Characterising DSCATT: A case series of Australian patients with debilitating symptom complexes attributed to ticks, 2021, Schnall et al.

Objectives(s):
To characterise the clinical profile, aetiology and treatment responsiveness of ‘Australian Lyme’, or Debilitating Symptom Complexes Attributed to Ticks.

Methods:
Single-centre retrospective case analysis of patients referred to the Infectious Diseases Unit at Austin Health – a tertiary health service in Heidelberg, Australia – between 2014 and 2020 for investigation and treatment of suspected Debilitating Symptom Complexes Attributed to Ticks. Patients were included if they had debilitating symptoms suggested by either themselves or the referring clinician as being attributed to ticks.

Results:
Twenty-nine Debilitating Symptom Complexes Attributed to Ticks cases were included in the analysis. Other than Lyme disease (83%), the most common prior medical diagnoses were Epstein–Barr virus (38%), chronic fatigue syndrome (28%) and fibromyalgia (24%). Prior histories of anxiety (48%) and depression (41%) were common. The most frequently reported symptoms included fatigue (83%), headache (72%) and arthralgia (69%). National Association of Testing Authorities/Royal College of Pathologists of Australasia–accredited serology was not diagnostic of acute infective causes, including Lyme disease, in any patient. Of 25 cases with available data, 23 (92%) had previously been prescribed antimicrobials, with 53% reporting benefit from them. The most common diagnoses made by our hospital were chronic fatigue syndrome (31%), migraines (28%) and fibromyalgia (21%). Only one patient’s symptoms were not accounted for by other diagnoses.

Conclusion:
This is the first case series of patients with Debilitating Symptom Complexes Attributed to Ticks. They had high rates of other medically unexplained syndromes, and no evidence of acute Lyme disease, or any common organic disease process. Debilitating Symptom Complexes Attributed to Ticks remains medically unexplained, and may therefore be due to an as yet unidentified cause, or may be considered a medically unexplained syndrome similar to conditions such as chronic fatigue syndrome.

Source: https://journals.sagepub.com/doi/10.1177/00048674211043788

 

Apparently, there "no evidence that the bacterial complex that causes acute Lyme disease – Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) – exists in Australian ticks."

So that makes it unlikely that these cases were due to Lyme disease (it could have been another tick-borne infection that triggered their illness though).

 

Quotes:

"Patients were included if they had debilitating symptoms suggested by either themselves or the referring clinician as being attributed to ticks."

"The most common diagnoses made by our hospital were chronic fatigue syndrome (31%), migraines (28%) and fibromyalgia (21%)."​

 

Here are more frustrating quotes from the article, including a reference to the PACE trial

"The high symptom overlap between these syndromes and low diagnostic stability in individual patients can be argued to support core transdiagnostic aetiological factors underlying these disorders and that common processes may perpetuate their symptoms and associated disability (Chalder and Willis, 2017). The fact that these syndromes commonly occur following infectious illnesses may suggest a multi-factorial response that, while incompletely understood, involves processes that may be universal (Chalder and Willis, 2017). In the case of DSCATT, tick bites may act as either an infective trigger or, potentially, through fear or anticipation of infection, as a psychological trigger."​

"While there is aetiological uncertainty, it may be best approached with transdiagnostic, aetiologically neutral rehabilitative therapies, which have proven effective for other unexplained syndromes (Chalder and Willis, 2017; White et al., 2011)."​

 

The lead author is Richard Kanaan, a crony of Wessely's and a promulgator of the 'secondary benefits' model.

After a Senate Inquiry into tick-borne illness here recommended allocating funding into researching possible causes of these illnesses, Kanaan ended up with the bulk of it to develop a CBT-based treatment for TBI.

I wouldn't trust a word of this paper.

 

It annoys me that they haven't bothered to investigate the obvious - namely there may be other tick-borne infections that are specific to Australian ticks.

 

Researchers at Murdoch Uni found a new Australian strain of Borrelia in echidna ticks apparently. They still don't know whether it can be transmitted to humans or whether it has an effect on human health.

The three year grant to this team to study possible tick borne infections runs out this year. Meanwhile, quacks like Kanaan continue to get taxpayers' money.