萊姆 (疏), 無形體病/埃立克體病, 巴貝蟲病, 落基山斑疹熱, 巴爾, 兔熱病, 以及最近, 伯氏miyamotoi (萊姆疏的遠房親戚) 在美國公認的蜱傳播的傳染病，其中疾病控制中心和預防 (CDC) 索賠萊姆病是最常見的，發展最快的疾病.
今天我重點萊姆病和世界各地的其他蜱傳疾病, 我期待在澳大利亞的情況. 我對莎朗·懷特曼加盟, 澳大利亞的萊姆病協會主席, 博士. 安米特羅維奇, 誰是蜱傳疾病研究單位的疏一部分, 巴貝蟲病, 無形體病和埃立克體病在悉尼大學, 博士. 安德魯Ladhams, 全科醫生, 免疫, 病毒學家和著名萊姆識字醫生.
沙龍, 什麼是萊姆病在澳大利亞的年發病?
沙龍: 萊姆病已在所有澳大利亞行政區劃據報導，被收購… and city suburbs are not immune. The first locally acquired case of Lyme disease was reported in 1982, although the precise figures are unknown. Many patients with Lyme disease are not properly tested and are often misdiagnosed with a wide range of other diseases. 萊姆病是不是在澳大利亞呈報疾病, 因此，沒有機制的正式理貨.
早在1990年的, Westmead醫院的專科實驗室報導 1,000 每年的疑似病例. 在 2012, 同樣的實驗室報導的處理 2,000 血液測試萊姆病. 在過去的一年, demand for advice and assistance through the LDAA has more than doubled. We are aware that there are a minimum of 75-100 被派往海外的每個日曆月測試萊姆血液檢測樣本.
該LDAA估計有超過 10,000 澳大利亞確診病例.
安, 什麼是你的研究的重點，它是如何涉及到鑑定萊姆病和治療和疾病所引發萊姆的挑戰?
安: Our situation in Australia is quite different in that a Borrelia species has not conclusively been identified in Australian ticks. One study published in 1994 surveyed 12,000 ticks and could not find evidence to support the existence of Borrelia burgdorferi sensu stricto, so the position since then has been that Australian ticks are unlikely to transmit Lyme disease. 然而, I believe because this study was focused on the American Borrelia species, it would be worthwhile reinvestigating with a broader approach to see if any Borrelia species can be identified in our ticks. As you are aware, several pathogenic species of Borrelia have been identified in the USA, Europe and Asia. It may be that Australia has a unique Borrelia genospecies that has evolved within our unique fawna.
We are also conducting a clinical study investigating Borreliosis in participants that have supportive evidence (mainly serology) of an exposure to Borrelia and have clinical symptoms consistent with Borreliosis. We are interested as well in other tick borne pathogens that may contribute to the clinical presentation that have not been investigated in Australian ticks to date. 因此, our research is at a very preliminary stage and currently we are not addressing issues of treatment/cure of Borreliosis or associated tick borne-infections.
安, I have been told that there are numerous incidences of Lyme disease in Australia as identified by serology. How can there be there no conclusive identification of a Borrelia species in Australian ticks while there are so many apparent cases of Lyme disease?
安: I will need to clarify a few things to explain the serology diagnostics. 在澳大利亞, we follow the USA CDC criteria, ELISA first, then if positive or equivocal, a western blot is performed. Very few people return a positive western blot to meet the CDC criteria of 5 positive bands. The Australians that do return a positive western blot have usually traveled and as such are presumed to have contracted the infection overseas. In saying that, 還有一些已經返回一個積極的，但一直沒有離開澳大利亞的幾個; 這些然後通常解釋為假陽性, 作為已經在海外報導來自非疫區.
最近, Australians have been sending their blood to overseas specialty laboratories such as IgeneX in the USA because they can’t get a western blot in Australia if they have returned a negative ELISA. IgeneX reports 2 criteria, the CDC criteria and also IgeneX criteria, which reports a positive if two IgG bands are positive out of a group of selective antigens.
Do you have a reliable test for Lyme disease in Australia?
沙龍: 目前, there is no Australian testing facility set up to test for all the bacterial species that can cause Lyme disease. The most reliable testing is conducted through the IGeneX lab in the United States and Infectolab in Germany.
安: Diagnostics for Borreliosis is such a complicated area that I don’t believe any one test will be reliable in all patients at all stages of the disease and perhaps a multi-test approach is warranted. I am afraid I am not an expert in this area.
沙龍, what does chronic Lyme disease mean to you?
沙龍: Lyme disease is caused by a bacterial infection, which soon after a bite from an infected tick will spread through the blood to lymph and then to other tissues and organs. It has been demonstrated that the bacteria can cross into the brain within 48 小時, although typically Lyme disease is classed as ‘early’ 用於第一 6-12 weeks of entering the body. After that time, 未經處理, 萊姆感染可以通過機體大致擴散到腦, 神經和器官，其中在該點它被歸類為“慢性’ 或“傳播’ 病.
It’s chronic or disseminated Lyme disease which most challenges health professionals in treating and Lyme patients in recovering to wellness. 底線 – the sooner treatment is initiated, the better the outcome. It is not advisable to wait for symptoms to present as the delay may allow the tick borne infection to progress.
沙龍, do you believe doctors can adequately treat the symptoms triggered by this disease?
沙龍: To have effective treatment of symptoms and underlying pathology, there first must be accurate diagnosis of Lyme disease. Lyme disease is primarily a clinical diagnosis, based on the patient’s history, symptoms and presentation. Blood tests are relied upon to support a Lyme disease diagnosis but because current testing is not accurate, results are unable to be used to conclude a positive or negative diagnosis of Lyme disease.
It is important to remember that even if blood tests are negative, Lyme disease could still be at play.
Adequate treatment of Lyme disease requires a combination of therapies to address the bacteria, parasites, protozoans and viruses passed through the bite of a tick. Research indicates that initial combination treatment should persist for a minimum of 6-8 weeks and be repeated/extended if clinical symptoms persist. Research exploring the efficacy of treatments is advancing rapidly and each patient may require an individualized approach.
On what research do you believe scientists around the world must give priority in order to better treat patients suffering from tick borne illnesses?
Andrew: 理想的情況下, there needs to be an accepted diagnostic and therapeutic approach to this illness, this should be the most simplistic imperative. 但 (and very big BUT), key stakeholders seemed mired in reaching a consensus on the disease itself. 總體, it is imperative that a memorandum of understanding be reached between the key clinical bodies involved with diagnosis and management of this disease. 慢性, 沒有慢性, 極具感染力, 沒有很強的傳染性, 蜱傳, 節肢動物 (昆蟲)-得緊, 性傳播, blood-borne and not – science needs to focus on all these aspects, and not through proving negatives with negatives but proving negatives with positives.
沙龍: The global priority for research into tick borne diseases needs to be built on the foundation of recognition of the complexity of the bacteria itself. There needs to be awareness of a multitude of vectors for transmission, advancement in testing for the indicated 130 or greater species of the bacteria and recognition that different species will be prevalent in different geographic areas. 一樣, these same advancements must embrace the testing for common co-infections as well.
Research advancements must also include rigorous testing on efficacy of treatments for both the Borrelia bacteria and other tick borne illnesses and must include the evaluation of the importance of detoxification to assist the body in sustaining treatment and optimizing foundational cell and systemic function. Priority research needs to be implemented in the area of the transmission of Lyme disease outside of vector initiated. The risk of transmission through blood transfusion, mother to child in utero and by sexual contact must be confirmed or eliminated definitively.
欲了解更多信息，美國: http://www.tbdalliance.org
For more Australian information: http://www.lymedisease.org.au/aboutlyme/contact-us.
Photos courtesy of Lyme Disease Association of Australia.
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