1. Lyme disease in IrelandJ. S. Gray, F. Kirstein, O. Kahla and J. N. RobertsonInstitute of Zoology, Free University of Berlin, Germany; Lyme Disease Reference Unit, Southampton General Hospital, UK.

[link below no longer available…]http://www.ucd.ie/agri/html/homepage/research_96_99/research_1998_99/ERM/ERM05.html

Lyme disease (Lyme borreliosis - LB) is a potentially debilitating disease transmitted by ticks, but although the tick vector, Ixodes ricinus, is common and widespread in Ireland, awareness of LB is low. The series of studies described here investigated the biology and epidemiology of Irish LB in an attempt to assess the present and future risk that it may pose.

Extracts from the text below (full report available on line)

Prevalence of infection in ticks:-

The influence of habitat characteristics on risk of infection was further investigated in field studies in Connemara, Co. Kerry and Co. Wicklow, in which ticks collected from well-described habitats were analysed for infection by IFA or polymerase chain reaction (PCR). It was found that ticks collected from woodland had markedly and consistently higher infection prevalences (11-28%) than ticks collected from open farmland (0-1%), in which tick hosts were almost exclusively sheep or cattle. Additionally, it was found that the highest infection prevalences were found in the most heterogeneous woodland, presumably reflecting the wider variety of vertebrate hosts present. It is thus apparent that risk of LB cannot be determined from risk of tick-bite alone and that the nature, abundance and variety of tick-hosts in a given habitat are also important.

Identification of hosts of the Lyme disease spirochaete:-

It is evident from these studies that large animals such as sheep and cattle, while important tick-hosts in many areas, are not important for the maintenance of the Lyme disease spirochaete. Studies on the distribution of infected ticks in relation to fenced herds of red and fallow deer suggest that these animals may also be discounted as significant reservoir hosts. Various species of woodland rodent have been implicated as important reservoir hosts of B. burgdorferi in the USA and Europe and this was thought to explain the association between highly infected tick populations and woodland in Ireland. However, recent studies in woodlands in Co. Kerry (2) and Co. Galway (3) have shown that whereas tick infection rates ranged from 11-18%, infection rates of trapped rodents (wood mouse, Apodemus sylvaticus, and bank vole, Clethrionomys glareolus) were very low (2- 3%). Furthermore, analysis of blood-meal remnants in B. burgdorferi-infected ticks collected from the vegetation at one particular site in Co. Kerry showed that none of them had acquired their infection from rodents (2). Although it was not possible to ascertain the identity of the vertebrate hosts of B. burgdorferi in this particular study, genospecies analysis of the spirochaetes suggested that the majority may have originated in birds. It is now recognised that B. burgdorferi consists of a complex of closely related genospecies; B. afzelii, B. burgdorferi sensu stricto, B. garinii, B. lusitaniae and B. valaisiana (1). There is increasing evidence that two of these genospecies, B. garinii and B. valaisiana, are associated with ground feeding woodland birds such as robins and blackbirds (4), and these were the predominant genospecies at the Co. Kerry site (41% and 33% respectively). Further studies at another five locations (Fig. 1) showed that B. garinii and B. valaisiana are also the predominant genospecies detected in ticks throughout the country, suggesting that birds may have widespread importance as reservoir hosts in Ireland.

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2. Human babesiosis in ireland: Further observations and the medical significance of this infection

P. C. C. Garnham, Joseph Donnelly, Harry Hoogstraal, C. Cotton Kennedy, and Gerald A. Walton

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1630245

An extract of the text below (full report available on line)

Three splenectomized persons in Yugoslavia, California, and Ireland have been reported to be infected by three different Babesia species; two cases were fatal. In a study of the site where the fatal infection was contracted in Ireland, blood samples from 36 persons who had recently been bitten by ticks were inoculated into two splenectomized calves; no response to Babesia divergens was detected. Field-collected Ixodes ricinus ticks inoculated into another splenectomized calf resulted in fever and recovery of the agent of tick-borne fever (Cytoecetes phagocytophilia). This attempt to determine the presence of latent infection in human beings with intact spleens should be repeated on a larger scale in areas with a demonstrably high incidence of Babesia in ticks and animals. Few places in the world are free of piroplasms; their presence may present a hazard to splenectomized persons or to those whose splenic function is deficient.

3. A Lyme borreliosis human serosurvey of asymptomatic adults in Ireland (1991)Smith HV, Gray JS, Mckenzie G.

Department of Bacteriology, Stobhill Hospital, Glasgow, U.K.

http://www.ncbi.nlm.nih.gov/pubmed/1741921

Blood samples were obtained through the Blood Transfusion Service in Ireland in order to obtain information on the prevalence of asymptomatic B. burgdorferi infections and in an attempt to identify the type of habitat that presents the most risk of infection. Areas in the country were rated as low, medium or high risk based on the availability of suitable tick habitat, access to the public and the distribution of deer, the latter parameter being related to both the occurrence of rodent reservoir hosts and woodland recreational areas. Approximately 100 plasma samples from each of four areas were analysed for IgG anti-Borrelia antibodies by indirect immuno-fluorescence with a titre of 1 :80 indicating a positive reaction in asymptomatic individuals. Prevalence figures of 15, 11, 8 and 5% were obtained for high, high/medium, medium/low and low risk areas respectively. No positive samples were detected in blood from an Icelandic population which is not exposed to I. ricinus bites. The overall subclinical prevalence (9.75%) is surprisingly high in view of the apparent rarity of clinical cases in Ireland, though under-diagnosis probably occurs. These results seem to indicate that farmland is less important than woodland as Lyme borreliosis habitat. If this is so, it is probably due to the presence in woodland of Apodemus sylvaticus, a putative reservoir host, and also to the use of such areas for recreation at certain times of the year.

4. Minireview -Ixodes ricinus seasonal activity: Implications of global warming indicated by revisiting tick and weather data (2007)

Authored by Gray JS. School of Biology and Environmental Science, University College Dublin, Belfield, Dublin 4, Ireland.http://www.citeulike.org/user/neteler/article/2298033

International Journal of Medical Microbiology, Vol. 298, No. S1. (2008), pp. 19-24.

A recent climate experiment predicted that average maximum summer temperatures in southern regions of the British Isles may approach 30 degrees C by the year 2020. An opportunity for retrospective analysis of the implications of such a change for tick phenology and disease transmission was presented by the coincidence of unusually high early summer temperatures in 1976 with the collection of tick data from sites in Ireland where host availability was controlled. Subsequent identification of diapause threshold periods and simulation of temperature-dependent tick development showed that high summer temperatures can cause mass transfer of ticks between development cohorts, resulting in increased activity and therefore increased disease transmission in late autumn and early spring. This suggests that in northern temperate regions of Europe global warming is likely to cause changes in the seasonal patterns of tick-borne diseases.

5. PCR-BASED SURVEY OF TICK-BORNE DISEASES IN THE UK/IRELAND

European Society for Veterinary Internal Medicine, 2001

Department of Clinical Veterinary Science, University of Bristol, UK

http://www.bris.ac.uk/acarus/esvimabst.htm

Extracts of report below:

A PCR-based survey of UK/Irish dogs and cats was undertaken to obtaina preliminary picture of the distribution and presence/prevalence oftick-borne infections. Blood samples from 180 systemically ill animals(120 dogs and 60 cats) from 41 practices distributed throughout UK andIreland were collected during September-October, 2000. The study wasstratified according to clinical signs and each sample was tested byPCR for Ehrlichia, E. phagocytophila, Borrelia and Bartonella DNA.Simple PCR targeting of genus- or species-specific regions of rRNAgenes (Ehrlichia), housekeeping genes (citrate synthetase and gltA inBartonella), virulence factors (ospA in Borrelia) or multicopysequences (epank1 in E. phagocytophila)was used.

DNA of endemic tick-borne pathogens was detected in 6.6% of sick dogsand 5% of sick cats. Borrelia burgdorferi sensu lato was detected in 5% and E. phagocytophila in 0.8 % of canine samples. In sick cats, 3.3%were infected with B. burgdorferi sensu lato and 1.6% were infectedwith E. phagocytophila. No samples were positive for Bartonella DNAusing PCR. However, in a larger separate survey of cats studied here,11% were positive for Bartonella henselae using culture.

Retrospective study of UK samples submitted for PCR diagnosis

A rapid PCR-based diagnostic service for arthropod-borne diseases incompanion animals has been developed at the University of Bristol. PCRmethodology used is as described for the PCR-based survey. BetweenJanuary 2000 and May 2001, 100 blood samples from ill non-travelled UKdogs and cats were PCR tested. Of 89 samples tested, 6 dogs werepositive for E. phagocytophila (6.7%). Of 68 tested for Borrelia, 2dogs (3%) were positive and of the 66 samples tested for Bartonella, 2dogs (3%) were positive.

Conclusions

These preliminary data suggest significant exposure of UK/Irishcompanion animal populations and possibly their owners, to infectedarthropod vectors. Ehrlichia phagocytophila, Borrelia and Bartonellaspp are human pathogens and companion animals may act as sentinels forhuman infection (10). In addition, the presence of E. phagocytophilainfection in dogs and cats in UK and Ireland has been confirmed.Molecular evidence of Borrelia infection in dogs is confirmed and isreported for the first time to our knowledge, in cats. The Borreliagenospecies involved in infection will be further characterised usingrestriction fragment length polymorphism analysis. Canine Bartonellainfection is reported for the first time in Europe and the canineBartonella DNA will be sequenced.

6. First isolation and characterisation of Borrelia garinii , agent of Lyme borreliosis, from Irish ticks

Irish Journal of Medical ScienceSpringer LondonISSN 0021-1265 (Print) 1863-4362 (Online)Volume 165, Number 1 / January, 1996DOI 10.1007/BF02942796Pages 24-26

J. S. Gray1 , A. Schönberg2 , D. Postic3 , J. Belfaiza4 and I. Saint-Girons3

(1) ERM Department, University College, Dublin, Ireland(2) Robert von Ostertag-Institute, Federal Health Office, Berlin, Germany(3) Unité de Bactériologie, Pasteur Institute, Paris, France(4) University Chouaib Doukkali, Faculté des Sciences, El Jadida, Morocco

Summary

Nymphal Ixodes ricinus, the tick vector of Lyme borreliosis, were collected from the edges of paths in Muckross Demesne, Killarney National Park, Co. Kerry, Ireland. Examination of some of these nymphs by indirect immunofluorescence showed an infection prevalence of 12% withBorrelia burgdorferi sensu Iato, the spirochaete agent of Lyme borreliosis. Gerbils (Meriones unguiculatus) were infected by infesting them with other nymphs from the same batch. Subsequently uninfected laboratory larvae were applied to the gerbils and the contents of the resulting infected engorged ticks were then placed in media and the spirochaetes cultured. The spirochaetes were identified asB. burgdorferi sensu Iato by indirect immunofluorescence using monoclonal antibodies and they were further characterised by polymerase chain reaction and pulsed-field gel electrophoresis. Both of these latter techniques showed that spirochaetes in all samples belonged to the genomic species, Borrelia garinii.

7. Lyme Disease Factsheet, Ireland

Health Protection Surveillance Centre25-27 Middle Gardiner StDublin 1, Ireland.http://www.ndsc.ie/hpsc/A-Z/Vectorborne/LymeDisease/Factsheet/

Excerpts are below - full report or printable leaflet available in above link:

How do you come in contact with Lyme disease?Lyme disease has been reported from North America, Europe, Australia, China and Japan. Infected ticks are most likely to be encountered in heathland and lightly forested areas of North America and Northern Europe. Ramblers, campers and those who work in such areas especially if they come into contact with large animals are at greatest risk of being bitten by ticks and of going on to develop disease. Cases of Lyme disease appear in Ireland every year.

What symptoms can it cause?Many infected people have no symptoms at all. The commonest noticeable evidence of infection is a rash called erythema migrans that is seen in about three-quarters of infected people. *Tick talk note - remember that many Lyme sites indicate that 50% or less of sufferers experience a rash. The rash can be painless or painful but usually not itchy. It can be widespread or contained in small brown pigmentations. It can be in a bull's eye ring or spread across the body. Check out http://www.canlyme.com/ (symptoms link) for rash pictures * This red, raised skin rash develops between 3 days and a month after a tick bite and spreads outwards from the initial bite site. This rash can last up to a month and be several inches in diameter. People can also complain of 'flu-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue. Occasionally, there may be more serious symptoms involving the nervous system, joints, the heart or other tissues.

What complications can result from Lyme disease?Complications following Lyme disease are not terribly common, and tend to occur less frequently in Europe than in North America. Complications tend to occur quite some time after initial infection and are common in people who did not realise they had been infected or who were not initially treated. Complications can affect different parts of the body including:

* Joints: swelling and pain in large joints (arthritis) which can recur over many years* Heart: inflammation of heart muscle (myocarditis) with irregularities of heart rhythm* Eye: conjunctivitis and eye pain.* Nervous System: numbness and weakness, meningitis/encephalitis and Bell's palsy (facial paralysis).

How is Lyme disease diagnosed?Lyme disease is diagnosed by medical history and physical examination. Diagnosis can be difficult if there has been no erythema migrans rash. The infection is confirmed by special blood tests. The tests used, look for antibodies to B. burgdorferi, which are produced by an infected person's body in response to the infection. Antibodies will take several weeks to develop and may not be present in the early stages of the rash. They will usually be present in the later stages of the infection. More sophisticated tests can be used if the diagnosis is not clear.

How common is Lyme disease?Lyme disease is not a notifiable infectious disease in Ireland. This means that there is no legal requirement on doctors to report cases to their local Director of Public Health. A number of cases are diagnosed each year, but the true figure is unknown. In the UK, about 300 laboratory-confirmed cases are reported to the Health Protection Agency annually; however, estimates suggest that the true figure could be between 1000 and 2000 cases annually. In the US, there are about 15,000-20,000 cases each year.

Who is at risk for Lyme disease?Lyme disease can affect anyone but is commonest among ramblers, hill-walkers, hikers, campers and

others whose leisure activities or work takes place in heathland or light woodland areas or brings them in contact with certain animals e.g. deer. Summer and autumn is the period when most cases occur.

Is there a treatment for Lyme disease?Yes, common antibiotics such as doxycycline or amoxicillin are effective at clearing the rash and helping to prevent the development of complications. They are generally given for up to three weeks. If complications develop, intravenous antibiotics may need to be used. *Tick Talk's note - stage 3 Lyme is where the early signs have not been caught or treated. In these cases antibiotics are needed for several months or even years. This is why it is VERY important to be treated as soon as possible*

8. Questions for Minister of Health re: status of Lyme disease in Ireland

Gormley - Green Party Leader & TD for Dublin South East

http://www.kildarestreet.com/wrans/?id=2006-09-27.2239.0&s=Lyme#g2240.0.q

Mr. Gormley asked the Minister for Health and Children the statistics in relation to the incidence of Lyme disease here; her views on whether awareness of the fact that this disease can be transmitted to humans via tick bites needs to be increased and that it should be a notifiable disease; and if she will make a statement on the matter.

Extract of reply - full report available in above link:

Minister for Health and Children (Ms Harney):Lyme disease is not a notifiable infectious disease in Ireland. This means that there is no legal requirement on doctors to report cases to their local Director of Public Health, so this makes estimates of incidence difficult. In Ireland, researchers have tried to determine levels of Lyme borreliosis; it has been estimated that there were about 30 human cases per year in the mid-1990s. Data, however, from the National Virus Reference Laboratory which is responsible for undertaking testing for B. burgdorferi has confirmed that there were only 11 positive cases in 2003; these numbers have been steady at that level for the last couple of years. There were, however, more than 1,000 requests for testing for B. burgdorferi in 2003. Over the last several years, the NVRL confirms that virtually all positive cases were associated with travel in the US. It is felt that there is some, unknown degree of underreporting and under diagnosis of this condition. It would, therefore, appear on initial review, that despite confirmed Irish cases of Lyme borelliosis having been principally associated with travel to North America, there is the potential for individuals to be exposed to biting ticks in Ireland. It would seem sensible for this reason, to recommend that simple, straightforward information should be made available that will assist those who may potentially be exposed (whether as a result of occupational or leisure activities) to take necessary precautions. As a response to this in 2004, the Vectorborne Subcommittee of the Scientific Subcommittee of the Health Protection Surveillance Centre’s (HPSC) Scientific Advisory Subcommittee was established. One of its terms of reference was to identify and determine the burden of certain significant vectorborne diseases in Ireland and to make recommendations in relation to the provision of advice and guidance. As part of the initial risk assessment, the available information on Lyme disease was collated and reviewed. As in common with many other countries, estimation of true levels of this condition is rather difficult. What is apparent is that, in Ireland, a number of cases appear every year and a proportion of these are likely to have been acquired in Ireland. A fact sheet on Lyme Disease

has been made available on the HPSC’s website to provide members of the General Public and Media with advice on minimising the risk of Lyme Disease (additional incidence information appears here). In addition, part of the work of the Vectorborne Subcommittee in the New Year will be the development of Clinical Guidance on the management of Lyme Disease and raising awareness of this condition among clinicians.

This entry was posted on Wednesday, September 27th, 2006

9. Management of Lyme disease.

Expert Rev Anti Infect Ther. 2008 Apr;6(2):241-50.Corapi KM, Gupta S, Liang MH.Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. kricorapi@rcsi.ie

http://www.lifestages.com/health/lymedise.html

It has been 30 years since Lyme disease was first described in a cohort of patients from Connecticut. An understanding of disease transmission, clinical manifestations and prevention strategies has been established. With the number of new cases increasing each year, it is important that clinicians are aware of the available treatment options. Most patients respond well to a course of treatment with a recommended antibiotic; however, for those patients who develop post-Lyme disease syndrome, the management is unclear. This review provides an overview of Lyme disease and the recommended treatment options available to physicians.

10. Strategies for primary and secondary prevention of Lyme disease.

Nat Clin Pract Rheumatol. 2007 Jan;3(1):20-5Corapi KM, White MI, Phillips CB, Daltroy LH, Shadick NA, Liang MH.Royal College of Surgeons in Ireland. kricorapi@rcsi.iehttp://www.lifestages.com/health/lymedise.html

Lyme disease (borreliosis) incidence continues to increase despite a growing knowledge of primary and secondary prevention strategies. Primary prevention aims to reduce the risk of tick exposure and thereby decrease the incidence of new Lyme disease cases. Secondary prevention targets the development of disease or reduces disease severity among people who have been bitten by infected ticks. Numerous prevention strategies are available, and although they vary in cost, acceptability and effectiveness, uptake has been universally poor. Research in areas where Lyme disease is endemic has demonstrated that despite adequate knowledge about its symptoms and transmission, many people do not perform behaviors to reduce their risk of infection. New prevention strategies should aim to increase people's confidence in their ability to carry out preventive behaviors, raise awareness of desirable outcomes, and aid in the realization that the necessary skills and resources are available for preventive measures to be taken. In this article we evaluate the prevention and treatment strategies for Lyme disease, and discuss how these strategies can be implemented effectively. As many patients with Lyme disease develop arthritis and are referred to rheumatologists it is important that these health-care providers can educate patients about disease-prevention strategies.

11. Studies on the ecology of Lyme disease in a deer forest in County Galway, Ireland (1992)

Gray JS, Kahl O, Janetzki C, Stein J.

http://www.ncbi.nlm.nih.gov/pubmed/1460628

Department of Environmental Resource Management, Faculty of Agriculture, University College Dublin, Republic of Ireland.

The abundance of the tick Ixodes ricinus (L.) and the infection rate of ticks with Borrelia burgdorferi (Johnson et al.) were compared on either side of a deer fence in a forest park in County Galway, Ireland, in an attempt to elucidate the role of fallow deer, Dama dama, and woodmice, Apodemus sylvaticus, in determining the population density of I. ricinus and the transmission of B. burgdorferi. The results showed that tick numbers were much higher on the deer side of the fence, although the density of mice was similar on both sides. This suggests that, in the absence of other obvious factors, deer rather than mice are responsible for tick abundance in this habitat. Tick infection rates, determined by immunofluorescence, were consistently higher outside the deer fence than inside it. It is suggested, therefore, that mice rather than deer may be the important reservoir hosts of B. burgdorferi in this habitat and that deer, by feeding many larvae, probably contribute large numbers of uninfected ticks to the population. If this is the case, there will not be a direct relationship between deer abundance and tick infection rates. This has important implications for risk assessment.

12. The spatial distribution of Borrelia burgdorferi-infected Ixodes ricinus in the Connemara region of County Galway, Ireland (1995)

Gray JS, Kahl O, Janetzki C, Stein J, Guy E.

http://www.ncbi.nlm.nih.gov/pubmed/7634971

Department of Environmental Resource Management, University College Dublin, Ireland.

Studies were carried out in the Connemara area of County Galway in the west of Ireland in order to determine the abundance and distribution of the tick, Ixodes ricinus and the prevalence of its infection with Borrelia burgdorferi. The tick was very abundant locally, in particular when associated with cattle, sheep and enclosed red deer. Large numbers of ticks not only occurred on the pastures, but also on adjacent roadside verges. No infections with B. burgdorferi could be demonstrated when nymphal ticks were sampled from central areas of the pastures, suggesting that livestock and red deer are probably not significant reservoirs of the spirochaete. Small numbers of infected nymphal and adult ticks were associated with hedges, dry stone walls, the margins of woodland adjoining infested pastures and in woodland from which livestock were excluded. Woodmice (Apodemus sylvaticus) were most numerous in such habitats and the majority were infected with B. burgdorferi.

13. Borrelia burgdorferi sensu lato in Ixodes ricinus ticks and rodents in a recreational park in south-western Ireland (1999)

Gray JS, Kirstein F, Robertson JN, Stein J, Kahl O.

University College Dublin, Ireland.

http://www.ncbi.nlm.nih.gov/pubmed/10581711

Ixodes ricinus ticks infected with Borrelia burgdorferi sensu lato were numerous on the edges of paths and roads in a recreational park in south-western Ireland. The abundance of ticks at different sites was related to the presence of deer, but a negative relationship was shown between tick abundance and tick infection rates. This is thought to be due to the deposition of large numbers of uninfected ticks by deer, which are apparently not good reservoir hosts of B. burgdorferi s.l. Blood meal analysis only detected deer DNA in uninfected nymphs. Reservoir competent rodents, Apodemus sylvaticus and Clethrionomys glareolus, were abundant at all sites and a high proportion of captured specimens were infested with larval ticks. However, very few rodents were infected with B. burgdorferi s.l. and none of the unfed infected nymphs analysed for the identity of their larval blood meal had fed on rodents. The spirochaetes detected in I. ricinus in the study area may be poorly adapted to rodents or are not transmitted readily because of the absence of nymphal infestation. The majority of spirochaetes in these ticks were apparently acquired from non-rodent hosts, such as birds.

14. Babesiosis: under-reporting or case-clustering? (1989)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429486/pdf/postmedj00176-0080.pdf

C. S. Clarke, E. T. Rogers, and E. L. EganDepartment of Haematology, Galway Regional Hospital, Ireland.

Abstract (full report available in above link)

Babesiosis is a tick-borne protozoan disease which principally affects animals but occasionally affects humans. Cases have been reported from many parts of Europe with no evidence of case-clustering. We report the second case of babesiosis from a small area in the west of Ireland.

15. Prevalence of selected infectious agents in cats in Ireland (published 15 May 2010)

Florence Juvet DMV1, , , Michael R. Lappin DVM, PhD, DACVIM2, Sheila Brennan MVB, DipECVIM-CA1 and Carmel T. Mooney MVB, MPhil, PhD, DipECVIM-CA, MRCVS1

1 University Veterinary Hospital School of Agriculture, Food Science & Veterinary Medicine, University College Dublin, Ireland

2 College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO., Ireland

Vector-borne bacterial and rickettsial agents and Toxoplasma gondii, are common organisms in cats. Some are potentially zoonotic or may be transmitted via blood transfusion. The current study investigated the prevalence of these agents in cats from Dublin, Ireland, for which no published data exists. Whole blood (n = 116) and sera (n = 83) samples were obtained from 121 cats. DNA was extracted from blood and assayed using polymerase chain reaction techniques for Anaplasma species, Bartonella species, Ehrlichia species, Mycoplasma haemofelis, ‘Candidatus Mycoplasma haemominutum’, ‘Candidatus Mycoplasma turicensis’ and Rickettsia species. IgG and T gondii IgG and IgM serum antibodies were detected by enzyme-linked immunosorbent assay. DNA consistent with B henselae (3.4%), B clarridgeiae (0.8%), both Bartonella species (0.8%), C M haemominutum (12.9%), or M haemofelis (2.5%) was amplified from 24/116 blood samples (20.6%). Antibodies to T gondii and Bartonella species were detected in 28 (33.7%) and 22 (26.5%) of 83 sera, respectively.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WJC-50338Y2-1&_user=10&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=241ce18ab3708d350bf49b1773736ac6

16. Climate change could increase Irish Lyme disease risk (Irish Medical News 2010)

http://www.imn.ie/index.php/news/3425-climate-change-could-increase-irish-lyme-disease-risk

The risk of Lyme disease in Ireland may increase as a result of climate change, according to a study published by the Irish Medical Journal. Lyme disease is the most common tick-borne disease in Europe.

The mean temperature in Ireland has risen by 0.5 degrees Celsius in the 20th century and as ticks live outside their host for the majority of their life, they can be affected by such climate change.

According to the study, the changes to the climate in Ireland, including rising temperatures and humidity, are making it a more suitable habitat for the tick to reside. Because of global warming, warmer winters are expected in Ireland, which accelerates a tick’s development.

The tick is also extremely reliant on vegetation cover, therefore, increased temperatures and forests will further its growth.

Untreated, Lyme disease can spread to produce various other symptoms, including aseptic meningitis, meningo-encephalitis, polyarthirits and myocarditis.

The study stresses the need for promotion about Lyme disease and suggests making it a notifiable disease in Ireland and Europe to help provide an explanation between this disease and the environment.

The study was carried out by the Department of Community Health in Co Kildare.

17. The Clinical Spectrum of Lyme Neuroborreliosis (Irish Medical Journal 2010)

M Elamin, T Monaghan, G Mulllins, E Ali, G Corbett-Feeney, S O’Connell, TJ CounihanDepartment of Neurology, University Hospital Galway, Newcastle Rd, Galway

http://www.imj.ie//ViewArticleDetails.aspx?ArticleID=4785

Abstract Lyme disease is a multisystem infectious disease, endemic in parts of Europe, including the West of Ireland. Neurological manifestions (neuroborreliosis) are variable. Presenting neurological syndromes include meningitis, cranial neuropathies, myeloradiculitis and mononeuritis multiplex. A lack of specificity in serological diagnosis may add to diagnostic confusion. We reviewed thirty cases of acute Lyme disease in the West of Ireland and found neurological syndromes in 15 (50%), with painful radiculopathy (12 patients; 80%) and cranial neuropathy (7 patients;46%) occurring frequently. Neuroborreliosis needs to be considered in the differential diagnosis of these neurological syndromes in the appropriate clinical context.

IntroductionLyme disease is a multisystem infectious disease caused by the Borrelia spirochaete genus. The predominant species in North America is Borrelia burgdorferi sensu stricto, and in Europe the predominant species are B. afzelli and B. garinii. Deer and other mammals are the intermediate hosts1. Lyme disease is the most frequently reported arthropod–borne infection of the nervous system in Europe and the USA1. Erythema migrans (EM) is regarded as the most common clinical marker of infection and is estimated to occur in 60-80% of patients1. Neurological manifestations of

Lyme disease (neuroborreliosis; NB) comprise an array of both central and peripheral neurological syndromes, mimicking a variety of common disorders2. Typical neurological presenting syndromes include include meningitis, cranial neuropathies (with a predilection for the facial nerve), myeloradiculitis and mononeuritis multiplex3,4. Difficulties in the diagnosis and management of patients with Lyme NB may be compounded by a lack of specificity and sensitivity of serological tests in active disease5.

Seroprevalence studies report the Republic of Ireland as having one of the highest rates of Lyme disease in Europe6. Lyme disease is considered endemic in the West of Ireland7,8. However, few studies have explored the clinical presentation and natural history of Lyme NB in Ireland9-11. We therefore undertook a retrospective analysis of the clinical characteristics of Lyme NB in the West of Ireland. We conducted a retrospective review of the clinical presentation of patients with serologically confirmed Lyme disease diagnosed over a five-year period at a single referral centre in the West of Ireland. We identified the proportion of patients presenting with NB, we define the neurological syndromes at presentation, and report the clinical outcomes.

MethodsThe study population included those patients who had serological testing consistent with Lyme disease, based on referrals to the Department of Medical Microbiology, University Hospital Galway. The study period extended from January 1999 to August 2004. During that period, approximately 2100 sera were tested using the screening ELISA. A two-tier diagnostic process was utilized in accordance with international standards12, comprising an initial screening enzyme-linked immunosorbant assay (ELISA) for anti Borrelia antibodies. In those patients who had positive screening ELISA tests, antibody positivity was confirmed by a positive IgG and/or IgM immunoblot assay at the Lyme Borreliosis Unit, Southampton, UK. We identified 42 samples over the sixty-six month study period with serology consistent with Lyme disease.

After obtaining Ethics Committee approval and written informed consent from the referring physician, we then obtained clinical data for 32 patients. Data was collected by chart review and included demographic characteristics, potential exposure to tick bite, clinical presentation and results of imaging and cerebrospinal fluid analysis. Patients were included in the study in whom there was a clear temporal relationship between the onset of a clinical syndrome known to be associated with Lyme disease, (such as EM) and serological testing. Exclusion criteria were equivocal serological results or positive tests that were deemed to represent convalescence serology. Two patients were excluded; both had IgG anti B. burgdorferi antibodies but their clinical presentation and imaging studies were compatible with alternative diagnoses (multiple sclerosis and brain neoplasm). Data on the remaining 30 patients was analyzed as pooled data.

ResultsBaseline characteristicsAntibody subtypes directed against B burgdorferi in the thirty patients included in the study were detected as follows: seventeen patients (57%) had both IgM and IgG antibodies; six patients (20%) exhibited anti IgM antibodies only, and seven patients (23%) had only IgG anti-Borrelia antibodies. Patients ranged from 26 to 80 years of age, with a mean of 52.5 years; 60% were male. Twenty patients (67%) were resident of western counties of Ireland. Only one patient was resident outside the state. Recent travel outside Ireland was documented in seven cases. Nine patients (30%) had documented potential exposure to heavily wooded areas due to occupation or leisure activities. A history of tick bite was elicited in only one third of the patients. Lyme serology was requested by the patient’s general practitioner in twelve cases, by a consultant physician in thirteen cases and by a neurologist in five cases.

Clinical PresentationThe majority of patients (25/27, 93 %) presented between the months of May and October. While twenty-two patients (71%) had a rash at presentation, only 43% of patients presented with EM rash. Fatigue was a prominent symptom in more than half of the patients (16/30), but fever >38 degrees C was reported in only four patients (13%). Seven patients (23%) had polyarthralgia at presentation; one patient had anterior uveitis. None of the patients had cardiovascular symptoms.

Neurological ManifestationsFifteen patients (50%) had neurological manifestations at presentation (Table). The most common symptom was radiculitis (12/15 patients; 80%). Cranial neuropathy occurred in seven patients, among whom unilateral facial palsy was present in six patients (40% of patients with neurological manifestations). Bilateral facial palsies were documented in only one patient. Four patients had headache at presentation. Psychiatric disturbances, in the form of marked irritability and reduced concentration, were noted in one patient.

Laboratory Findings in NB patientsEleven patients with Lyme NB had both anti-Borrelia antibodies for IgM and IgG; two patients were IgM positive only, and two were IgG positive only. Cerebrospinal fluid (CSF) analysis was carried out in five of the fifteen patients with NB and was abnormal in all five (Table). All had raised CSF protein levels ranging from 0.6 g / l to greater than 1g/l. Four had CSF pleocytosis (>6 white cells/mm3), predominantly a lymphocytosis. Oligoclonal bands were present in one patient. Lyme serology in CSF was positive for IgM and IgG antibodies in the only patient in whom it was requested. MRI brain scans were abnormal in two out seven cases in which it was performed. In both cases, the abnormalities found were considered to be incidental findings (acoustic schwannoma; hypertensive leukoencephalopathy).

Treatment and Follow upDoxycycline was used in three patients; seven patients received intravenous cefotaxime/ceftriaxone, and two patients received oral amoxicillin, one patient received vibramycin while treatment was not documented in two patients. Follow up of the fifteen patients with Lyme NB was as follows: four patients showed definite clinical improvement, defined as complete resolution of symptoms (three had received intravenous ceftriaxone/cefotaxime and one had received oral doxycyline; five patients

showed partial improvement or relapse (two patients received oral doxycyline, two received oral amoxicillin and one received oral vibramycin); five patients were lost to follow up and one patient who had received only steroids showed no response.

DiscussionWe identified forty-two patients with serological evidence of acute Lyme disease over a five-year period presenting to a single referral laboratory in the West of Ireland. Fifty percent of the patients on whom clinical data was available had evidence of Lyme NB. Both the incidence of Lyme disease as well as the proportion of patients with NB in our study appears to be higher than in previous reports9-11. The first reported cases of Lyme disease in Ireland appeared in the late 1980s9. The West of Ireland has been identified as a high-risk area because of high rates of sero-prevalence among asymptomatic adults6; the highest seroprevalence was documented in the western area of Portumna (8.7%) compared to a national average of 3.4%7. In a retrospective seroprevalence study, only 13 of 483 serum samples were seropositive for Lyme antibodies, mainly from patients attending Dublin hospitals, but Galway area patients formed the second largest group despite its much smaller catchment population10. Given the apparent high incidence of Lyme disease in Ireland, information regarding Lyme NB in this region is sparse. Reilly and Hutchinson in 1991 described the clinical presentation of six cases of NB diagnosed in Ireland over a 4 year period, five of whom contracted the disease in the West of Ireland11. The authors recommended further epidemiological studies to establish the prevalence and pattern of infection with B. burgdorferi in Ireland. The larger number of patients in our study may reflect a combination of higher awareness among physicians, as well as more reliable serological diagnostic techniques.

The proportion of patients with Lyme NB in our cohort is high, amounting to 50% of patients presenting with confirmed Lyme disease. Although estimates vary, previous studies in Ireland and Europe report rates of neurologic involvement in Lyme disease ranging from 18% -31%13. Sensory or sensory-motor radiculitis and facial palsy were the two most common neurological presentations in these patients; we have recently reported perineuritis as a pathological finding in one of this cohort4. Lymphocytic meningoradiculitis (Bannwarth's syndrome) is a radicular neuralgia associated with a chronic lymphocytic pleocytosis in cerebrospinal fluid and frequently with unilateral or bilateral peripheral facial palsy) is one of the commonest neurological manifestations of Lyme disease in clinical studies conducted in Ireland and other parts of Europe13. Truncal neuralgic pain in one of our patients was severe enough to prompt investigation for a cardiac cause. All patients with Lyme facial palsy in our cohort had additional neurological symptoms, and 87% reported constitutional complaints. This highlights the fact that while NB may be responsible for up to 10% of cases of facial palsy1, Lyme disease should be considered in a patient with facial palsy when it is associated with other signs or symptoms of borreliosis.

A relatively small number of our patients had symptoms of meningism. Meningitis in NB seems to cause less pronounced meningitic symptoms than aseptic meningitis14. Only one third of our patients with symptoms suggestive of NB had a lumbar puncture and cerebrospinal fluid analysis; however, CSF was abnormal in all of these cases. Oligoclonal bands were present in cerebrospinal fluid and not serum in one case. Current guidelines consider the presence of intrathecal specific antibodies as essential laboratory evidence for the diagnosis of early Lyme NB and the presence of specific CSF oligoclonal bands as supporting evidence15. Given the relatively high yield of CSF for identification of Lyme antibodies physicians should be encouraged to carry out CSF analysis in all patients with symptoms suggestive of NB even in the absence of meningism.

This study has some inherent limitations due to its retrospective design and potential for ascertainment bias. However the potential for overestimation of disease incidence through the use of serology as part of patient selection is more than offset by the fact that only about 40-60% of

patients with early disease EM have positive serology5. Moreover, serology may not be requested in these patients as current guidelines recommend diagnosis and treatment of EM on clinical grounds15. However in patients in whom the duration of illness is 4 weeks or more, the sensitivity and specificity of IgG response is very high (range of 95%-99%) as determined by the 2 test approach12, and thus a single test (for IgG only) is usually sufficient for diagnosis if the clinical picture is compatible1. We believe our results indicate a relatively high incidence of neurological complications in patients with Lyme disease, particularly in patients with serologically confirmed disease. There is a high incidence of Lyme NB among patients with Lyme disease in the West of Ireland, higher than that suggested by previous studies. The absence of a history of tick bite, potential exposure to ticks or EM is not reliable in the exclusion of the diagnosis. CSF analysis and serology testing is recommended in all suspected cases of neuroborreliosis, even in the absence of meningeal symptoms.

Correspondence: TJ CounihanDepartment of Neurology, University Hospital Galway, Newcastle Rd, GalwayEmail: Timothy.counihan@hse.ie

References1. Wormser GP. Early Lyme disease. Clinical practise. N Engl J Med 2006;354:2794-801.2. Kaiser R. Neuroborreliosis. J Neurol 1998;245:247–55.3. Halperin JJ. Diagnosis and Treatment of neuromuscular Manifestations of Lyme disease. Curr Treat Options Neurol. 2007 Mar;9:93-100.4. Elamin M, Alderazi Y, Mullins G, Farrell M, O’Connell S, Counihan T. Perineuritis in acute Lyme neuroborreliosis. Muscle and Nerve 2009;39(6):851-54.5. Steere AC, McHugh G, Damle N, Sikand VK. Prospective study of serologic tests for Lyme disease. Clin Infect dis 2008;47:188-95.6. Muhlmann MF, Wright DJ. Emerging pattern of Lyme Disease in the United Kingdom and the Irish Republic. Lancet. 1987 Jan 31;1:260-2.7. Robertson JN, Gray JS, MacDonald S, Johnson H. Seroprevalence of Borrelia burgdorferi sensu lato infection in blood donors and park rangers in relation to local habitat. Zentralbl Bakteriol. 1998 Oct;288:293-301.8. Smith HV, Gray JS, Mckenzie G. A Lyme borreliosis human serosurvey of asymptomatic adults in Ireland. Zentralbl Bakteriol. 1991 Aug;275:382-9.9. Carmody E, Hutchinson M. Tick borne lymphocytic meningo-radiculuitis in Ireland: Bannwarth’s Syndrome/Lyme Disease. Ir Med. J 1987; 80 154.10. Cryan B, Cutler S, Wright DJ. Lyme Disease in Ireland. Ir Med.J.1992 ; 85: 65-7.11. Reilly M, Hutchinson M. Neurological manifestations of Lyme Disease. Ir Med J. 1991 Mar; 84: 20-1.12. Wilske B et al. MiQ12 2000. Quality Standards for the microbiological diagnosis of infectious diseases: Lyme borreliosis. Accessed at:http://nrz-borrelian.Imu.de/miq-Lyme/frame-miq-lyme.html13. Hansen K, Lebech AM. The Clinical and Epidemiological Profile of Lyme Neuroborreliosis in Denmark 1985-1990: A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain 1992;115:399–423.14. Tuerlincz D, Bodart E, Garrino MG, de Bilderling G. Clinical data and cerebrospinal fluid findings in Lyme meningitis versus aseptic meningitis. Eur J Ped 2003;162:150-3.15. Wormser GP et al. The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases 2006;43:1089-1134 .

18. Warning on ticks link to Lyme disease

Irish Independent - Wednesday June 23, 2010http://www.independent.ie/national-news/warning-on-ticks-link-to-lyme-disease-2230815.html

POTENTIALLY debilitating Lyme disease is on the rise in humans after being carried by ticks from the blood of deer and sheep, writes Anne Lucey.

Kerry County Council is asking for a national campaign to raise awareness among GPs and the public, after a number of anecdotal reports of an increase in cases.

Leaflets have also been distributed to visitor centres of the National Parks and Wildlife Service.

The HSE South confirmed there had been cases of the "generally mild" but potentially debilitating disease in the Cork and Kerry region.

However as it was not a notifiable disease it was impossible to say with accuracy how many cases there were.

Ticks are usually present in forests, in long grass, in heather and non-pasture land.

19. Ticked off by danger of Lyme disease

The Irish Times - Tuesday, June 15, 2010http://www.irishtimes.com/newspaper/health/2010/0615/1224272506521.html

Researchers are hoping to halt the spread of the fastest growing parasite-transmitted disease in the northern hemisphere by reducing tick numbers, writes MICHELLE McDONAGH

AS OUTDOOR recreational activities increase during brighter days and longer evenings, so too does the risk of being bitten by a tick and developing a potentially serious disease.

Lyme disease is the fastest growing parasite-transmitted disease in the northern hemisphere and the main period of risk in Ireland is between mid-March and mid-October. However, through taking simple and sensible precautions, you can reduce your risk of contracting the disease to a very low level.

Dr Eoin Healy, a research associate in the Department of Zoology, Ecology and Plant Science at University College Cork, is involved in research into the biochemical drivers of tick behaviour. The goal of this work is to contribute to the development of baiting and trapping methods to reduce tick numbers and, as a consequence, the incidence of Lyme disease in humans.

“In Ireland, Lyme disease is not a notifiable disease and so there are no official data to inform us about its prevalence. However, based on laboratory data in the Cork/Kerry area, it is very likely that several hundred cases a year occur in Ireland. In addition, many more cases may go undiagnosed or misdiagnosed,” he explains.

The risk of coming into contact with ticks is likely to be high in areas where there is a significant number of deer and sheep grazing in rough, non-pasture land, explains Healy. Counties Wicklow, Kerry and Cork are known high-risk areas.

“Only a very small proportion of people who are bitten by ticks develop Lyme disease, but given that thousands of people will be bitten between now and autumn, it’s important to be aware of this risk,” says Healy.

The first indication of Lyme disease is usually a red expanding weal around the site of the tick bite, followed shortly by fatigue and chronic flu-like symptoms in the second phase of the illness.

Healy says: “If untreated, the third phase of Lyme disease is a chronic arthritis in the vast majority of sufferers. This is extremely painful and particularly affects the knee joints.

“The late conductor of the Berlin Philharmonic, Herbert von Karajan, spent much of his last months of life in a wheelchair because of severe attacks of Lyme disease.”

However, Healy stresses that as well as being preventable, Lyme disease can be effectively treated with antibiotics. He points out that the risk of being bitten by a tick can be reduced by taking sensible precautions, the most obvious of which is to wear appropriate clothing.

Ticks are more visible and can be easily removed from light-coloured clothing. Wear trousers tucked into socks and long-sleeved shirts to try to prevent direct access to the skin. A general purpose insecticide used on the wrists and ankles can provide a decent degree of protection.

“When in recreational forest parks, stay on the paths and discourage children from straying into knee-high vegetation, heather and long grass that is likely to harbour ticks. Walkers and backpackers may be tempted to lie back on the heather and look at up the sky, but they should be aware that they could pick up a few or even hundreds of ticks if they are in a high tick area.”

Healy stresses the importance of conducting an all-over body examination of the skin within a few hours of spending time in outdoor activities in high-risk areas as the parasites do not begin to release the bacteria Borrelia for about six hours after they start feeding. The tick is flat and dark in appearance and cannot fly.

Remove any tick visible with a tweezers and crush it between a coin and hard surface just to be safe. Dab the site of the bite with antiseptic ointment and make a written note of the date and location where the bite occurred.

“Check the site of the bite daily and if you notice any sign of a red weal widening around the site, consult your GP within the next couple of days,” advises Healy.

“Given that 25 per cent of people do not develop this rash, keep an eye out for other signs of flu-like symptoms. Lyme disease may not be the obvious reason for your symptoms, so if you have been bitten by a tick, you should make that clear to your GP.”

LYME DISEASE: WHAT IS IT?

Lyme disease in humans is caused by infection with bacteria of the genus Borrelia. Infection can happen as a result of a person being bitten by a tick. As a tick sucks blood from its victim, the bacteria enter the bloodstream and may, in certain cases, result in the development of a condition called Lyme disease or borreliosis.

In cases where infection progresses to the disease state, symptoms usually begin with flu-like indications. Inflammation of joints is common and, in untreated cases, severe chronic arthritis may develop.

People who live and work in areas with significant tick numbers and those who visit tick-infested localities for recreational use are at a much higher risk of being bitten.

The risk is highest in children in the under-12 age group as they are more likely to be bare-legged, closer to the ground and in contact with tick-infested vegetation as they run around in woodland. Unless taught and supervised by parents, they will be less likely to rigorously examine themselves for ticks.

20. Tick Study Killarney National Park, Co. Kerry (1997)

Appl Environ Microbiol. 1997 March; 63(3): 1102–1106. PMCID: PMC168399

Local variations in the distribution and prevalence of Borrelia burgdorferi sensu lato genomospecies in Ixodes ricinus ticks.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC168399/

F Kirstein, S Rijpkema, M Molkenboer, and J S Gray University College Dublin, Belfield, Ireland.

Abstract

Unfed nymphal and adult Ixodes ricinus ticks were collected from five locations within the 10,000-ha Killarney National Park, Ireland. The distribution and prevalence of the genomospecies of Borrelia burgdorferi sensu lato in the ticks were investigated by PCR amplification of the intergenic spacer region between the 5S and 23S rRNA genes and by reverse line blotting with genomospecies-specific oligonucleotide probes. The prevalence of ticks infected with B. burgdorferi sensu lato was significantly variable between the five locations, ranging from 11.5 to 28.9%. Four genomospecies were identified as B. burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, and VS116.

Additionally, untypeable B. burgdorferi sensu lato genomospecies were identified in two nymphs. VS116 was the most prevalent of the genomospecies and was identified in 50% of the infected ticks. Prevalences of B. garinii and B. burgdorferi sensu stricto were similar (17 and 18%, respectively); however, significant differences were observed in the prevalence of these genomospecies in mixed infections (58.8 and 23.5%, respectively). Notably, the prevalence of B. afzelii was low, comprising 9.6 and 7.4%, respectively, of single and mixed infections. Significant variability was observed in the distribution and prevalence of B. burgdorferi sensu lato genomospecies between locations in the park, and the diversity and prevalence of B. burgdorferi sensu lato genomospecies was typically associated with woodland. The distributions of B. burgdorferi sensu lato genomospecies were similar in wooded areas and in areas bordering woodland, although the prevalence of B. burgdorferi sensu lato infection was typically reduced. Spatial distributions vegetation composition, and host cenosis of the habitats were identified as factors which may affect the distribution and prevalence of B. burgdorferi sensu lato genomospecies within the park.

For full paper go to:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC168399/pdf/631102.pdf

21. Neurological manifestations of Lyme disease. (1991)

Ir Med J. 1991 Mar;84(1):20-1.

Reilly M, Hutchinson M. Department of Neurology, Adelaide Hospital, Dublin.

http://www.ncbi.nlm.nih.gov/pubmed/2045261

Abstract

Neurological disorder may be the initial manifestation of Lyme disease. Six cases of neurological Lyme disease have been seen in the years 1986-89, five of whom contracted the disease in the West

of Ireland. Three presented with a radiculoneuropathy, one with myalgia/fatigue and one with bilateral sixth nerve palsies and ataxia. These cases indicate the spectrum of neurological involvement of Lyme disease in Ireland which reflects that seen in Europe. They also highlight some of the problems in diagnosis which sometimes necessitate treatment while awaiting serological studies. We feel even in the absence of a history of tick-bite or rash, Lyme disease should be considered in the differential diagnosis of many neurological disorders, especially in patients from the West of Ireland.

PMID: 2045261 [PubMed - indexed for MEDLINE]

22. West of Ireland Lyme Borreliosis Mapping Project. (2010)

Session: Abstracts: Bacterial Infections (IDSA)Saturday, October 23, 2010

http://idsa.confex.com/idsa/2010/webprogram/Paper4330.html

Background: Lyme disease is the most common vector-borne infection in temperate regions of the Northern Hemisphere. However, in many Lyme endemic areas epidemiologic data are sparse.

Methods: Serum samples referred for Borrelia serology processed through our centre from 2005 to 2009 inclusive were reviewed. Samples fulfilling immunoblot criteria for positivity were included. All cases were mapped using Geographical Information System (arcGIS) software based on their residential address. Cases were mapped against landuse using Corine data (Co-ordination of Information on the Environment) Land Cover 2006 courtesy of the EPA via the European Environmental Agency. Cases were also mapped per DED (District Electoral Divisions). Using population data from CSO (Central Statistics Office) Census 2006, 5 year incidence per 100,000 population per DED was calculated and mapped.

Results: 152 cases were identified over the study period, 18 in 2005, 23 in 2006, 19 in 2007, 41 in 2008 and 51 in 2009. Clinical data were available for 55 cases. There was a considerable variation in incidence per DED. ( Map to be shown) Landuse types of peat bog and transitional woodland were associated with higher incidence rates. 5 year incidence per DED showed clustering of 5 year incidence rates above 151 per 100,000 in an area of west Galway called South Connemara.

Conclusion: Considerable disparity in incidence by region was observed. This could be partially explained by differences in landuse and local ecology of hosts. This needs to be further investigated for biological explanation, such as tick or host infection rate, borrelia genospecies and human behaviour. These maps allow for targeted public health intervention, with the provision of information on prevention of tick bites and early diagnosis of Lyme Disease in high incidence areas.

Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Speakers: Eoghan de Barra, MB, Bch , Department of Infectious Diseases, University College Hospital GalwayEavan Muldoon, MB, Bch , Department of Infectious Diseases, University College Hospital GalwayGeraldine Moloney, MB, Bch, Department of Infectious Diseases, University College Hospital, GalwayDeirdre Goggin , Department of Public Health, Health Service Executive West, Galway, Ireland Belinda Hanahoe, BSc , Department of Microbiology, University College Hospital Galway, GalwayGeraldine Corbett Feeney, MB, Bch, Dept of Microbiology, University College Hospital, GalwayCatherine Fleming, MPH, MB, Bch, Dept of Infectious Diseases, University College Hospital Galway

23. Blood-meal analysis for the identification of reservoir hosts of tick-borne pathogens in Ireland.

Vector Borne Zoonotic Dis. 2005 Summer;5(2):172-80. Pichon B, Rogers M, Egan D, Gray J.Department of Environmental Resource Management, University College Dublin, Belfield, Dublin.

http://www.ncbi.nlm.nih.gov/pubmed/16011434?dopt=Abstract

Abstract

The results of analysis of blood-meal remnants in unfed nymphs, despite relatively low detection levels (49.4%, n = 322), support the conclusion from an earlier study that small rodents are relatively unimportant as reservoir hosts of B. burgdorferi s.l. in this particular area, and suggest that songbirds (Passeriformes) are the most significant hosts in this respect. Tick (Ixodes ricinus) abundance was greater in the present study, but the overall Borrelia burgdorferi s.l.-infection prevalence of nymphal ticks was the same (12.2%), and the relative proportions of the various Borrelia burgdorferi s.l. genospecies were similar. B. garinii and B. valaisiana were the most frequent, B. burgdorferi s.s the least frequent, and B. afzelii of intermediate frequency. An unusually high proportion of nymphs (39%) with multiple infections of different B. burgdorferi genospecies was detected, and Borrelia spp. related to relapsing-fever spirochetes were detected in Ireland for the first time. The results of the present study contribute to the validation of blood-meal analysis as a means of determining the host origin of certain pathogens in unfed questing ticks, and raise some questions concerning the extent of B. burgdorferi s.l. host specificity.

PMID: 16011434 [PubMed - indexed for MEDLINE]

24. Call for Lyme disease to be added to HPSC’s notifiable diseases list

Ailbhe Jordan | 29 Apr 2010 | 0 Comment(s)

http://medicalindependent.ie/page.aspx?title=call_for_lyme_disease_to_be_added_to_hpscs_notifiable_diseases_list

A Galway GP is calling for Lyme disease to be added to the Health Protection Surveillance Centre's (HPSC) list of notifiable illnesses.

Dr John McCormack, who practices in Rosmuc, spoke out following the publication in February of a study by neurologists at University College Hospital Galway, which found that the Republic of Ireland has one of the highest rates of Lyme disease in Europe and suggested that the condition was "endemic," in the West of Ireland.

According to the research, Portumna in Galway has the highest seroprevalence in the country of 8.7 per cent, compared to a national average of 3.4 per cent.

The report was prompted by research Dr McCormack carried out in Connemara in 2006 after discovering that GPs were dealing with a cluster of at least 19 cases in the area.

His survey, which was published in the ICGP journal Forum in May 2008, challenged the preconception that the disease was "a rare illness that someone brings home, having travelled to North America".

Of 19 patients who were suffering from the disease - which in Ireland is commonly transmitted through deer ticks - only two contracted it abroad; one in the US and one in Prague.

"Smallpox is still a notifiable disease, so too is anthrax, which is irrelevant apart from when terrorists send powder in white envelopes, but Lyme disease, which is genuinely with us and on the up-and-up, is not," Dr McCormack told the Medical Independent.

The UCHG report found that of 42 patients with serological evidence of acute Lyme disease, 67 per cent were living in the West of Ireland, while recent travel outside Ireland was documented in just seven cases.

Consultant Neurologist Dr Timothy Counihan, senior author of the report, said awareness and diagnosis of Lyme disease was poor amongst Irish medical practitioners.

While the disease is usually treatable by common antibiotics such as amoxicillin, the report found that Lyme disease can lead to "significant neurological complications," especially if it is left untreated.

"The disease is under recognised," Dr Counihan told the MI.

"It is treatable but easy to miss and if not treated, can be very serious. And there is a lack of awareness about it except in niche areas like dermatology and neurology."

Latest figures available from the HPSC show that in 2007, 71 cases of Lyme disease were reported in Irish hospital laboratories, indicating a crude incidence rate of 1.67 per 100,000. However the report acknowledged that the true figure was likely to be higher due to the lack of available data.

As the summer season approaches, when most cases of the disease are diagnosed, Dr McCormack said more up-to-date data are needed.

"We just have no proper figures or data on it," he said.

"There is a trailer-load of Lyme disease out there - it may not be spotted or is being spotted late and that has significant consequences."

Minister for Health Ms Mary Harney said last September there were no plans to make Lyme disease notifiable, in correspondence with the patient advocacy group Tick Talk.

25. Lyme disease in Ireland.

Cryan B, Cutler S, Wright DJ.

Source Dept of Medical Microbiology, Cork Regional Hospital, Wilton.

Ir Med J. 1992 Jun;85(2):65-7.

Abstract

The data pertaining to Irish specimens sent to the Lyme disease Laboratory at Charing Cross Hospital since 1986 is presented and discussed. In the period up to June 1990, 484 specimens were tested, 14% of these were positive by enzyme linked immunosorbent assay or indirect immunofluorescent assay. Only 13 of these were confirmed as positive by immunoblotting.

PMID: 1628946[PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/1628946

26. Acquisition of Borrelia burgdorferi by Ixodes ricinus ticks fed on the European hedgehog

Gray JS, Kahl O, Janetzki-Mittman C, Stein J, Guy E.

Exp Appl Acarol. 1994 Aug;18(8):485-91.

Source Department of Environmental Resource Management, University College Dublin, Ireland.

http://www.ncbi.nlm.nih.gov/pubmed/7628256

Abstract

A hedgehog, Erinaceus europaeus, was found to be heavily infested with larval and nymphal Ixodes ricinus in a forest park in Co. Galway, Ireland. A large proportion of the ticks that engorged and detached were infected with the spirochaete, Borrelia burgdorferi, the causative agent of human Lyme borreliosis. The identity of these spirochaetes was confirmed by immunofluorescent assay with B. burgdorferi-specific monoclonal antibody and by polymerase chain reaction test and they were transmitted from the hedgehog to laboratory-reared ticks and from the ticks obtained from the hedgehog to gerbils (Meriones unguiculatus). The high infection rate of the larvae that fed on the hedgehog in comparison with unfed larvae from the same habitat was interpreted as strong evidence that this host species is reservoir competent. Since hedgehogs can evidently feed adult ticks as well as many immature stages, they may well have an important role in the ecology of Lyme borreliosis in some habitats.

PMID: 7628256 [PubMed - indexed for MEDLINE]

27. Babesias of red deer (Cervus elaphus) in Ireland

Vet Res. 2011 Jan 18;42(1):7.

Zintl A, Finnerty EJ, Murphy TM, de Waal T, Gray JS.UCD School of Biology and Environmental Science, University College Dublin, Ireland.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037898/?tool=pubmed

The initial screen using PCR protocol I revealed that 18 deer carried Babesia spp. infections (26%), with 17 originating from Glenveagh and 1 from Killarney.

The deer in all the locations were exposed to heavy tick (Ixodes ricinus) challenge judgingby the numerous attached ticks observed at culling.

The significance of these parasites as disease agents is unknown and further studies, in additionto gene analysis, including isolation of the parasites and transmission studies in vitro or in vivo systems are necessary to establish their identities, particularly that of the putative B. divergens.

28. Tick-borne disease on Irish farms

By Micheal Casey

http://www.farmersjournal.ie/site/farming-Tick-borne-disease-on-Irish-farms-12922.html

#Mícheál Casey from the Department of Agriculture's Regional Veterinary Laboratory service, outlines the common tick-borne diseases affecting Irish livestock

Ticks are blood-sucking parasitic members of the Arachnidae - the same class of eight-legged arthropods as spiders. Diseases transmitted by ticks are a major cause of economic loss, disease and deaths in farmed animals worldwide.

Although there is only one species of tick that affects Irish livestock - the 'castor bean tick', Ixodes ricinus - it can act as a vector for a range of diseases. All references to ticks in this article refer to this tick.

Ticks have some fairly precise environmental requirements, especially when they leave the relative shelter of the base of the vegetation. They find a new host by 'questing', where they climb to the tips of the vegetation and grab onto any animal (or person) that passes.

They need mild and moist conditions for questing, which are provided in late spring and in autumn in a typical Irish year, resulting in clearly defined spring and autumn peaks in tick-borne diseases.

On some farms the ticks have become adapted to one or the other season, while on other farms both peaks are seen.

Tick-borne fever

This disease is caused by a bacterium (Ehrlichia phagocytophila) and is normally mild and transient. Although this is not commonly diagnosed, it is probably the most important tick-borne disease in Ireland.

Firstly, it is very common; so common, in fact, that most herds have a high level of resistance and most infection occurs in young and bought-in animals. As the name suggests, animals run a temperature for a couple of days, lose their appetite, they may cough a little and milk yield of cows drops significantly.

The reason for the significance of tick-borne fever is the brief but severe immunosuppression that accompanies infection with the organism. Affected animals are very susceptible to other infections at the time of infection, and vaccines for other diseases that are administered at the time of tick-borne fever infection will not take effect.

Furthermore, if the tick that infects the animal is also carrying one of the other tick-borne diseases, then infection is more likely and the ensuing disease may be more severe.

Tick-borne fever is a hidden but important factor in every other tick-borne disease.

Babesiosis -'Redwater'

This parasite, Babesia divergens, is carried by ticks and is capable of being transmitted from one generation of tick to the next, so a reservoir of infection can be maintained on pasture even when no livestock have grazed that pasture for several years.

Once inoculated into the bloodstream, the organism replicates rapidly in red blood cells, which are ruptured as each generation of the parasite emerges. Animals run a high temperature which then falls rapidly, often below normal, as the disease progresses. Affected animals become dull, lose their appetite, become slow and may have difficulty standing or walking as the disease progresses. The oxygen-carrying haemoglobin is released from the ruptured red blood cells and passes through the kidneys and out in the urine, giving it a characteristic reddish brown colour and giving the disease its common name - 'redwater'. The heart races as the body tries to compensate for the loss of circulating blood cells. Deaths can occur due to heart failure, kidney failure or anaemia, and blood transfusions may be required in the treatment of the most severely affected cases.

Drugs that prevent multiplication of the parasite are administered, but it is the effects of disease that are the most difficult to treat - anaemia, dehydration (and associated constipation).

One unique feature of redwater is the 'reverse age immunity' phenomenon. Calves are resistant to the disease until they are about six months of age. After that, the resistance an animal has to redwater in later life will depend on whether they were exposed to the disease as calves. Animals that have no resistance tend to develop a very severe form of the disease, and many farms routinely protect bought-in animals with a drug that gives protection for about four weeks. If this is given just before peak tick activity, there is a good chance that the animal will be bitten, infected and develop resistance without getting the disease, while protected by the drug.

Redwater seems to be decreasing in incidence and in severity in recent years. Partly, this is due to improved pasture management, which eliminates tick habitat. It also seems likely that the widespread use of Ivermectin-type products may have had an impact on tick productivity.

Tick pyaemia

This is a disease of young lambs, which is caused by a common skin bacterium, Staphylococcus aureus. These bacteria are inoculated from the skin surface by the tick as it bites and get into the bloodstream causing septicaemia (blood poisoning). While the lamb's blood carries the bacteria around the body, the tick will frequently be infecting the animal with tick-borne fever, which results in the bacteria 'seeding' the internal organs and tissues, especially the liver and the joints. A second septicaemia, often fatal, may occur at this stage. Affected lambs become slow and stiff and will die if untreated.

Q fever

Q fever is caused by bacterium, Coxiella burnetti, and is very similar to tick-borne fever. Little is known about Q fever in Irish farm animals, largely because of the unavailability of diagnostic tests. It is known to occur here, and is tick-transmitted. It is likely to be behind some abortion outbreaks in sheep and cattle and may have an immunosuppressive role in a wide range of diseases

Lyme disease

This bacterial tick-borne disease caused by Borrelia burgdorferi is strongly associated with deer, and the infection risk for humans and animals is highest in woodland and nearby pasture.

It is 'one to watch' as our wild and farmed deer population grows. It causes a fever and rash and can progress to cause central nervous system disease, arthritis and blood vessel damage in humans.

Again, little is known about the disease in Ireland, as it is rarely diagnosed, although blood testing shows that exposure to infection is common.

This is a serious and potentially fatal disease in humans, so it is very important to seek medical attention if any relevant symptoms are seen after a tick bite.

Louping Ill

This virus causes encephalitis (brain inflammation) in sheep and is often fatal. It tends to occur in ticks in well-defined areas and is best controlled on affected farms by sourcing replacements from home-bred animals, or at least from within those areas.

Control

A common feature of many tick-borne diseases is the strong, often life-long, immunity that results from infection. As a result, strong herd immunity develops, and very little disease tends to occur in stable, closed herds, even in heavily infested areas.

The exception here would be tick pyemia in lambs, where certain farms have a problem year after year unless they control the ticks.

Control of ticks requires the recognition and elimination of ideal tick habitat. Because ticks require mild, moist conditions, they are usually found at the base of dense vegetation. Ideal conditions for ticks occur where grass is growing through one or two years of dead previous growth (areas ungrazed for several years), and there is a moist decaying mat of old vegetation at the base of the sward. This is something to watch for when renting grazing land that may have been fallow for some time.

Control is achieved by minimising this phenomenon and by keeping animals fenced out of likely areas. Good pasture management and the rotation (where possible) of forage and grazing areas should minimise the amount of tick habitat.

The use of acaricides (chemicals that kill ticks) with residual effect will give protection against ticks for several weeks, and is a common practice, as a way to protect cattle or lambs during periods of peak risk.

However, preventing tick bites will also prevent the acquisition of immunity, so these animals will continue to be vulnerable once the protection offered by the acaricide wears off.

Another useful control measure is to source replacements within the herd, or at least locally, so that they will have been exposed to the range of tick-borne diseases that occur in that area.

Great care is needed when introducing animals from tick-free farms to areas where they will face a significant challenge, as these animals will have no immunity to tick-borne disease.

29. A Lyme Disease Serosurvey of Deer in Irish National Parks

J. S. Gray, T. J. Hayden, S. Casey, F. Kirstein, S. Rijpkema and S. CurtinBiology and Environment: Proceedings of the Royal Irish Academy Vol. 96B, No. 1 (Jun., 1996), pp. 27-32 Published by: Royal Irish Academy

Full download available to members, abstract & preview of first page available at: http://www.jstor.org/discover/10.2307/20499953?uid=2&uid=4&sid=21102640989881

30. Considering the unusual diagnosis

This was published in medical independent by Dr Fry (TMB clinics) Feb 2013:

Case report 5

A 22-year-old female (MC) was referred by her GP who considered that she was probably suffering with drug abuse withdrawal after her return to Ireland from Connecticut (USA) where she had been during the summer months. On presentation this patient was fully conscious but had persistent tonic/clonic movement of the right side of her body for the entire 40 minutes of this initial consultation. The main points from past medical history were unremarkable (including no drug abuse) except she did report that she had a circular rash on her right forearm some months previously – which was confirmed on a coincidental holiday photograph. On closer evaluation she had some park and forest type exposure during the preceding weeks before the rash appeared. Blood evaluation confirmed no specific abnormality except her Lyme serology showed ‘reactive’ change but her Western Blot examination was reported as negative. No confirmed definite diagnosis was made but the patient responded very well to intense antibiotic treatment for presumed borreliosis.

Case report 3

TH and RH went on their honeymoon to South Africa. As part of this holiday trip they visited a national park close to Port Elizabeth for a few days. During this part of their holiday they undertook a guided walking safari along some of the trails to get a better view of some of the small animals Africa has to offer. They returned home a few days later and both remained well for a few days. However, on the fourth day back in Ireland they both became significantly ill. Presentation included high fever, rigors, and myalgia and, perhaps quite understandably, the initial presentation with their GP raised the possibility of malaria – although they had not actually been to any of the at-risk regions within South Africa. Following referral, on close examination the only clear physical finding they both had was a small eschar lesion, which strongly suggested the possibility of tick bite fever. In both cases they responded very quickly to a course of doxycycline.

Chronic fatigueNowadays the term ‘chronic fatigue syndrome’ is regularly used to cover a wide variety of clinical conditions where the underlying cause may vary from physical (endocrine, tumours, bacterial, viral, parasitic, metabolic, poisoning etc) to psychological issues. Shrinking the differential diagnosis to a more manageable level takes all the detective skills of the modern medical practitioner. Of course, mistakes will be made where conditions are not considered or perhaps disregarded due to a preconception that the disease has a psychological basis. When assessing these patients it is important to consider a number of points including when the condition first become noticeable, what the individual had done in the days, weeks and even months prior to this, what aggravates or eases the condition and also if any physical (objective) signs are evident. A detailed history of the individual’s social lifestyle before becoming sick may uncover risk factors (hill walking, animal lover, work / social experiences etc) as well as potential exposure risks (organophosphate exposure, lead or radon poisoning etc). If any other individuals are affected, then the possibility of a common source needs to be considered.

31. The biology of Ixodes ticks, with special reference to Ixodes ricinus

J. S. Gray, Department of Environmental Resource Management, University College Dublin, Ireland.

Abstract

Ticks of the Ixodes ricinus (persulcatus) species complex are vectors for several zoonotic diseases including, babesiosis, ehrlichiosis, Lyme borreliosis and tick-borne encephalitis. An understanding of the biology of the vectors is fundamental to prevention and control of these diseases, and in addition to summarising established knowledge, this review addresses recent work on seasonal activity, host specificity, inter- and intraspecific variations in biology and factors affecting distribution and abundance.

Inc table on bovine baesiosis cases in Co Westmeath plus numbers of borrelia infected mice in Ireland..http://www.zooeco.org/zooeco/soczee/meetings/CRTBI/abstract/grey.asp?print=yes

32. Exposure of cattle immunised against redwater to tick challenge in the field: challenge by a homologous strain of B divergens.

Taylor SM, Kenny J, Purnell RE, Lewis D., Vet Rec. 1980 Feb 23;106(8):167-70.

Abstract

A field trial was conducted in Northern Ireland to determine whether calves could be protected against babesiosis by the prior inoculation of irradiated blood infected with Babesia divergens; The trial involved 30 yearling calves. Ten were inoculated with infected blood from a donor calf after the blood had been irradiated at 25 kilorads, and 10 with blood irradiated at 30 kilorads. Their reactions

to the inoculation were observed daily for a month. They were then released, along with a control group of 10 susceptible calves, into an area heavily infested with B divergens-infected Ixodes ricinus ticks for two months. Between 24 and 41 days after exposure all the control animals contracted babesiosis and six of them reacted severely. None of the immunised animals suffered clinical babesiosis although 14 had detectable low-level infections. The relative severity of the reactions of the groups of calves was reflected in their haematology.

PMID:7361409 [PubMed - indexed for MEDLINE]http://www.ncbi.nlm.nih.gov/pubmed/7361409

33. Lyme disease often under diagnosed says HPSC

Epi-Insight, Volume 10, Issue 11, November 2009

http://ndsc.newsweaver.ie/newepiinsight/u39uoefvv381trn9tg2qo4

34. Newspaper articles & radio interviews..

Published in the Irish Independent December 9th 2013 I was so tired and had this feeling that I’d just collapse Tracy Brennan’s struggles to get diagnosed & treatedhttp://www.independent.ie/lifestyle/health/i-was-so-tired-and-had-this-feeling-that-id-just-collapse-29820427.html

Published in the Irish Independent November 22nd 2013 Poor diagnosis exposes hundreds to potentially deadly Lyme disease Report of the recent hearing in Dublinhttp://www.independent.ie/irish-news/poor-diagnosis-exposes-hundreds-to-potentially-deadly-lyme-disease-29775250.html

A copy of the full hearing transcript of the Oireachtas Heath Committee debate available at: http://oireachtasdebates.oireachtas.ie/Debates%20Authoring/DebatesWebPack.nsf/committeetakes/HEJ2013112100001?opendocument

Published in the Galway Advertiser September 20th 2013 Living with Lyme Disease Benen Smyth (TTI volunteer) describes the struggles with Lyme & how it changed his life forever..http://www.advertiser.ie/galway/article/63862/living-with-lyme-disease

Published in the Irish News August 31 2013 Ticking off Bug Biteshttp://ticktalkireland.files.wordpress.com/2012/04/irish-news-aug-31-2013.pdf

Published in the Irish Times August 6th 2013 What Lurks in the Long Grass http://www.irishtimes.com/life-and-style/health-family/my-health-experience-what-lurks-in-the-long-grass-1.1485296?page=1

Published in the Irish Daily Mail June 11 2013 Lady describes how she became wheel chair bound after a tick bite in Scotland http://ticktalkireland.files.wordpress.com/2012/04/daily-mail-ireland-june-2013.pdf

Tipperary Star publishes school children holding a copy of Luna & Dips, Tick Talk’s new book on ticks – May 2013 http://ticktalkireland.files.wordpress.com/2012/04/tipp-star.jpg

Irish Independent – May 2013 Don’t Get Ticked Off This Summerhttp://www.independent.ie/lifestyle/health/dont-get-ticked-off-this-summer-29244233.html

Irish Daily Mail – May 2013 Experts Warn About Lyme Diseasehttp://ticktalkireland.files.wordpress.com/2012/04/daily-mail-article-may-2013.pdf

Galway Independent Nov 2012 Ballinasloe woman warns of Lyme Disease threat (with Tick Talk officer Jenny O’Dea) http://galwayindependent.com/20121115/news/ballinasloe-woman-warns-of-lyme-disease-threat-S6447.html

Sunday Mirror article about Marina Murphy July 2012 If Marina doesn’t get treatment soon I’ll be burying her http://ticktalkireland.wordpress.com/2012/07/25/stuck-in-a-rut/

Published Westmeath Independent – April 2012 Ballinasloe woman starts campaign (with Jenny O’Dea) https://ticktalkireland.files.wordpress.com/2012/04/westmeath.jpg

Published Wicklow People – April 20 2011 Focus on Lyme Disease (with TTI chair Pauline Reid) https://ticktalkireland.files.wordpress.com/2012/04/wicklow-people-lyme-april-20-2011.pdf

Published Irish Examiner – April 8 2011 Lyme Disease ticked all the boxes (with Niall McDermott, TTI volunteer) https://ticktalkireland.files.wordpress.com/2012/04/my-lyme-story-9th-april-2011.pdf

Published in the Irish Evening Herald April 2011 Ray Mears raises awareness http://ticktalkireland.files.wordpress.com/2012/04/ray-mears-lyme-disease-2011.pdf

Published Irish Times – Tuesday, July 27 2010 Blood-sucking mites at root of Lyme disease http://www.irishtimes.com/newspaper/health/2010/0727/1224275535938.html

Published Irish Independent Monday July 12 2010 Be careful of walks on wild sidehttp://www.independent.ie/health/be-careful-of-walks-on-wild-side-2254859.html

Published Irish Herald Thursday June 24 2010 Tick warning over cases of Lyme diseasehttp://www.herald.ie/national-news/tick-warning-over-cases-of-lyme-disease-2232993.html

Published Irish Independent - Wednesday June 23 2010 (see item 18 in list) Warning on ticks link to Lyme disease http://www.independent.ie/national-news/warning-on-ticks-link-to-lyme-disease-2230815.html

Published Irish Times - Tuesday, June 15 2010 (see item 19 in list) Ticked off by danger of Lyme disease http://www.irishtimes.com/newspaper/health/2010/0615/1224272506521.html

Published Daily Star April 2010 Lyme Disease rife across countryhttps://ticktalkireland.files.wordpress.com/2012/04/star-lyme-disease-2010.jpeg

Published Irish Kerryman Wednesday January 06 2010 Letter by Tick Talk co-founder Janet Fitzgerald http://www.kerryman.ie/lifestyle/letters-deer-and-the-risk-of-lyme-disease-2000912.html

Published Kerryman 2010? Tick could be a time bomb (by co-founder Janet Fitzgerald)https://ticktalkireland.files.wordpress.com/2012/04/killarney-article.jpg

Published Irish Mountain Log summer 2009 Are you tick aware? (Article by Jenny O’Dea)https://ticktalkireland.files.wordpress.com/2012/04/mountaineering-article.jpg

Published Irish Farmer’s Jnl June 2009 Getting Ticked Off (interviews with Tick Talk members Janet & Ness)https://ticktalkireland.files.wordpress.com/2012/04/farmers-jnl-1-jun-09-small.jpg (pg 1)https://ticktalkireland.files.wordpress.com/2012/04/farmers-jnl-2-jun-09.jpg (pg 2)

Published Irish Independent 2007 Irish Patients could be misdiagnosedhttps://ticktalkireland.files.wordpress.com/2012/04/irish-ind-sunday-2007-scan1.jpg

Published in Prima Magazine April 2003 My Nasty Holiday Souvenir (with TTI member Ann)http://ticktalkireland.files.wordpress.com/2012/04/prima-apr-2003.jpg

Published on My Kids Time site Protect your Kids article by Jenny O’Dea (Tick Talk Ireland):http://www.mykidstime.ie/protecting-your-kids-from-the-dangers-of-ticks/

Radio interviews with Tick Talk members

Kilkenny Radio

For a radio interview by Tick Talk member Ann Maher who was in the public gallery of the Oireachtas Health Committee Hearing: KCLR 96 FM 22 Nov 2013 (Sue Nunn show)

http://kclr96fm.com/the-sue-nunn-show/anne-maher-talks-lyme-disease/

Midland FM Radio

David Galvin talking about his wife’s struggle with Lyme Disease & getting treatment for her new diagnosis. Wheelchair bound & having speech problems they are seeking help with Carol’s treatment fund (Oct 2013)

http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.midlandsradio.fm%2Fcustom%2Fpublic%2Ffiles%2Flyme-disease.mp3&h=DAQGI71dr

Galway Bay FM

Tick Talk volunteer Mary Smyth on Galway Bay FM talks about her husband’s experience with Lyme Disease & how difficult it was to get diagnosed (6th Sep 2013)

http://www.galwaybayfm.ie/home/podcasts/item/2446-galway-talks-with-keith-finnegan-friday-6th-september

Skip to 48:45 into the show (Keith Finnegan) & lasts until 1:00.

RTE Radio

7th January 2014: RTE 2 Ryan Tubridy show with Tracy Brennan (Tick Talk member & committee member for the recent Lyme Disease Hearing talks of her experiences getting a diagnosis & treatment) http://www.rte.ie/radio/utils/radioplayer/rteradioweb.html#!rii=1%3A20500479%3A4678%3A07%2D01%2D2014%3A

RTE 1 (Liveline) covered Lyme Disease over 2 days. Some Tick Talk members joined the show to talk about their experiences..

20th August 2013:http://www.rte.ie/radio1/liveline/programmes/2013/0820/469252-liveline-tuesday-20-august-2013/?clipid=1292576

21st August 2013:http://www.rte.ie/radio1/liveline/programmes/2013/0821/469464-liveline-wednesday-21-august-2013/?clipid=1293293

2nd June 2012: Interview with Tick Talk officer Jenny O’Dea & Dr John McCormack on Countrywide Radio

http://www.rte.ie/radio1/countrywide/2012-06-02.html (podcast seems to be no longer available!)

On the 4th and 5th of July 2011, Radio 1 s Liveline discussed Lyme Disease in Ireland. Many members′ of the public that have been affected by Lyme phoned in to tell their stories. We have the podcasts here for anyone who missed them.

http://ticktalkireland.org/radio.html

2009: Discussion on RTE FM re: Lyme with Tick Talk member Niall:http://www.rte.ie/podcasts/2009/pc/pod-v-1425s-20909-weeklyryan.mp3

2009: Dr Eoin Healy of the Dept. of Zoology talks on how to prevent tick bites:http://www.rte.ie/podcasts/2009/pc/pod-v-30809-358s-weeklyryan.mp3

Disability Radio

19th June 2012: Interview with Tick Talk member Niall McDermott on Disability radio (Cork Life FM) sound quality a bit bad in places..http://ericisherwood.podomatic.com/entry/2012-06-19T01_00_00-07_00

An Ode to Health & Ignorance on Radio Netherlands (with Tick Talk member Ann Maher)

http://static.rnw.nl/migratie/www.radionetherlands.nl/radioprogrammes/voxhumana/060922vh-redirected (link no longer working however part of script can be found at: http://ticktalkireland.wordpress.com/lyme-links/lyme-on-radio/

TV interview with Tick Talk members

Chair Pauline Reid talks of her struggles on the Morning Show (link no longer working)http://www.tv3.ie/videos.php?video=39778&locID=1.65.370

Pauline from Tick Talk speaks on TV just before our conference in 2012!http://vimeo.com/44034845