Plan B Forum

A six-year-old Newcastle girl is at the centre of a major medical storm over whether a debilitating tick-borne disease exists in Australia.



Laura France was diagnosed with Lyme disease late last year following tests done on her blood in the US.

Her family and several doctors are convinced she has the illness, caused by a tick bite, but NSW Health disagrees.

The department says the disease does not exist in Australia and will not fund any treatment for it.

The family is paying $3000 a month for medication typically used to treat Lyme disease.

Laura has trouble walking, struggles to catch her breath, suffers from severe headaches and is lucky to make it through a full day of school.

Michelle France said that at night her daughter had trouble sleeping, cried and complained of constant aches and pains.

"On a daily basis it's hard, we have had to buy a stroller to get her around, she is exhausted after walking short distances," Mrs France said.

"It's bad enough that Laura is sick, but the battle to find help has been a nightmare."

Since the December diagnosis the Frances have found themselves thrust into an academic battle over Lyme disease, a bacterial infection spread by ticks that has reached epidemic proportions in the United States, with up to 20,000 new cases diagnosed each year.

Left untreated it can become crippling.

The first reported case of Lyme disease in Australia, based on clinical symptoms, was from the Hunter in 1982.

According to the NSW Ministry of Health, Australian animals do not carry the bacteria that causes Lyme disease, the microscopic Borrelia burgdorferi.

It says occasional positive tests for the disease in NSW are from people who have picked up the infection overseas. Laura has never left Australia.

A Health Ministry spokesman told the Newcastle Herald the US laboratory where Laura's blood was tested was not validated for use in Australia. Her NSW test for Lyme disease came back negative.

Experts agree the bacteria that causes Lyme disease often fail to show up in blood tests, can hide in other parts of the body and false negatives or false positives are common.

GP Peter Mayne, who is treating Laura, said NSW Health had its "head in the sand".

Dr Mayne published a paper in the International Journal of General Medicine last year detailing at least 28 positive tests for Lyme disease from Australian-based patients, the majority of whom had never travelled abroad.

"The proof is irrefutable ... there are a very considerable amount of unrecognised and undiagnosed cases in Australia," he said. "The problem is far greater than anyone has acknowledged."

Laura's test results have been reviewed by controversial US-based paediatrician Dr Ray Jones, who has treated more than 10,000 children for Lyme and chronic Lyme disease.

Dr Jones confirmed Laura's diagnosis and urged her parents to travel to the US if appropriate treatment could not be found in Australia.



Read more: http://www.smh.com.au/nsw/battle-for-la ... z1ms5VZ9xk

A 2 - 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease. The specific antibiotic used depends on the stage of the disease and the symptoms.

Conclusions - Australia

There are some major differences between Australia and the endemic areas of the northern hemisphere with respect to the natural history of LD:

No ticks of the I. persulcatus complex, the principal vectors to humans in the northern hemisphere, occur in Australia. In eastern Australia, the logical candidate vector would be I. holocyclus which has a wide host range and is the most common tick biting humans. It was unable to transmit a North American strain of B.burgdorferi but an association with a so far undiscovered Australian spirochaete can not be excluded.

None of the mammal species identified as reservoir hosts in the northern hemisphere are present in Australia. There are reports of spirochaetes in Australian native animals, and a local mammal could be a reservoir host for an indigenous spirochaete that occasionally infects humans through a tick vector and produces a clinical syndrome similar to LD; however, no spirochaete was detected in the 12,000 ticks or animals processed.


Summary

The diagnosis of LD outside known endemic areas cannot be based solely on serological tests especially if they fail to conform with internationally accepted criteria, because of the high incidence of false positive results.

A clinical diagnosis in a non-endemic disease area (especially of Stage II or III disease), is difficult to support without isolation of the causative agent from the patient, from other patients with similar illness or from a known vector in the region.

The existence of LD in Australia will remain controversial until an organism is isolated from a local patient and fully characterised, or until a tick-borne organism can be shown to be responsible for the human infection. If it exists it shares few of the epidemiological or clinical characteristics of US or European patterns of LD.