Annual progress reports
Developing Treatment for Debilitating Symptom Complexes attributed to Ticks (1169827)
- Professor Richard Kanaan (Chief Investigator A)
- University of Melbourne
- Budget: $1,055,766.00
- Funding period: 2019 to 2024
Project Synopsis
Chronic Lyme Disease is an unexplained condition. The causative organisms for Lyme Disease have long been identified and typically respond well to simple antibiotics, but many patients continue to report symptoms. Though in some cases this reflects inadequate treatment, there is a 'post-Lyme disease syndrome' whose aetiology has not been established and which remains controversial. This is even clearer in the Australian context, where no Lyme-causative organisms have been found. With analogous conditions, such as chronic fatigue syndrome, mechanistic models and effective therapies have been developed that focus on symptom management and graded activity to improve functioning and quality of life. These approaches adopt the principle of aetiological neutrality, with moderate success. This project would extend this approach to the Australian Chronic Lyme Disease variant, DSCATT (Debilitating Symptom Complexes attributed to Ticks). We plan to:
- review the many cases that have presented to our services to determine a case definition and a set of diagnostic requirements
- adapt the treatment approach for unexplained syndromes to the specifics of DSCATT
- conduct a feasibility randomised controlled trial to confirm the suitability of the therapeutic method to the population as well as assess the feasibility of a future trial using a priori parameters.
Progress report April 2024
The preparatory phases of the project have all now been completed. The case definition was established by a modified Delphi process involving consumers, clinicians and researchers, supplemented by statistical analysis of consumer survey data. This case definition has been included in the trial protocol and will be published in due course. The DSCATT symptom scale was completed following statistical analysis and has been included in the trial protocol, to be published in due course. The intervention was piloted and found to be acceptable and with evidence of efficacy; it has been modified following feedback from the pilot, and the patient manual included in the trial protocol. The pilot intervention's outcomes have been analysed and are also being written up for publication. The main project protocol has been submitted to ethics and received provisional approval. The feasibility randomized controlled trial was approved and commenced recruitment in 2023. The trial remains underway.
Publications and other resources
Schnall J, Oliver G, Braat S, Macdonell R, Gibney KB, Kanaan RA. Characterising DSCATT: A case series of Australian patients with debilitating symptom complexes attributed to ticks. Aust N Z J Psychiatry
G Oliver, VMZ Yap, T Chalder, VL Oliver, KB Gibney, A Dharan, SJ Wilson, RAA Kanaan, The challenges of living with debilitating symptom complexes attributed to ticks (DSCATT) – A qualitative study. Australian and New Zealand Journal of Public Health, 48(4): 100163 2024
For more information see University of Melbourne, Developing a treatment for DSCATT.
Troublesome Ticks: Determining the aetiology of DSCATT in Australia (1169949)
- Professor Peter Irwin (Chief Investigator A)
- Murdoch University
- Budget $1,934,788
- Funding period: 2019 to 2024
Project Synopsis
A four-year longitudinal study of patients with tick bite was conducted in order to provide a scientifically valid, evidence-based understanding of the cause(s) of debilitating symptom complexes attributed to ticks (DSCATT). With current uncertainty about the aetiology of DSCATT, the proposal encompassed clinical, psychological and laboratory assessment of tick bite patients, and matched controls, to better define the illness and to determine if infectious organism(s) are contributing to the symptom complexes. Utilising advanced molecular testing, immune profiling and routine pathology together with clinical and psychometric testing at the time of tick bite, and at subsequent occasions up to 12 months, physical and psychological correlates, and laboratory markers were evaluated. This study built upon recognised research and was conducted by a national team with expertise in medicine, psychology, epidemiology, microbiology, immunology and infectious disease and, crucially, Australia-wide access to samples. The team was therefore uniquely placed to analyse ticks, blood and skin biopsies from people bitten by ticks, and from controls living in the same geographical locations.
Progress report April 2024
Final samples from patients enrolled in the study during the 2022/2023 tick season were collected during the first few months of 2024, ending all formal patient interaction. Over 550 patient and control time-points have been sampled in total. Laboratory testing including tick identification and analysis, skin biopsies, pathologies, serology, and microbial cultures is complete. Metagenomics and immunological (transcriptomics and miRNA) data are in final stages of analysis, together with all psychometric data. Systems biology (conducted on a subcohort of patients) is complete, data analysed, and manuscripts have been published or are in review. All other results will be brought to publication during 2025.
Publications and other resources
Barbosa et al. (2022) The Troublesome Ticks Research Protocol: Developing a Comprehensive, Multidiscipline Research Plan for Investigating Human Tick-Associated Disease in Australia. Pathogens Nov 3;11(11):1290. https://doi.org/10.3390/pathogens11111290
Lee et al. (2023) A systems biology approach to better understand human tick-borne diseases. Trends Parasitol Jan;39(1):53-69. https://doi.org/10.1016/j.pt.2022.10.006
Lee et al. (2024) Molecular analysis of human tick-bitten skin yields signatures associated with distinct spatial and temporal trajectories - A proof-of-concept study. Heliyon 10 e33600. https://doi.org/10.1016/j.heliyon.2024.e33600