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INFECTIOUS disease experts have sought to set the record straight on the existence of locally acquired Lyme disease amid concerns that patients are being prescribed prolonged, often intravascular, antibiotics that the experts say could do more harm than good.
In a Narrative Review published in the MJA this week, the authors reported on a review of 5628 serological tests for Lyme disease received by a large private diagnostic clinic over a 23-month period.
Initially, 256 samples were found to be positive, but after two-tier testing with immunoassay and immunoblot, 50 samples from 43 patients were confirmed as positive. Of these patients, travel histories were available for only 37, and all had returned from countries in which Lyme disease was endemic, mostly Europe.
Lead author Professor Peter Collignon, infectious disease physician and microbiologist at Canberra Hospital and Executive Director at ACT Pathology, said there was no doubt that people were developing illnesses after tick bites.
“But the honest answer is, we don’t know why,” he said. “We have looked for Borrelia burgdorferi – which causes classic Lyme disease – and we haven’t been able to find it in any reproducible way.”
Professor Collignon told MJA InSight that false positives were common in antibody tests, and the only way to confirm existence of bacteria was to culture the microbe or detect the genome using polymerase chain reaction testing, and this had not been achieved in Australia.
He said it was possible that other unknown pathogens were causing people to develop illness after tick bites, as well as bacteria such as Rickettsia, which was known to be transmitted by ticks in Australia. He said a course of doxycycline or tetracycline was effective for Rickettsia, and could be given to these patients.
Associate Professor Josh Davis, vice president of the Australasian Society for Infectious Diseases, said that infectious disease physicians and other experts had been trying to identify Lyme disease in Australia for 30–40 years and had not found a single, proven, locally acquired case.
“It’s extremely unlikely that indigenous Lyme disease exists in Australia,” he said. “But it’s certainly possible that there are other tick-borne infections that have not yet been identified.”
Professor Davis said he had also seen many patients who had been bitten by ticks in Australia and developed non-specific illnesses.
“They think they have Lyme disease, but none of them do,” he said, adding that the only patients he had seen with confirmed Lyme disease had contracted the disease overseas.
“Of those people who have been bitten by ticks and have symptoms and illnesses, some of them, in my view, have acquired some kind of infection from the tick that we’re not able to diagnose yet, but most didn’t.”
Professor Davis said there was an increasing tendency to categorise illnesses with a constellation of symptoms – chronic fatigue, chronic aches and pains, concentration difficulties – as “Lyme-like illness”. This was concerning, he said, because it was based on an assumption that the illness was caused by an infection, and this may not be the case.
“There are a lot of people who have this constellation of symptoms and they are very real and distressing to people, so it’s very tempting to put a neat label on it,” he said.
However, he said this was leading to patients being placed on prolonged courses of high-dose antibiotics.
Professor Collignon said such therapy was likely to do more harm than good, both to society, by contributing to antibiotic resistance, and to the individual as antibiotics were often delivered intravascularly.
“Intravascular therapy kills people. People may get complications, such as clots or other infections, such as golden staph infections or Candida infections. We know that if you get those in your blood you have a 15–20% chance of dying.”
Professor Collignon said evidence from the US and Europe – where Lyme disease is confirmed – had also found that more than 4 weeks of therapy was not beneficial.
In early October 2016, the Medical Board of Australia reported that a West Australian GP, Dr Almayne du Preez, had been fined and reprimanded by the State Administrative Tribunal of WA for her treatment of a 17-year-old boy with suspected Lyme disease.
Dr du Preez referred the boy to a radiological clinic for insertion of a peripherally inserted central catheter (PICC) line for the administration of vitamins. He later developed sepsis due to the growth of Staphylococcus epidermidis in the PICC line.
Patient groups feel strongly that many in the mainstream medical profession are dismissive of their symptoms and concerns. As a result, in late 2015 the matter was referred to a Senate inquiry.
In an interim report published in May 2016, the inquiry recommended that education and awareness strategies be developed for the public (about the prevention of tick bites and seeking medical attention) and the medical profession (about the diagnosis and treatment of classical Lyme disease acquired overseas and of known tick-borne illnesses acquired in Australia). The inquiry is expected to continue.
Professor Collignon said efforts were underway to identify new tick-borne pathogens, pointing to a 2012 report of the first human case of Babesia infection in Australia, as well as recent efforts by WA researchers.
Speaking on SBS InSight in October 2016, Dr Charlotte Oskam of Murdoch University said her team had identified five new bacterial species unique to Australian ticks – including a novel species of Borrelia – but were yet to determine if the bacteria were transmissible to humans, or could cause disease.
Professor Collignon said it was important to look beyond Lyme disease, to broader potential causes of illness.
“My personal view is that we need to look at ticks and the diseases they transmit rather than focusing on Lyme disease,” he said. “Then, if we find bacteria, we have to find out if they are transmissible to people, and if they are likely to be causing symptoms.”
Professor Davis said that as well as investigating potential tick-borne pathogens, research was needed into chronic fatigue-type illnesses.
There also needed to be a change in the mindset of mainstream clinicians, he said.
“Mainstream medical practitioners also need to take these patients seriously. I don’t think modern scientific medicine is very good at acknowledging when we don’t know what’s causing something, and treating the patient’s symptoms on their merit and ruling out important treatable conditions.
“It’s important for us to have an open mind about other possible tick-borne pathogens, and about these syndromes of undefined illness that need further attention,” Professor Davis said.
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I was first bitten by a tick in 1958, very shortly after I developed classical Lyme symptoms which I have to this day. I first tested positive to Borrelia burgdorferi, B. garinii and equivocal to B. afzellii by Western Blot in 1995 (the Gold Standard at that time). I have subsequently tested positive using PCR (no false positives with this), the lab, in fact, commented that it was the strongest PCR response they’d ever seen). To reject the plethora of good replicable evidence for the presence of B. burgdorferi in favour of the political “head in the sand” attitude is both professionally incompetent and verges on the criminally negligent.
Dear Rosemary. a short excerpt from a tick allergy info sheet, with fairly new research, explains your problem!
You do have more to worry about then your list above.
Australian allergic diseases physicians first described an association between tick bites and the development of mammalian meat allergy and these findings have since been confirmed by researchers in the USA and in Europe. A subgroup of these patients will also be allergic to mammalian milks and animal-derived gelatin (present in some food products, as a binding agent in some medications as well as in intravenous blood substitutes known as gelatin colloid (e.g. Haemaccel®, Gelofusine®). The target allergen associated with these allergic reactions appears to be a sugar molecule known as alpha-galactose, present in the gut of ticks (and probably tick saliva) and all mammalian meats except for humans, great apes and Old World monkeys (e.g. beef, pork, lamb, kangaroo, venison, buffalo) and some more exotic meats eaten in some countries (e.g. guinea pig) in South America and ethnic specialty restaurants in North America and even Australia; and probably even whale meat (e.g. in Japan) as well as gelatin.
Researchers have identified that the following blood allergy tests are positive in the majority of those with serious allergic reactions to mammalian meat, and that testing (which can be ordered by any doctor) may assist in confirming the diagnosis:
Beef, lamb, pork Immunocap®.
Alpha-galactose Immunocap® a sugar molecule present in mammalian meats (but not in humans, great apes or Old World monkeys), as well as the gut of ticks.
Elevation of tryptase (an enzyme that is increased in those with a condition called mastocytosis, which is associated with an increased risk and severity of allergic reactions to a number of allergic and non-allergic triggers including insect stings and tick bites).
By contrast, blood allergy testing to gelatin is usually negative (even in patients who have had clear allergic reactions to gelatin orally or by injection).
I have been bitten by ticks regularly since childhood in Australia
First I developed an allergy to fish the age of 12.
I have had 2 anaphylactic reactions to tick bites requiring an ambulance ride to the local hospital emergency department-where I needed intravenous fluids and steroids. I carry an Epipen. The anaphylactic reaction comes very quickly after the tick bites me.
Now I have allergies to pork /beef /lamb /and unpasteurised milk.I feel ill after going to restaurants because they have cooked my food in a container that has been used to cook the above.
The feeling of unwellness lasts for weeks.
Did this start as an allergy to the tick venom ? Is this an allergy to the bacteria in the tick ? or viruses in the tick?
I see an allergist at Royal North Shore Hospital called Prof Sheryl Van Noonan.
I have visited countries that have endemic lymes disease and where a friend had treatment for lymes disease .
These changes show in my IgM IgG level.
Thank heavens for brave doctors like Dr Almayne du Preez who are at least brave enough to try and treat this insidious disease. The rest of the doctors are either too lazy to do some research, or couldn’t be bothered. Shame on them.
How dare you say they need to treat any tick borne pathogen, yet you do not allow doctors to treat any patients with what is known to be proven modern day treatments. You stay with your archaic idea of what is needed for treatment while people are getting better on proven treatments from other parts of the world.
You are scared of facing the truth.
Speak to some of us who are better, but who were ignored by you with all the other pathogens acquired somewhere else. Those of us who had to go somewhere else for help.
After falling ill in 2012 and going to over 9 Dr’s only to be told i was making my symptoms up (symptoms included sudden onset of anxiety and panic attacks, crippling fatigue, twitching leg muscles, tinnitus as well as my thyroid and adrenal glands packing it in) or offered anti depressants even though i wasn’t depressed i finally found a Dr who sent my blood overseas to be tested.
My blood tests came back positive for borrelia, bartonella, babesia, toxoplasma & mycoplasma. No Dr’s in Australia could tell me what was wrong yet here’s a blood test proving i had these infections as well as some others. Of course i am more inclined to believe my blood tests than some Dr’s opinion to the contrary.
It could well be that there are unknown bacteria in our ticks causing us illness, who would know because certain labs in Australia are so far behind the rest of the world in their testing it is beyond a joke. Australian Biologics Testing lab in Australia is getting positive tests for borrelia (the bacteria family that is Lyme) from Australian patients who have never left the country. Has been since 2002.
It’s nearly 50 years since the first test was done for classical Lyme in Australia and in that time Australian medicine still has no idea what is in our ticks! Seriously??
Ticks captured and submitted for testing at Murdoch University by the Lyme community under new testing methods (by Australian standards) have already discovered 8 previously unknown bacteria’s in these ticks including a native borrelia. So you tell me, are my symptoms all in my head or does Australian medicine need to pull it’s head out of its ass and start helping sick people instead of belittling them in a time of need.
While this review adds to the evidence of absence of true Lyme disease in Australia, unfortunately it does nothing to clarify the muddy waters regarding any possible Lyme-like disease in Australia.
“[T]here [is] no doubt that people [are] developing illnesses after tick bites. […] But the honest answer is, we don’t know why” is hardly going to reassure anyone, especially someone convinced they have a Lyme-like disease.
In particular, until there is evidence whether or not the “novel species of Borrelia” found in Australian ticks causes a Lyme-like disease, then nobody can say with any confidence whether or not such a disease exists. Obviously this issue needs more research, as does the pathogenicity of any novel tick-borne Rickettsiae.