1. LYME DISEASE IN AUSTRALIA?
Mualla McManus B.Pharm Ph.D AACP,

2. Possible Sources of Borrelia in Australia
Imported animal species
cattle, sheep, rabbit, deer, fox, rats, mice imported during the last 2
centuries from Europe proven reservoirs of Borrelia.
Migratory birds
Nest or visit Australia carry ticks with Borrelia and co-pathogens
Australia has it own unique species
Migratory birds are reservoirs themselves.
Australia has ITS own …. You left off the S

3. B. burgdorferi imported into Australia?
tick infested Brahmin cattle were brought to Darwin from Java Indonesia
Babesiosis and anaplasmosis spread throughout the cattle country Kimberley to Northern NSW
Mulhearn (1946) isolated B. theileri from cattle tick (Boophilus microplus)
Migratory birds that nest along the seaboard and in the wetlands
B in B. Burgdorferi needs to be ITALICISED
Brahmin spelt incorrectly BrahmAn

4. East-Asian Australasian Flyway- Bird migration
You need to identify the other two birds also

5. Australian Indigenous Borrelia
Shaw (1800) saw spirochetes in great grey kangaroo
Desmarest (1822)- red kangaroo
Mackeras (1959) identified Borrelia spirochetes from bandicoots, kangaroos, wallabies
Carley and Pope (1962)- isolated Borrelia spirochetes from native rats and characterised a new species – B. queenslandica
Borrelia queenslandica-fastidious growth 2 weeks in vitro and 2 weeks in in vivo. Caused relapsing infection in lab mice

6. Common Ticks in Australia

7. Tick 3 Host Life Cycle eg Ixodes holocyclus
Warm, moist conditions allow eggs to
hatch within 7-9 weeks into larvae
Larvae seek 1st host, a small
mammal such as a bandicoot,
feed & drop off host
Engorged female tick
lays eggs on ground
(approx 3000) then dies
Larva are the size of a
pinhead & have 6 legs
Engorged adults can be the size of a pea & have 8 legs
Tick 3 Host Life Cycle eg Ixodes holocyclus
Engorged larva
shelters in grass &
moults to nymph
Adult tick seeks
3rd host, a large
mammal
including humans,
engorges with
blood, mates & drops
off host.
Nymphs are the size of a
matchhead & have 8 legs
Nymph seeks 2nd host,
small to medium mammal
feeds & drops off
Male
Female
Engorged nymph shelters in grass
& moults into adult, male and female

8. Borrelia in Australian ticks
Paralysis tick: (Ixodes holocyclus)- indigenous tick
Brown dog tick- (Rhipicephalus sanguines)- not indigenous, common in warm climates. Shown to harbour Borrelia
Bush tick (Haemaphysalis longicornus)- imported from Japan Shown to harbour Borrelia, Anaplasma, Ehrlichia (Meng et al 2008, Mi-Jin&Joon, 2010)

9. Distribution of Borrelia

10. Clinical Cases of Lyme Disease
Stewart et al First clinical case of Lyme Disease- erythema migrans rash and arthritis in Hunter valley
Lawrence et al Central Coast
McCrossin, South Coast
QLD State Health % ELISA and IFA
Hudson et al skin biopsies- +ve Borrelia.
Recently Mayne skin biopsies- +ve for Borrelia

11. NHMRC Funded study Russell et al (1994)- study
Unable to isolate Borrelia burgdorferi sensu lato from Australian ticks
They were looking for B. burgdorferi sensu stricto (American strain)
PCR products not Borrelia , SLO- aggregates of bacterial flagella
Conclusion: No definite evidence of Borrelia or any other TB spirochetes that may cause Lyme disease in Australia

12. Uni. of Newcastle group
Uni. of Newcastle group- Prof Richard Barry’s group
Cultured spirochetes from fed ticks collected from the North of Sydney to Mid North Coast
Isolated spirochetes who had fastidious growth requirements and died after 2 weeks in culture
PCR products which had sequence homology to B.burgdorferi and variation in DNA sequence suggesting the presence of unique Australian genospecies. (Wills 1995)

13. Conclusion Given that Mackerras (1959), Carley
and Pope (1962) and Wills and Barry
(1995) managed to isolate, grow and
identify Borrelia in Australia, scientific
evidence supports the existence
of Borrelia in Australian ticks, rather then the absence.
Both imported and indigenous Borrelia is highly likely to be present in Australia
endOgenous should be endIgenous

14. Borrelia In Australia
Indigenous Borrelia genospecies in Australia- very high probability.
Other imported Borrelia strains highly likely
B.garinii, B.afzelii, B.burgdorferi and others imported by travellers- people and birds
Very high probability
endOgenous should be endIgenous
Very high probability is part of point above, B. garinii…….. Like you have in 1st point

15. Borrelia microbiology
Spirochete
21 plasmids - fast evolving protozoa like bacteria, genomic flux
Can exist in 3 different forms- spirochete, cell wall deficient and dormant cyst, intra and extracellular
Slow replication time in vivo and in vitro (12-18hrs).
Release exo and endo toxins-Jarisch Herxheimer’s reaction

16. Diagnosis Clinical – familiarity with clinical signs and symptoms
Patients with baffling set of symptoms
consider Lyme
Path lab tests supplement the diagnosis.
Tests should not be used as the sole method of diagnosis

17. Diagnostics Testing in Australia 2 Tier- ELISA then Western Blot
ELISA- recombinant Borrelia proteins embedded in a matrix bind to antibodies from the patient
Western Blot (Immunoblot)- proteins separated electrophoretically that bind antibodies
I have rearranged to make WB bigger

18. Australian Criteria: based on CDC Surveillance Criteria
Positive ELISA
Western Blot ( WB)
IgM WB- Greater than 2 bands = Positive within 6 weeks of a tick bite
IgG WB 5 bands from ( 10 bands)- (18,22,25,28,30,39,41,45,58,66, 99KDa)
No correlation with clinical symptoms
Cdc criteria still states equivocal go to WB it is only in Australia they don’t. So title could be changed to Australian Criteria based on CDC surveillance criteria as above,

19. LYME DISEASE TESTING ELISA, WB- Serology based tests
PCR- Bacterial DNA detection- Non Serology test, highly sensitive narrow specificity.
ELISPOT- T cell stimulation- T cell immunity
Culture- in vitro culture biopsy

20. Why ELISA is not the right test for Borrelia infection
Only one, or more recombinant Borrelia antigens in the matrix
Complex immunosuppression induced by Borrelia decreases the sensitivity of the test
The situation where patients are deficient in IgG or IgM will never get a positive= False negative
Never get is not good english, “will NOT PRODUCE A POSITIVE” OR “NOT RESULT IN A POSITIVE”

21. ILADS versus IDSA
ILADS- International Lyme and Associated Diseases Society
Treat with antibiotics till patient is better.
IDSA- Infectious Diseases Society America
Treat acute Lyme disease- 28 days of antibiotics if still have symptoms
Post- Lyme syndrome. Psychosomatic disease
No such thing as Chronic Lyme
change TILL to UNTIL
I would add INFECTION after Chronic Lyme

23. Lyme Disease in Australia
Growing number of people have the symptoms of Lyme disease, some have never travelled outside Australia and many have confirmatory results from overseas labs.
Australian testing needs to redesigned to suit the Australian situation.
Add “some and many” in “Growing number of people have the symptoms of Lyme disease, SOME have never travelled outside Australia and MANY have confirmatory results from overseas labs.”

24. Summary
Lyme Disease and Co-infections in Australia- A state of Immune dysregulation
Immune system needs to be supported
Diagnostic results should be interpreted accordingly the diagnostics based upon serology assume a competent immune system, a negative result may not be a real negative
The immune status of the patient needs to be assessed before diagnosis and during treatment
Ig levels, and lymphocyte markers , Vit D125OH
Need a comma between 1, 25-OH