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

Figures & data

Table 1 Demographic and epidemiologic parameters extracted from the dataset

Demographic, epidemiologic, and clinical parameters	Number	Percentage	Total number
Average age at presentation	41		500
Average age at onset of illness	35		500
Sex, female	310	62	500
Never left the country	83	17	492
Average illness length in years at time of presentation	7.4		343
Tick bites recorded	240	71	340

Table 2 Clinical parameters extracted from the dataset

Clinical parameters extracted from the dataset	Incidence	Percentage	Number
EM rash adequately described	108	78	139
Cranial nerve dysfunction	355	71	500
More than three cranial nerves involved	296	59	500
Cardiac problem of any description	52	58	89
Suspected postural orthostatic tachycardia syndrome	48	54	89
Gastrointestinal symptoms of any kind	80	52	153
Genitourinary symptoms	68	44	153
Dermopathy of any type	55	36	153
Morgellons evidenced by direct skin microscopy	29	6	500
Small joint pain	57	37	153
Large joint pain	2	1	153
Mono arthritis (documented illness in the United States)	2	0	500
Clinical borreliosis – more than three cranial nerves involved	307	61	500
Clinical babesiosis – specific babesiosis symptoms	268	92	292
Clinical bartonellosis – specific bartonellosis symptoms	240	89	270

Abbreviation: EM, erythema migrans.

Table 3 Cranial nerve assessment tool for neuroborreliosis and bartonellosis

Cranial nerve	Reported symptoms	Examination
1	Phantom smells	Anosmia partial/full
1	Any loss of smell
1	Left or right	Which side
2		Visual acuity
2	Loss of any part of vision	Visual fields
2	Any floaters	Check patient’s understanding
2	Any loss of night vision
3		Full pupil assessment
3		Focusing difficulty with small print
3	Dilated pupil(s)
3	Double vision – directional	Diplopia – medial or upwards
3	Drooping eyelids	Ptosis
4	Double vision – downwards direction	Diplopia – downwards direction
6	Double vision – lateral with weak affected eye	Diplopia – lateral with weak affected eye
5	Facial pain	Facial pain trigeminal divisions
5		Loss of corneal reflex
5	Taste changes
5	Dental pain
5	Jaw pain
7	Facial paralysis (Bell’s palsy)	Facial paralysis (Bell’s palsy)
7	Facial muscle weakness or muscle twitching	Facial muscle weakness or muscle twitching
7		Test masseters
7		Mental reflex
8	Loss of hearing during illness
8	More sensitive to loud sound or pain
8	Tinnitus	Tinnitus
8	Vertigo	Vertigo, check on true meaning
8	Imbalance	Imbalance
8		Rombergism
8		Nystagmus (rapid is affected side)
9	Throat sore
9	Difficulty swallowing
9		Elevates larynx swallowing
9		Gag reflex present
9	Lack of saliva
10	Neck pain around the throat
10	Slurring of speech	Slurring of speech
10	Mispronunciation	Mispronunciation
10	Rapid beating of the heart or irregularity	Rapid beating of the heart or irregularity standing up quickly
10	Feeling faint	Feeling faint
10		Clinical evidence or suggestion of POTS
11	Cannot shrug shoulders
11		SCM and trapezius strength
12	Difficulty with tongue movements	Tongue movement and strength full
12	Biting tongue

Abbreviations: POTS, postural orthostatic tachycardia syndrome; SCM, sternocleidomastoid.

Table 4 Borreliosis and coinfection investigation parameters extracted from the data for AB

AB testing	Positives	Percentage	Number
Borrelia
Whole-blood PCR	81	55	146
Serum PCR	18	58	31
Urine PCR	46	84	55
Immunoblot IgM	7	47	15
Immunoblot IgG	4	27	15
Total immunoblot positive	10	67	15
ELISPOT LTT	16	84	19
AB Borrelia total positive testing	127	59	216
AB Borrelia total negative testing	89	41	216
Mycoplasma PCR positive	30	43	69
Mycoplasma fermentans PCR positive	18	26	69
AB Chlamydia Pn PCR positive	9	18	50

Abbreviations: AB, Australian Biologics; PCR, polymerase chain reaction; Ig, immunoglobulin; ELISPOT, enzyme-linked immunosorbent spot test; LTT, lymphocyte transformation test; Pn, pneumonia.

Table 5 Borreliosis and coinfection parameters from IGeneX data

Investigation parameters at IGeneX	Positives	Percentage	Number
Borrelia
IFA	19	95	20
PCR serum	18	60	30
PCR blood	9	43	21
Western blot IgM	93	79	117
Western blot IgG	71	69	103
IGeneX Borrelia total testing positive	146	58	252
IGeneX Borrelia total testing negative	106	42	252
Babesia
Babesia duncani serology	43	35	123
Babesia microti serology	18	15	123
PCR Babesia	1	1	123
FISH Babesia	5	4	123
IGeneX Babesia total testing positive	66	54	123
Bartonella
Bartonella sero	23	19	122
Bartonella PCR	0	0	122
Bartonella FISH	6	5	122
IGeneX Bartonella total testing positive	29	24	122
Anaplasmosis	8	31	26
Ehrlichia chaffeensis	5	19	26

Abbreviations: IFA, immunofluorescent antibody assay; PCR, polymerase chain reaction; Ig, immunoglobulin; FISH, fluorescence in situ hybridization.

Table 6 Other investigations

Other investigations	Incidence	Percentage	Number
Abnormal CT SPECT brain from 55 requests	40	73	55
Chlamydia Pn serology positive (positive for IgG or IgM)	48	32	152
Mycoplasma sero (positive for IgG or IgM)	44	25	174
EBV sero (positive for IgG or IgM)	140	89	158
Rickettsia sero (positive for IgG or IgM)	30	11	279
Initial CD57 number assessed	418
Average CD57 count	78

Abbreviations: CT, computed tomography; SPECT, single-photon emission computed tomography; Pn, pneumonia; Ig, immunoglobulin; EBV, Epstein–Barr virus.

Table 7 Coinfection questionnaire assessment tool for Babesia and Bartonella

Fevers at night*

Saturated bed clothing from sweating*

Chest wall pain*

Sternum central chest pain*

Shortness of breath air hunger*

Headache at the top of the head or crown*

Dark urine*

Cough chronic and dry excessive bruising*

Vivid dreaming*

Small joint pains***

Fevers in morning**

Tender lumps under skin**

Electric shocks in limbs**

Skin stretch marks**

Glands swollen – particularly neck**

Ice pick headaches**

Irritability**

Angry outbursts**

Pain or soreness in the soles of the feet when getting out of bed**

Notes:

* Babesia;

** Bartonella;

*** both.

Figure 1 Cumulative age histogram of patients in years.

Figure 2 Histogram of the incident of involvement for each cranial nerve.

Figure 3 Histogram showing the incidence of the total number of cranial nerves involved in the dataset (red) and respective laboratory proof of borreliosis (green).

Figure 4 Cumulative involvement of the cranial nerves by total and laboratory-proven borreoliosis by cranial nerve involvement.

Notes: (A) Cumulative involvement of the cranial nerves by total; (B) laboratory-proven borreoliosis by cranial nerve involvement.

Table 8 Incidence and cumulative data for the cranial nerves with laboratory proof

Cranial nerve	1	2	3	4	5	6	7	8	9	10	11	12
Incidence of involvement	8	21	14	43	55	51	69	49	24	2	1	2
Cumulative count	8	29	43	86	141	192	261	310	334	336	337	339
Laboratory confirmed	6	12	3	21	32	23	37	27	16	1	0	1
Cumulative count	6	18	21	42	74	97	134	161	177	178	178	179