Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort

Abstract

Background Borrelia burgdorferi is the causative agent of Lyme borreliosis. This spirochete, along with Babesia , Bartonella , Anaplasma , Ehrlichia , and the Rickettsia spp. are recognized tick-borne pathogens. In this study, the clinical manifestation of these zoonoses in Australia is described. Methods The clinical presentation of 500 patients over the course of 5 years was examined. Evidence of multisystem disease and cranial nerve neuropathy was sought. Supportive laboratory evidence of infection was examined. Results Patients from every state of Australia presented with a wide range of symptoms of disease covering multiple systems and a large range of time intervals from onset. Among these patients, 296 (59%) were considered to have a clinical diagnosis of Lyme borreliosis and 273 (54% of the 500) tested positive for the disease, the latter not being a subset of the former. In total, 450 (90%) had either clinical evidence for or laboratory proof of borrelial infection, and the great majority of cases featured neurological symptoms involving the cranial nerves, thus mimicking features of the disease found in Europe and Asia, as distinct from North America (where extracutaneous disease is principally an oligoarticular arthritis). Only 83 patients (17%; number [n]=492) reported never leaving Australia. Of the 500 patients, 317 (63%) had clinical or laboratory-supported evidence of coinfection with Babesia or Bartonella spp. Infection with A. phagocytophilum was detected in three individuals, and Ehrlichia chaffeensis was detected in one individual who had never traveled outside Australia. In the cohort, 30 (11%; n=279) had positive rickettsial serology. Conclusion The study suggests that there is a considerable presence of borreliosis in Australia, and a highly significant burden of coinfections accompanying borreliosis transmission. The concept sometimes advanced of a “Lyme-like illness” on the continent needs to be re-examined as the clinical interplay between all these infections. Evidence is presented for the first report of endemic anaplasmosis and ehrlichiosis on the continent.

Is there a Lyme-like disease in Australia? Summary of the findings to date

“…The remaining four positives had only four or less of the 10 bands required for positive IgG. A further 19 IFAs, 100 IgM immunoblots and 75 IgG immunoblots have also been reported as positive in Australian patients presenting with a Lyme-like condition but also showing concurrent positive antibody titres in several other infectious disease serology tests [88]. It must be reiterated that in a non-endemic or low-endemicity setting, cross reaction of non-specific antibodies due to the presence of other diseases will often lead to the visualisation of false-positive immunoblot bands.…”

Awareness of Lyme Borreliosis of the Patients of Ternopil Regional Tb Dispensary

“…The epidemiological features of LB in the world, in particular in Ukraine, proved the annual incidence increase [5,12,15,17]. Due to the location in the zone of moderate continental climate with warm humid summers and mild winters, chernozem, broadleaf and mixed forests, the territory of Ternopil region is endemic with LB.…”

Therapy of Lyme Disease

“…Doxycycline is recommended as the treatment of choice for patients who are suspected of having symptomatic human granulocytic anaplasmosis. The dosage regimen for adults is 100 mg orally twice daily for 10 days [55,84]. Babesiosis is a malaria-like protozoan infection of erythrocytes that is transmitted by Ixodes spp.…”