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Karl McManus Foundation Representing the Australian Lyme disease Community PATHOGEN Borrelia DISEASE Beta lactam antibiotics amoxicillin ceftriaxone cefuroxime Spirochaete can induce the conversion to the L form or the Cyst form Fast, even in viscous environments, intercellular infection. Rapidly converts to other forms, intracellular infections. Dose - always start low Depending on the Patients Herxheimer Response. Borreliosis Tetracyclines egdoxycycline Macrolides azithromycin clarithromycin Immune evasion Borreliosis Nitromidazolines metronidazole tinidazole hydroxychloroquine Avoid concurrent cell-wall-inhibiting antibiotics Resistant to beta Lactams macrolides & Tetracyclines. Can convert to spirochete under favourable conditions Cell Wall Deficient form L FORM Borrelia Cyst Form Extracellular Form Intracellular Form Babesia Protozoa B. microti,B. duncani NOTES Borreliosis B.burgdorferi B.afzelii B.garinii Spirochete form Extracellular intracellular Borrelia TREATMENT Babesiosis Atovaquone - a malaria like atovaquone and illness proguanil Malarone is contraindicated with CoQ10. azithromycin clindamycin with quinine, Alternative Artemisinin Blackmores artemether + lumefantrine Riamet ™ 1 Common Co - infection B.duncani more virulent and need extensive treatment. B.microti B.divergence Karl McManus Foundation Representing the Australian Lyme disease Community PATHOGEN Bartonella B.henselae B.quintana B. divergens Ehrlichia/ Anaplasma DISEASE Bartonellosis Cat - scratch disease Trench fever. Human Monocytic Erhlichia chaffeensis Ehrlichiosis, Anaplasma Human phagocytophilum Granulocytic Ehrlichiosis Rickettsiae R.honei R.australis R.typhi Orientia tsutsugamushi Mycoplasma M.fermentans M.pneumoniae TREATMENT NOTES azithromycin ciprofloxin or rifampicin Note: atovaquone can inactivate Ciprofloxin so treat Bartonella before Babesia Gram negative bacterium Intracellular Extracellular Side effects of Ciprofloxin causing tendom problems doxycycline or rifampicin Small gram-negative bacterium. Infects white blood cells. A persistent leucopenia. Prevention: High dose Vitamin C Magnesium Thrombocytopenia and elevated liver enzymes may occur in acute infection. Flinders Island doxycycline Spotted Fever, Queensland Tick Typhus, Murine Typhus, Scrub Typhus Mycoplasmosis doxycycline azithromycin or clarithromycin and hydroxychloroquine 2 Maculopapular skin rash severe headache - especially behind the eyes Over 100 species smallest bacteria known Intracellular Difficult to eliminate and slow growing. Utilises host cholesterol … Depression, SOB, Gastrointestinal problems Karl McManus Foundation Representing the Australian Lyme disease Community PATHOGEN DNA Viruses HHV6 Human Herpes Virus EBV Epstein Barr Virus CMV cytomegalovirus DISEASE TREATMENT famciclovir valaciclovir ganciclovir or anti-retrovirals such as zidovudine ritonavir RNA Viruses NOTES Low bacterial load and minimal symptomology. Usually no treatment If serious symptomology and big viral load, anti virals are utilised. Vaccine available for TBE Tick borne Encephalitis Virus TBE Common with tick bites as co-infection and can present with serious symptomology or paralysis if not detected early. Murray Valley Encephalitis Virus Other Flavi Viruses should be explored in chronic Lyme Like Illness, with very serious paralytic nature in Australia. Vaccination should be encouraged in people travelling to Europe and Asia. Japanese Encephalitis Virus (Banzhoff et al 2008) 2 Vaccines are available: the K23 / Neudorfl shows cross protection for Subtypes: Far Eastern Siberian Subtypes 3
