring skin rash (Europe) . Long term symptoms can resemble those of chronic fatigue syndrome.
Diagnosis, Treatment and Prevention
Diagnosis for Lyme disease is generally attained through a patient’s symptoms and history, and is then followed up with testing in a laboratory. Lab results, particularly in Australia, have proven less than reliable due the complex genome of the Borrelia bacterium and the mimicking behaviours of other similar bacteria .
Treatment for early symptoms usually entails a course of antibiotics, resulting in a complete recovery. For chronic or relapsing symptoms a further regimen of antibiotics may be prescribed – recovery, however, for late stage symptoms is less successful .
Prevention of Lyme disease is encouraged through avoidance of tick-infested areas, particularly when travelling in the northern hemisphere. Early effective removal of the tick is recommended. If still concerned it is recommended the patient consult their GP; if seeking further independent analysis, ensure the laboratory is appropriately accredited.
Lyme disease in Australia
The first reported case of symptoms resembling Lyme disease in Australia occurred in the Hunter Valley NSW in 1986, while in Queensland the State Health Laboratories performed tests on 1,247 patients from 1986-89; further multidisciplinary investigation was carried out by Westmead Hospital in 1988. The clinical evidence for all these studies remains inconclusive .
Over the recent years since, much speculation and hearsay has emanated from the media about Lyme disease in Australia. One only need search online to access the plethora of current affair stories about peoples’ experience with the disease. While these stories have their place in the machinations of the media, it must be recognised that many advocacy groups also exist who are publishing accurate information to raise community awareness about the disease in Australia.
In 2013 the Australian Government established a Clinical Advisory Committee on Lyme disease to prove or disprove the existence of an indigenous Lyme disease strain in the southern hemisphere, or if Borreliosis is actually here. Its scope is to investigate the gaps in knowledge about if Australian ticks carry and transmit Lyme disease, if there are better diagnostic tools to search for the disease, and whether there are similar pathogens in Australia which may present as a ‘Lyme-like’ disease.
Currently, as in other countries, Lyme disease is not ‘notifiable’ in Australia – meaning it is not recognized or reported through the Public Health authorities. Several cases of misdiagnosis have been documented, with patients opting to undertake testing in labs abroad. The prolonged process would undoubtedly be distressing for those affected. It must be noted, however, that the current research in this country is an evidence-based methodology, and until an organism is isolated to a local patient, the reporting status of the disease in this country is not likely to change.
While Lyme disease has been reported in Australia, the majority of cases are linked to patients visiting known infested areas overseas. One such Australian to contract the disease in this manner is winner of the US Open: tennis player Samantha Stosur . She talks candidly about her experience with the disease and remains a popular ambassador.
Can Lyme disease be transmitted from person to person?
No, Lyme disease is only spread from infected ticks to people.
Can dogs be host vectors for Lyme disease?
Yes, dogs can be vectors however they are less likely to contract the disease from infected ticks than humans. And the chances of a dog being a vector unless it cohabits a Lyme affected area are next to none.
What should I do if I think I might have Lyme disease?
Consult your GP if symptoms persist after being bitten by a tick, particularly if you have been abroad in known tick-infested areas. Early detection is important and effective treatment easily sought. If you are travelling to known tick-infested areas, consult the area’s local public health agency for further information.
Knowledge and awareness about Lyme disease is increasing; conversations in Australia are being had far and wide. The media – with all its bells and whistles – has engaged extensively with Lyme disease over the recent years, with information we must critique sagely. Whatever the viewpoint about its presence in this country, and in what capacity, the research is continuing and we are slowly getting closer to a resolve about this controversial topic.
Like climate change, Lyme disease is not going away, particularly with the global nature of our world today. We Outdoor Types need to be aware, particularly going to places where the disease is prevalent. And as with all outdoor exploits, we need to look after ourselves and be aware of the inherent risks, and manage ourselves accordingly.
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11: Stosur, S., (2011). My Battle with Lyme disease. (Last update: 1 December 2011). Available: http://samstosur.com [2014, June 10].