Home' Australian Pharmacist : September 2011 Contents Vol.30–September#09,2011
LB testing In Australia
Despite this, the existence of Borrelia,
and the transmission of LB by Australian
ticks is not recognised at both Federal
and State level (NSW Health fact sheet:
are also no official statistics on the
number LB sufferers in Australia.
Most are usually misdiagnosed with
neurodegenerative diseases such as
motor neurone disease, Parkinson’s or
Alzheimer’s disease. Most patients send
blood samples to the USA and Germany
for confirmation of diagnosis, and also
travel to these countries for treatment.
LB testing in Australia involves an
ELISA test initially, and only if this
is positive an Immunoblot test is
performed. Unfortunately, the ELISA
test is sensitive only for strains of
Borrelia endemic overseas, not for
the potential Australian Borrelia strain.
Furthermore, experience overseas
shows that ELISA assays are very poor
at detecting clinically diagnosed LB
(www.ilads.org.au). There is thus an
urgent need to identify the Australian
strain of Borrelia and to set up
appropriate tests so that diagnosis of
LB in Australia can be improved.
Symptoms of LB
Because Borrelia can affect every
cell in the body, all body systems
can be affected. Symptoms can
be dermatological, neurological,
or psychological. Common initial
symptoms include persistent flu-like
symptoms, stiff neck, photophobia,
audiophobia, malaise and fatigue. There
may also be an erythema migrans rash,
although this occurs in less than 30%
of cases. This complexity of symptoms
makes LB diagnosis very difficult.
Treatment of LB must be
comprehensive if it is to relieve the
symptoms and kill the bacteria. A
regimen of multiple antibiotics will
be required. Concurrent detoxifying
treatments are necessary, because the
dying Borrelia release toxins that can
exacerbate inflammatory processes
and trigger a Herxheimer (die-off)
reaction. The latter can also be used to
confirm the presence of LB infection.
The pharmacist’s role
Pharmacists are often the first point
of contact for people suffering a tick
bite, so it is vital that we are alert to
the possibility of tick bites, are able to
remove ticks efficiently if necessary,
and can recognise the initial signs and
symptoms of LB.
Pharmacists can also play an
important role in prevention of LB
and other tick-borne diseases through
provision of preventive advice to
those people at risk of tick bites, such
as people who live or work near the
bush, are keen gardeners or travellers,
or who work with animals.
All pharmacists are encouraged to
stock tick-removal devices, and be
able to advise on how to remove
ticks. Removal should be done as
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soon as possible, using high-quality
pointed tweezers. Grab the tick by
the head or mouth parts, as close to
the skin as possible, and pull gently
upwards. Do not crush the tick, as
this will release any Borrelia or other
pathogens, and increase the chance
Since Borrelia is a very slow-growing
bacteria, LB may occur many months
or even years following a tick bite.
Pharmacists can therefore also
give valuable advice on prophylactic
antibiotics to prevent the possibility
of serious infections occurring in the
Detailed information on LB, including
prevention, symptoms and treatments
can be found on the website of the
Karl McManus Foundation for Lyme
Disease Research & Awareness at:
The Foundation’s national Lyme
Disease Appeal will be launched on
1 September in pharmacies around
Australia to raise funds for research
into Lyme disease in Australia. The
goal is to raise $1 million to open a
Lyme disease research centre at the
University of Sydney.
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