Over the past 6 years, principally because of local publicity, there has been an increase in serologic testing for Lyme disease in Australia, particularly in southeastern Australia. Testing has often been initiated by patients with undiagnosed health problems. Thus, most Lyme disease patients seen by infectious disease specialists are self selected and are referred for assessment on the basis of tick exposure and reported positive serologic test results for Lyme disease. Patients with positive serologic test results frequently have long-standing symptoms for which no other diagnosis has been established. The most common symptoms are musculoskeletal, including myalgias and arthralgias without objective evidence of joint swelling, and syndromes involving fatigue and loss of energy resembling chronic fatigue syndrome.
Some patients fulfill diagnostic criteria for fibromyalgia.
The next most common symptoms are neurological, and include frequent headaches, inability to concentrate, and memory loss. The most common dermatologic manifestation of chronic Lyme disease, acrodermatitis chronica atrophicans, seen occasionally in Europe and rarely in the United States, has not been reported from Australia. Only eight specimens submitted to our laboratory included skin biopsies done to isolate spirochetes. B. burgdorferi s.l. was isolated from one patient returning from Europe, but no spirochetes were isolated from local patients. Problems of specificity and sensitivity associated with serologic testing for Lyme disease are well recognized, particularly in Australia where no local spirochete has been isolated for use as a reference antigen.