Lyme disease in Australia?

Erythema migrans

Bullseye rash of Lyme Disease aka Erythema migrans

Lyme disease is a bacterial infection transmitted by a tick.  Most North Americans will be very familiar with it, but here in Australia, no one believes it exists, or at least, there have been no cases that have originated in Australia.  But things are changing.  More Australians are coming forward with convincing symptoms of Lyme Disease, and although it’s been a while coming, the Chief Medical Officer in Australia has taken the first official steps to recognise an Australian indigenous form of the disease.

The challenge for Australian doctors is to become open-minded to the potential for Lyme Disease and for the clinical pathology labs to start testing locally, because at the moment, formal testing for the disease has to be done off shore.  The Commonwealth Government also needs to reinstate the committee that was working on the problem of Australian Lyme Disease.  The budget is tight, sure.  But Lyme Disease is a debilitating disease if it’s not diagnosed and treated early.  Surely the cost saving of one person prevented from years of sickness would justify the cost of the committee that is working to prevent it.

Lyme disease-like syndrome acknowledged in Australia
Sunalie Silva (Medical Observer 20/8/2014)

A SPECIALLY-established federal government advisory committee has officially acknowledged the possibility of an Australian ‘Lyme disease-like syndrome’ which warrants further investigation.

Just over a year after the federal government established the Clinical Advisory Committee on Lyme Disease in Australia (CACLD), the now-disbanded group handed down its final recommendations about diagnostic testing, treatment and further research requirements in relation to Lyme disease last month following its meeting on July 15.

A progress report released by the Chief Medical Officer Professor Chris Baggoley reveals there is still no conclusive evidence that Borrelia spp – the bacteria thought to cause the disease – exists in Australia, making exploration of a potential infection in Australian patients with no relevant travel history nearly impossible.

It states that an appropriate laboratory testing algorithm has yet to be agreed upon and, while clinical presentation is frequently the basis for diagnosis, there is still no agreed case definition.

However, it has now agreed that there may be an Australian ‘Lyme disease-like syndrome’ that needs investigation.

“The lack of an agreed case definition for Lyme disease hampers the diagnosis of patients in Australia. Clarity around the presenting signs and symptoms of an Australian Lyme disease-like syndrome would aid the investigation into whether an indigenous form of Borrelia exists in Australia,” it said in its report.

Dr Mualla McManus (PhD), pharmacologist, founder of the Karl McManus Foundation for Lyme Disease Research & Awareness and CACLD member said the outcome, though inclusive, is a significant step.

“The role of CACLD was to put to the CMO that a Lyme disease-like syndrome unique to Australia might be what’s happening here and we are pleased that the he has now officially taken this on board.”

She said many in the scientific community know that there is a pathogen or pathogens unique to Australia being transmitted to humans by tick bite. The focus now will be to find out what type of organism that is.

“There is a Lyme disease-like syndrome in Australia – it may be a totally unique bacterium that has its own distinct characteristics or it may be multiple bacteria transmitted together – we don’t know yet but we need to answer these questions before we can start diagnosing the condition,” she told MO.

Dr McManus said the treatment approach at the moment relies on the broad application of antibiotics.

“At the moment a lot of these patients are bombarded with a broad range of antibiotics. Luckily the antibiotics we’re using are killing basically every kind of bacteria you can think of but we don’t really know what we’re treating.”

According to the committee, a short course of antibiotics such as doxycycline would be the initial treatment for Lyme disease acquired overseas. However, treatment of chronic Lyme disease is contentious, it said because the existence of this form of disease is still strongly disputed.

Dr McManus argues that in the US, where Lyme disease is a recognised condition, people are treated at acute stages of the infection and so there are very few people who will present with a chronic form of the disease.

“It’s different in Australia. For the last 20 years no-one has been detecting and treating the acute phase of this disease, so we are in a situation now where a we have a backlog of people who have become chronically ill.

She said most people with chronic infection were ultimately diagnosed with chronic fatigue syndrome, fibromyalgia, Parkinson’s or motor neurone disease.

“These are the box of conditions that clinicians are able to treat without doing any differential diagnosis because there isn’t supposed to be any Borrelia spp. in Australia.”

The committee’s report advised that if a person who has been diagnosed with Lyme disease does not respond to treatment or has relapsed, then the treating medical practitioner should consult with a medical practitioner who has experience in treating Lyme disease.

According to Dr McManus, the way forward now lies within the scientific community. CACLD has identified 12 gaps in knowledge along with scoping study research proposals – though research groups will of course need to apply for NHMRC or ARC funding.

“The solution to the problem now has to be within the scientific community – our group pre-empted this long before and has been funding the research at the Tick Borne Diseases Unit at the University of Sydney.”

Research like this will hold the answer she said.

“We need to know what the causative agent is so we can develop tests and treatment protocols for that specific pathogen so that we know what we are killing.”


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