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New Position Statement on Testing and Management of Lyme Disease
By Petrina Smith
The Royal College of Pathologists of Australasia (RCPA) has released a new position statement surrounding the diagnostic testing and management of Lyme disease in Australia and New Zealand.
Dr Stephen Graves, a spokesperson for the RCPA, explains that as of January this year, ticks native to Australia and New Zealand are not thought to carry the Borrelia spp bacteria that causes Lyme disease.
"There is considerable misinformation regarding Lyme disease in Australia, sparking an ongoing debate as to whether the disease is present both here and in New Zealand. So far, research has failed to prove the presence of Lyme disease-causing Borrelia in ticks native to Australia and New Zealand. This infection however, is occasionally seen in Australia in travellers returning from countries where the disease is endemic, having been bitten by an infected carrier tick prior to returning to Australia," says Dr Graves.
To ensure the accurate diagnosis of Lyme disease, laboratory testing must be undertaken in National Association of Testing Authorities (NATA) accredited laboratories, explains Dr Graves.
"It is critical that NATA/RCPA accredited laboratories perform the diagnostic tests for Lyme disease by serology in patients who have returned from overseas with the Borrelia bacteria," says Dr Graves.
According to a number of Australian pathologists, many of the tests performed by non-NATA/RCPA accredited laboratories have not been validated for use in diagnosing Lyme disease, as evident in consensus documents published by European and North American professional bodies.
"Until advised otherwise, no confidence can be attached to the results of tests undertaken by non-NATA/RCPA accredited laboratories. The referring doctor and their patients must be advised that the results of these tests may result in inaccurate diagnoses," says Dr Graves.
The RCPA explains that Lyme disease presents in several clinical stages, however there can be overlap between these stages.
According to the RCPA, there are a number of challenges to be considered in the laboratory diagnoses of infectious diseases such as Lyme disease, including:
Culture in the laboratory of the causative microbe from a patient sample;
Molecular detection of DNA/RNA of the causative microbe from a patient sample, by molecular detection methods (e.g. Polymerase Chain Reaction (PCR) followed by a gene or genome sequencing); and
Serology detection of antibodies in the patient's serum, directed against antigens of the known causative microbe.
For cases where chronic Lyme disease symptoms occur, Dr Graves says the prolonged use of antibiotics is not recommended.
"Long term antibiotic treatment for Lyme disease is considered inappropriate by expert European and North American bodies and is not advocated in Australia and New Zealand. Any beneficial effect a patient experiences from such treatment is unlikely to be a result of the antibacterial activity of the antibiotic," says Dr Graves.
To date, the RCPA position statement outlines that there have been significant developments across the epidemiology and diagnosis of Lyme disease.
"Considerable progress has been made in the understanding of Lyme disease as well as in the development of new assays to diagnose the disease. If a definitive, endemic Australian case of Lyme disease can be confirmed by culture or PCR in a patient who has never left Australia, the issue of endemicity of Lyme disease in Australia will have been settled. As of January 2014, there is no evidence of Lyme disease borne endemically in Australia or New Zealand," says Dr Graves.
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