Open letter to Professor Michael Holland

25 March 2015

Dear Prof. Michael Holland,

This is an open letter to all colleges of medicine and to all committees that regulate those colleges. I am sure you are all aware of the Clinical Advisory Committee advising the CMO of Australia Professor Chris Baggoley on tick borne diseases, Borreliosis (Department of Health - Lyme Disease).

Prof Baggoley also sent a letter to all colleges of medicine about differential diagnosis of Borreliosis in Australia (attached).   Presently most clinicians assume that Borreliosis does not exist in Australia and are unfamiliar with the signs and symptoms of Borreliosis and are reluctant to do differential diagnosis.  In this context, I am not referring to just Lyme disease (B.burgdorferi sensu stricto) but to infection by other Borrelia genospecies such as B.miyomotoi, a relapsing fever Borrelia.  
Many Australians who acquire Borreliosis either overseas in endemic or indeterminate countries or in Australia do not get appropriate diagnosis and treatment. These patients develop chronic symptoms and due to unfamiliarity of clinical presentations of Tick Borne diseases they are misdiagnosed with an atypical form of chronic neurodegenerative diseases and are condemned to a life of suffering. 
For the last 20 years tick borne diseases have been neglected and research or active discussion has been rather lacking.  As health care practitioners you all have duty of care to those Australians who acquire tick borne diseases, overseas or in Australia, including Borrelia and to provide appropriate treatment. It is time for a change. All Colleges of medicine should take heed of the CMO's letter and provide education of their members to be familiar with the signs and symptoms of tick borne diseases especially Borreliosis so efficient differential diagnosis can occur. 
The cost of chronic diseases consumes a large portion of the health funding and it is continuously increasing. If we manage to reduce a small percentage of patients becoming chronically ill we not only give back those people their lives but also save much needed health funds. 

Borrelia is a bacterium with far more advanced survival skills than Staphylococcus aureus. Borrelia can have more than 21 plasmids while Staphylococcus aureus has 1. There is very high genetic variability due to horizontal gene transfer between the plasmids and the genome. In addition, Borrelia can induce intricate immune dysregulation in the host which can impact indirect diagnostics which are reliant upon the activity of B and T cells against Borrelia proteins.  

Members of each college of medicine need to keep abreast of new findings in diagnosis and treatment of tick borne diseases which have advanced remarkably over the last 20 years.  Due to the multi-systemic nature of Borrelia infection resulting in broad symptomology all members needs to be updated on the most recent understanding of diagnosis and treatment. Tick borne disease is not only the realm of infectious diseases but also neurologists, cardiologists, psychiatrists, rheumatologists, dermatologists etc.

It would be highly recommend that presidents of each college of medicine along with other members are encouraged to attend the 3rd Tick Borne Diseases Conference on 7-8 March at the Charles Perkins Centre, University of Sydney to get some understanding of the complexity of tick borne diseases.

The flyer for the TBD conference is attached please feel free to forward to other members. I have also attached a letter addressed to the Royal College of Pathologists for your information.




Dr Mualla McManus

School of Medical Sciences

University of Sydney, NSW 2006

Director of Karl McManus Foundation

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Submissions should be received by 31 March 2016. The reporting date is 20 June 2016.
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