Dr. Armin Schwarzbach:

I thank the committee for its invitation. I will speak about the problems associated with the diagnosis, treatment and prevention of Lyme borreliosis in Ireland.

I am a clinical laboratory specialist, MD and PhD, founder and director of the first clinic for tick-borne diseases and medical director of Infectolab in Augsburg, Germany, which is registered as an official clinic at the Bavarian Medical Council. I am the international expert for the chief medical officer's clinical advisory committee on Lyme disease in Australia, CACLD, and also a director of the International Lyme and Associated Diseases Society, ILADS, in the USA. I speak to the committee as a clinical laboratory specialist working with patients in diagnosing and treating Lyme borreliosis and co-infections in over 20,000 cases in the past ten years. More and more Irish patients attend me in the clinic to get the right diagnosis and treatment. Also, some Irish doctors have contacted me in recent years to get support in the diagnosis and treatment of Lyme borreliosis in Ireland.

Lyme borreliosis is a bacterial infection by a spirochaete named borrelia burgdorferi, which can move everywhere around the body and be the reason for many symptoms and syndromes. It is named the "Known Unknown" by Lyme borreliosis specialists, a chameleon-like bacteria that is difficult to diagnose and difficult to treat. Lyme borreliosis is the fastest growing vector-borne infection in the United States. A total of 300,000 patients get infected in the US according to the newest Centre for Diseases Control, CDC, USA reports, which means tens times more Americans than previously reported.

Up to 50% of the ticks in Lyme-endemic areas are infected with borrelia. The problem begins with the fact that just fewer than 50% of patients with Lyme borreliosis recall a tick bite. Fewer than 50% of patients with Lyme borreliosis recall any bull's-eye rash - erythema migrans - as a typical sign for a fresh infection. Without the recall of a tick bite or a bull's-eye rash, chronic Lyme borreliosis symptoms can be misdiagnosed as chronic fatique syndrome, CFS, fibromyalgia, rheumatoid arthritis, carpal tunnel syndrome, Parkinson's, Alzheimer's disease, multiple sclerosis, motor neuron disease, depressions, autism and so forth. In Ireland and all other countries worldwide, doctors are forced to use the borrelia-ELISA for borrelia antibodies as a screening test and not the borrelia Western Blot, even though the Western Blot has a higher test sensitivity, which means fewer false-negative results, and a higher specificity, which means fewer false-positive results.

The common ELISA test, which one receives at the doctor's office, misses 35% to 60% of culture proven Lyme borreliosis. The Western Blot finds about 60% of chronic infected patients, which means a lot of false-negative Western Blot results in the case of chronic Lyme borreliosis. The laboratory tests for borrelia antibodies are not standardised and cannot exclude chronic Lyme borreliosis. It is impossible. Therefore, the European Union has spent €1.1 million on the development of a highly sensitive and specific low-cost lab-on-a-chip system for Lyme diagnosis in the last two years by the Hilysens project. My clinic, the BCA clinic in Augsburg, was one of the scientific partners in the Hilysens project.

Lyme borreliosis is a clinical decision depending on Lyme-typical symptoms and differential diagnosis. The average patient sees five doctors over nearly two years before being diagnosed with the correct diagnosis, Lyme borreliosis. In Ireland and many countries, doctors are forced to treat a chronic Lyme patient for a restricted time with antibiotics. The allowed maximum is four weeks in general, so only four weeks are allowed to treat a patient with chronic Lyme disease. If the patient is not cured within four weeks, the definition of a "post-Lyme disease syndrome", PLDS, is given and most patients are treated symptomatically, but the persistent infection is not treated. Many of these patients develop psychiatric disorders. Short treatment courses with antibiotics have resulted in a 40% relapse rate, especially if the treatment beginning is delayed. There has never been a study demonstrating that 30 days of antibiotic treatment cures chronic Lyme borreliosis. Documentation is available which demonstrates that short courses of antibiotic treatment fail to eradicate borrelia burgdorferi. A total of 40% of Lyme patients end up with long-term health problems.

It is important to know and learn about each symptom which can be caused by borrelia burgdorferi to make the right clinical diagnosis in time to start the antibiotic treatment as soon as possible. The patient should be monitored by the doctor after the treatment of any fresh infection, but especially during and after the treatment of a chronic infection. The socio-economic costs for Ireland regarding misdiagnosed or too late diagnosed patients can be exorbitantly high, in addition to the costs for symptomatic therapies by painkillers or immune-suppressive remedies such as corticosteroids and all of their side effects for patients. The earlier one treats a Lyme borreliosis patient, the better is the prognosis in general.

My conclusions and proposals are as follows: first, teaching medical students at universities about all Lyme borreliosis symptoms by a standardised anamnesis, which means symptomatology, and teaching them about problems with diagnostic tests and about treatment options, including the long-term treatment aspects; second, a basic course for general practitioners, GPs, about the handling of tick bites, symptomatology by a standardised anamnesis - a patient's account of their medical history, problems with diagnostic tests and treatment options for a patient by long-term treatment including the monitoring of the patient; third, initiation for studies about bacteria in the ticks or tick tests, improvement of diagnostic tests and long-term treatment and the development of new antibiotics against borrelia burgdorferi; and fourth, information campaigns for the Irish population on how to prevent tick bites and about symptoms in fresh and chronic infections. The first step in that regard was taken by Jenny O'Dea, who is one of the first people I got to know here in Ireland. She published a fantastic booklet for children and their parents to inform them about the risks and possibilities of Lyme disease.

I offer the committee my full support and will be delighted to answer any questions the members might have.