more_vert
WHILE debate over the existence of Lyme disease in Australia continues, experts agree on the importance of GPs being alert to the disease in patients who have travelled overseas.
Professor Miles Beaman, medical director of Western Diagnostic Pathology and clinical professor of microbiology at the University of WA, told MJA InSight that “despite the press hysteria, there is no endemic Lyme disease in Australia”.
“Cases that do occur are imported from a known endemic area — which is most of the rest of the world.”
Professor Beaman was responding to a report published this week in the MJA which detailed the first case of Lyme neuroborreliosis in a returned Australian traveller. (1)
The 58-year-old woman presented to a NSW rural hospital in May 2014 with a history of worsening motor instability, confusion and bilateral occipital headaches. Her symptoms started 1 month after returning from a trip to Lithuania, where she had been bitten by a tick.
On presentation, there were no focal neurological signs, and cardiovascular, respiratory and gastrointestinal parameters were within normal limits. Serological screening of the patient’s serum and cerebrospinal fluid showed a positive immunoglobulin response to Borellia antigens. The results were confirmed by western immunoblotting.
The patient completed 2 weeks of treatment with intravenous ceftriaxone, and 5 months later her cerebrospinal parameters were normal. The patient continued to see her GP and made a good clinical recovery.
The authors wrote that the case highlighted how Lyme disease could present with non-specific symptoms that could persist for weeks to months after infection. “A careful travel history is therefore an important part of the assessment of any patient with clinical features suggesting the disease.”
Professor Peter Collignon, executive director of ACT Pathology and infectious diseases physician at Canberra Hospital, echoed Professor Beaman’s statement, telling MJA InSight “I do not believe we have Borrelia in Australia”.
However, he said the case report did highlight the importance of health professionals asking patients if they had travelled recently, especially if they presented with acute respiratory symptoms.
“Yes, it takes extra time but without asking we could diagnose Lyme disease as something else”, Professor Collignon said.
Dr Stephen Graves, microbiologist and spokesperson for Lyme disease for the Royal College of Pathologists Australasia (RCPA), was also “confident” that Lyme disease does not occur in Australia, but told MJA InSight that the case report confirmed “that we certainly do have the ability to diagnose Lyme disease here”.
Dr Graves said that while no diagnostic protocol was uniformly accepted as ideal, the two-tier system of enzyme immunoassay followed by confirmatory western immunoblotting used by the MJA authors was the most effective, and is endorsed by the RCPA. (2)
He said many laboratories in Australia and other parts of the world “were not doing these tests properly, which is where the problem of false-positives arises”.
Professor Beaman agreed, saying a common problem was doctors not properly assessing pre-test probability and “ordering the wrong tests from the wrong laboratories”.
However, Jennifer Sherer, vice present of the Lyme Disease Association of Australia, told MJA InSight her association disagreed with the assertion that Lyme disease did not exist in Australia, saying research was indicating otherwise.
A study published last week detected a relapsing fever Borrelia species in Australian ticks, as well as other potential pathogens. (3)
The Murdoch University researchers conducted an analysis of Ixode holocyclus and I. ricinus ticks collected in Australia and Germany respectively. They found evidence of Borrelia burgdoferi sensu lato (the aetiological agent of Lyme disease) in the German ticks but not the Australian ones.
However, they wrote that the relapsing fever Borrelia could potentially produce symptoms consistent with Lyme-like disease, but more research was needed to confirm this.
“The aetiological agent of Australian ‘Lyme-like’ illness has been a source of unresolved debate for many years and the discovery of these organisms in Australian I. holocyclus ticks may provide insights into this medical conundrum”, the researchers wrote.
Ms Sherer said research like this, in addition to the number of Australians travelling to Lyme endemic regions, highlighted the need to improve medical education, saying she had spoken to GPs who had never even heard of Lyme disease.
“This is often why many [people] with Lyme disease prior to diagnosis visit in excess of six doctors, with some detailing over 20 different doctor visits before being diagnosed”, she said.
(Photo: Dr Morley Read / Science Photo Library)
Beaman, Colignon and Graves could well put their presumed scientific training to work instead of making blatantly ill-informed pronouncements. They are behaving like the drunk looking for his coin under the streetlight rather than where he lost it because “the light is better over here”.
Absence of evidence is not evidence of absence. Just because in the USA, Borrelia burgdorferi is associated with a particular tick does not mean that all Borrelia species will use the same vector. In fact there is evidence to suggest that there are multiple vectors and that Borrelia species are associated with several disorders other than “Lyme Disease” or Lyme Like Illneses. The work by Alan McDonald and Judith Miklossy suggests a far wider concept of Borreliosis that perhaps even Beaman, Colignon and Graves may be able to ge their heads around
A significant number of people were tested by the University of Newcastle in the 1990s . Using European testing materials, positive titres for Borrelia burgdorferi sensu latum, B. garinnii and B. afzellii were found. Given that the so-called “signature” of erythema chronicum migrans is now recognised to be observed in a minority of patients with B. burgdorferi infections and possibly not at all with B. garinnii and B. afzellii infections, the lack of intelligent use of diverse diagnostic procedures is unforgiveable.
If Beaman, Colignon and Graves might concede that testing patients with Lyme or Lyme-like symptoms with a range of testing methodologies might give more useful information than looking at one putative vector.
I’ve heard about a new ultraviolet machine called the UVLRx that’s being used for Lyme patients. It uses a fiber optic thread which is inserted directly into the vein and the treatment lasts for an hour, so all the blood is treated. Has anyone tried this?
There is a lot of cross reactivity in ricketssial serological tests. Proof of diagnosis is difficult. I do not believe that there is Lyme disease in Australia. But many people with protean symptoms are keen to latch onto a diagnosis and some practitioners foster these ideas. Snake oil and rubbish. The number of tests done for Lyme disease and other unlikely diagnoses and the cost of unproven remedies is shameful.
I am infuriated at the fact that Lyme-like disease (Borelliosis) and associated Co-Infections have been alive and well in Australian Cattle, kangaroos, bandicoot’s, bats, etc. There is Veterinary evidence of this from 1959 onwards, yet the Medical Fraternity fail to acknowledge it’s existance in Australia. What are the Government hiding?? Why is it, that animals can get tested and treatment for it, but humans can’t. I have NEVER left Australia, I live on a property surrounded by National Park and have Cattle and Horses and have found numerous ticks on me over the past 20 years, two of which produced the bullseye rash. Why can I speak to my Veterinarian about Borelliosis, yet I can’t speak to my GP without fear of being labelled a Hypochondriac? Why can’t the Medical Fraternity consult the Veterinary Fraternity and work together on this?? We are in the middle of winter here and there are ticks everywhere at the moment! Can you imagine what “Tick Season” is going to be like? I have already collected a number of Paralysis nymph ticks to send for testing, why isn’t the Government doing this? How much longer do we have to suffer, before something is done?
Let’s say I’m a bit disappointed in these statements from Professors Graves, Colignon and Beaman regarding Lyme disease in Australia. The fact that people who travelled to Europe or North America may have acquired the disease there despite not presenting any symptoms for years provides no justification for their assertion that all Australian Lyme disease was acquired abroad. Borrelia burgdorferi and related parasites live in a wide range of mammalian and avian hosts, so even ignoring the fact that there are plenty of introduced species in Australia (without considering humans or dogs) that could harbour it, it might have one or more native hosts too. Borrelia has been found in Ixodes holocyclus so you clearly have at least one potential vector. There are thousands of people in Australia with symptoms very similar to those of Lyme disease. You have everything you need for transmission of Lyme disease there – it may not be the same parasite, it may not be the same vector but you certainly seem to have the same type of hidebound scientific establishment trying to stifle research as we do over here in the UK.