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Does Lyme disease exist in Australia?

Despite a number of reports of putative cases and a discussion across several decades,119 locally acquired classic Lyme disease has not been identified in Australia. Despite intensive efforts, the bacteria that cause Lyme disease, Borrelia species collectively termed the Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex, have not been cultured from any definite locally acquired cases of the disease. Further, Australia does not appear to have a competent tick vector for these species.8,13,18 Finally, bacterial DNA has not been definitively detected in patients for whom acquisition in a country where B. burgdorferi is known to be endemic could be excluded.10,18

The controversy is not restricted to whether B. burgdorferi s.l. and a competent tick vector exist in Australia. We also need to consider whether chronic Lyme disease exists here. This concept does not require the aetiological agent to be metabolically active beyond maintaining a resting metabolism; it need only be present in the patient and viable. Further, the term “chronic Lyme disease” is not…