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Human Tick-transmitted Diseases in Australia

Australian Lyme Borreliosis
Spotted Fever
Tick Alert Group Support (TAGS)
Serology Testing for Australian Lyme Borreliosis

Australian Lyme-like Disease

Lyme borreliosis (caused by Borrelia sp of some kind). If you experience any of the following symptoms after a few days, weeks or even months later, contact your doctor. Early infection: flu-like symptoms, headache, fever, muscle or joint pain, unusual fatigue, swollen glands, conjunctivitis. A rash may occur at the site of the bite or elsewhere,variable in shape and colour. Many people do not get a rash. Skin irritation immediately following tick bite is not necressarily a sign of infection. Chronic infection. Symptoms may include chronic fatigue, behavioural changes, severe headaches, neck problems, nerve inflammation, memory problems, eye problems, recurring rashes, intermittent or chronic disabling pain, arthritis, heart problems.

Spotted Fever

Tick Typhus (or Spotted Fever, caused by Rickettsia australis). Contact your doctor if the following symptoms occur any time up to 14 days after tick bite: fever, muscle or joint pain, headache, sore throat, cough, conjunctivitis, connnfusion, intolerance to bright light, neck stiffness. There may be generalised rash up to 12 days after tick bite (it can sometimes be confused with chicken pox). At the site of the bite there may be a black scab (an eschar).

T·A·G·S

Tick Alert Group Support
PO Box 95, Mona Vale, NSW 1660

Medical Advisor: Dr B. Hudson, Microbiology, Royal North Shore Hospital
Scientific Advisors: Bill Conroy, Sydney; Dr Michelle Wills, PhD Newcastle

TAGS is a self-funded non-profit organisation.

TAGS (Tick Alert Group Support, Australia) recommendations- for humans (2000)

• Remove the tick as soon as possible
• Use fine-point tweezers or a tick remover
• Grasp the tick as close to the skin as possible
• Gently pull the tick straight out with steady pressure
• If you have any difficulty seek medical attention
• Wash your hands, disinfect the bite and tweezers
• CHILDREN: tell them to seek adult help for proper tick removal
• MULTIPLE TICK BITES: usually of tiny grass ticks (larval stage) are best removed if you soak for 30 minutes in a bath with 1 cup of bicarb soda

Do not try to kill the tick with methylated spirits. petroleum jelly or any other chemicals. This will cause the tick to inject more toxins.

Save the tick in a small airtight container with moist paper or a piece of grass for further examination if you become ill within a few weeks.

Tick bite can make you ill. In the short term there can be local irritation or allergy caused by injected toxin. Seek medical attention for allergic reactions or unusual symptoms. In the longer term certain individuals can suffer from tick borne infectious diseases. Tick typhus and Lyme borreliosis are the two known bacterial infections transmitted by the Paralysis Tick, Ixodes holocyclus.

• Tick Typhus (or Spotted Fever, caused by Rickettsia australis). Contact your doctor if the following symptoms occur any time up to 14 days after tick bite: fever, muscle or joint pain, headache, sore throat, cough, conjunctivitis, connnfusion, intolerance to bright light, neck stiffness. There may be generalised rash up to 12 days after tick bite (it can sometimes be confused with chicken pox). At the site of the bite there may be a black scab (an eschar).
• Lyme borreliosis (caused by Borrelia sp of some kind). If you experience any of the following symptoms after a few days, weeks or even months later, contact your doctor. Early infection: flu-like symptoms, headache, fever, muscle or joint pain, unusual fatigue, swollen glands, conjunctivitis. A rash may occur at the site of the bite or elsewhere,variable in shape and colour. Many people do not get a rash. Skin irritation immediately following tick bite is not necressarily a sign of infection. Chronic infection. Symptoms may include chronicfatigue, behavioural changes, severe headaches, neck problems, nerve inflammation, memory problems, eye problems, recurring rashes, intermittent or chronic disabling pain, arthritis, heart problems.

Your Pets. Dogs, cats, horses, cows etc can be infected too, often suffering similar symptoms to humans, especially arthritis.

Serology Testing for Australian Lyme Borreliosis

Pacific Laboratory Medicine Services

(A Business Unit of the Northern Sydney Area Health Service)

Microbiology Department
Level 4, Royal North Shore Hospital
Pacific Highway, St Leonards, NSW 2065, Australia
Ph: 61 2 9926 8470 Fax: 61 2 9437 5746

Pacific Laboratory Medicine Services

A Business Unit of The Northern Sydney Area Health Service

LYME BORRELIOSIS

Information about Serology

Because the culture or direct visualisation of Borrelia burgdorferi (the spirochaete that causes Lyme disease in North America) from patient specimens is difficult, serology is currently the only practical laboratory aid in diagnosis. The best being a direct culture of the organism taken from a skin biopsy from the rash that often accompanies Lyme disease. After the first few weeks of infection many patients with LB have elevated antibody titres to Borrelia burgdorferi.

The Western Blot test for Lyme disease that was set up originally at Newcastle University in 1993 by Dr Michelle Wills ceased in April 1997 due to university funding cuts. The same test is now being offered at Royal North Shore Hospital, Department of Microbiology, under the supervision of Dr Bernie Hudson and other researchers from the TDRU (Tick-borne Diseases Research Unit). if known, it is useful for your doctor to include clinical details, including tick bite history with the serum sample as it would help indicate if the infection is recent or of long standing, (see data re Western Blot, published in Journal of Spirochaetal and Tick-Borne Diseases, Vol 1, No.2, 1994 - USA, for interpretation of Lyme Borreliosis testing and LB Cast Report Forms in *Doctors Kit).

Until recently the only serological tests available for detecting Borrelia burgdorferi antibodies are those based either on immunofluorescence test (WA) or enzyme-linked test ELISA). Unfortunately, these tests have proven to be very unreliable. It cannot be emphasised too strongly that serological results obtained with either of these two procedures must be interpreted with caution; the physician must be aware of false negative and, more commonly, false positive results.

The Western Blot tests against the type of Borrelia burgdorferi predominantly found in the USA, but also against two strains from Europe: Borrelia afzelii and Borrelia garinii. To do a Western Blot, purified strains of B. burgdorferi are disintegrated and subjected to electrophoresis on polyacrylamide gels which separates 30 or more proteins of the microbe into discrete bands that can be identified by their molecular weight. The proteins are then transferred from the gel onto strips of nitrocellulose paper. The final stage of the test is to incubate a paper strip with the patient's serum and then examine to see if any antibody has combined with any of the proteins. Of particular interest is the presence of antibody to the flagellin Flag) antigen and the outer surface protein A (Osp A). The presence of antibodies to both Flag and OspA is considered to be positive; antibodies to flagellin alone are non-specific but could indicate early infection. Antibodies to OspA are more specific, and if present may be confirmatory.

NB: All interpretations of the Western Blot must also take into account the tick bite history and clinical picture of the patient, especially if they live in an endemic area. Some people with LB will never make antibodies but they can still be diagnosed with Lyme Borreliosis.

The blood test for Lyme disease will cost $70.00. There will be a Medicare rebate provided no other serology tests have been requested on the same specimen. The rebate may not cover the whole amount of the charge. If you want Western Blot serological testing to be done at Royal North Shore Hospital please collect lOmI cloned blood tube and send with it a request form labelled "Borrelia antibodies" and send to:

Microbiology Department
Level 4, Royal North Shore Hospital
Pacific Highway, St Leonards, NSW 2065, Australia

*Should your doctor require more information on tick-borne diseases they may obtain a Doctor's Kit, which has a collection of information and up-to-date medical journal articles on tick-borne diseases, from: Cathy Butler, Health Promotion Unit, P0 Box 465, Manly 2095.

A more general Information Kit for patients, especially those diagnosed with Lyme disease, can be obtained from TAGS (Tick Alert Group Support) Inc, a voluntary information and support group, by sending your details and $5.00 (cheques made payable to: TAGS, PO Box 95, MONA VALE, NSW, 1660.

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