Public health

Time to tick Lyme disease off diagnosis list in Australia

A leading Australian researcher has called for clinicians to abandon the term Lyme disease in favour of a broader spectrum label, following the release of a new review which maintains there is no “convincing evidence” the actual disease occurs in Australia.

The narrative review, published this week in the Medical Journal of Australia, has stirred up the contentious issue once more, but co-author Professor Peter Collignon, from the Australian National University and executive director of ACT Pathology isn’t shying away from the controversy.

“There’s a lot of people who have an entrenched belief there is Lyme disease in Australia,” he told the limbic. “The problem is, the evidence isn’t there to support that.”

While he accepts that there have been cases of Lyme disease diagnosed in Australia, the researchers concluded this was acquired overseas by travellers before they returned to Australia.

He wants to see the use of the term Lyme disease, and even Lyme disease-like illness abandoned as a diagnosis, until such time as the appropriate bacteria or virus that is causing similar symptoms in Australians is identified.

“By using the wrong label, it inhibits the medical professionals in their care,” he told the limbic. “I actually think we need to change the term chronic Lyme disease to something like chronic tick syndrome.”

He said the wider community had embraced the Lyme disease hypothesis in the absence of any other scientific answers, and this was leading to patients “demanding” treatment for the disease, even though it was unlikely to work.

In fact, Professor Collingnon said he had heard of cases where patients had been treated with IV antibiotics for up to three months, a regime that carries its own risks and could promote wider antibiotic resistance.

He said patients should only ever receive oral antibiotics for suspected tick-borne illness for a month, and other issues such as allergies should also be investigated.

“There’s lots of things we know ticks do to you and lots of unknown things too,” he said. “But if the honest answer is we don’t know then we should say so and not give therapy that isn’t going to help.”

The authors of the MJA narrative review found no convincing evidence that classic Lyme disease occurs in Australia, or any evidence that the causative bacterium, Borrelia burgdorferi, is found in Australian animals or ticks.

The review stated that the bacterial species that causes Lyme disease, the Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex, has not been cultured from locally acquired cases of the disease. Additionally, Australia does not appear to have a competent tick vector for these species.

“Until there is strong evidence from well performed clinical studies that bacteria present in Australia cause a chronic debilitating illness that responds to extended antibiotic therapy, treating patients with “Lyme disease-like illness” with prolonged intravenous or oral antibiotic therapy is both unjustifiable and unethical, and is likely to do much more harm than good,” the authors concluded.

“This harm affects both the individual (eg, intravenous sepsis) and the Australian community (increased antimicrobial resistance rates).”

While he strongly backs this research, Professor Collingnon said he believed it was “entirely possible” that a strain of disease, either viral or bacterial, would be eventually identified as the cause of the range of debilitation symptoms such as joint pain and chronic fatigue.

“It quite possibly has a label, but it’s not Lyme,” he said. “It’s a needle in a haystack job but we have to know more and research is continuing.”

Identifying it as bacterial or viral would allow for the development of effective treatments regimes and even vaccines against tick-borne conditions

“The bottom line is we need to know more,” he said.

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