Wednesday, 27 September 2017
Topical Issue Debate
I thank the Deputies from Kerry for giving me the opportunity to update the House on this matter. Lyme disease is an infection caused by a spiral-shaped bacterium called borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The health protection surveillance centre of the HSE has extensive information concerning Lyme disease on its website. The infection is generally mild affecting only the skin, but can occasionally be more severe and highly debilitating. Many infected people have no symptoms at all. The most common noticeable evidence of infection is a rash called erythema migrans- a red, raised skin rash, often called a bulls-eye rash. People can also complain of flu-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue.
Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person’s body in response to the infection. In general, it is accepted clinical practice in Ireland, the UK, Europe and North America that laboratory confirmation is unnecessary for a confidently made, clinical diagnosis of erythema migrans.
In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease published by the Infectious Diseases Society of America in 2006. Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.
Misinformation concerning the long-term effects of Lyme disease is causing real harm to people who may seek inappropriate treatments. There is no evidence that viable borrelia burgdorferi persists in patients following confirmed Lyme disease. I am aware of people travelling to other countries and spending large amounts of money on treatment for so called "chronic Lyme disease". Chronic Lyme disease lacks an accepted clinical definition, and in practice the term has been applied to a wide variety of patients. These symptoms are very common in the general population, and the evidence does not show that they occur any more commonly in patients with a history of Lyme disease. The diverse natures of these symptoms, which can have both physical and psychological causes, are shared by many conditions. The majority of patients referred for chronic Lyme disease have no objective evidence of the infection, and most often have an alternative medical diagnosis or a functional syndrome such as fibromyalgia or chronic fatigue syndrome. As diagnosis and treatment of Lyme disease are available in most of the larger hospitals in Ireland, there is no need for anyone to travel abroad to access them. I advise anyone suffering from these symptoms to seek advice from their family doctor and referral for appropriate evidence-based treatment.