Written answers

Wednesday, 20 September 2017

Department of Health

Disease Management

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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423. To ask the Minister for Health if he will address a matter (details supplied) regarding the testing of Lyme's disease; and if he will make a statement on the matter. [39369/17]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Lyme disease (also known as Lyme borreliosis) 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 (HPSC) of the HSE has extensive information concerning Lyme disease on its website.

Lyme borreliosis can be asymptomatic or have a range of clinical presentations. Current best advice is that diagnosis should be made only after careful examination of the patient's clinical history, physical findings, laboratory evidence and exposure risk evaluation. Exposure to ticks prior to disease manifestations is necessary for the diagnosis of Lyme borreliosis. Since an awareness or recollection of a tick-bite is not always present, however, this should not exclude the diagnosis of Lyme borreliosis. Later stages require the use of antibody detection tests (or advanced DNA detection techniques). Testing for Lyme Disease is undertaken in most of the larger hospitals in Ireland. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Public Health England Porton Down facility which uses a two-tier system recommended by American and European authorities. This involves a screening serological test followed by a confirmatory serological test.

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. In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:

- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localised or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);

- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;

- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.

As testing and treatment for Lyme borreliosis is widely available in Ireland there is no requirement for people to travel to other EU Member States to access these services.

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