published by Dove Press, authored by Raphael B Stricker & Lorraine Johnson
International Lyme and Associated Diseases Society, Bethesda, MD, USA
Abstract: Although Lyme disease remains a controversial illness, recent events have created an unprecedented opportunity to make progress against this serious tick-borne infection. Evidence presented during the legally mandated review of the restrictive Lyme guidelines of the Infectious Diseases Society of America (IDSA) has confirmed the potential for persistent infection with the Lyme spirochete, Borrelia burgdorferi, as well as the complicating role of tick-borne coinfections such as Babesia, Anaplasma, Ehrlichia, and Bartonella species associated with failure of short-course antibiotic therapy. Furthermore, renewed interest in the role of cell wall-deficient (CWD) forms in chronic bacterial infection and progress in understanding the molecular mechanisms of biofilms has focused attention on these processes in chronic Lyme disease. Recognition of the importance of CWD forms and biofilms in persistent B. burgdorferi infection should stimulate pharmaceutical research into new antimicrobial agents that target these mechanisms of chronic infection with the Lyme spirochete. Concurrent clinical implementation of proteomic screening offers a chance to correct significant deficiencies in Lyme testing. Advances in these areas have the potential to revolutionize the diagnosis and treatment of Lyme disease in the coming decade.
Keywords: Lyme disease, Borrelia burgdorferi, L-forms, cysts, biofilms, proteomics
Download & read FULL PDF at: Lyme Disease – The Next Decade
The authors thank Drs Stephen Barthold, Robert Bransfield, Joseph Burrascano, Daniel Cameron, Allison DeLong, Brian Fallon, Chris Green, Nick Harris, Steven Harris, Robert Lane, Kenneth Liegner, Benjamin Luft, Alan Mac-Donald, Betty Maloney, David Martz, Carsten Nicolaus, Steven Phillips, Eva Sapi, Ginger Savely, Armin Schwarzbach, David Volkman, Edward Winger, and Ying Zhang for helpful discussion. We also thank Pam Weintraub and Kris Newby for their insight, and we are grateful to Pat Smith of the Lyme Disease Association, Diane Blanchard and Deb Siciliano of Time for Lyme, Staci Grodin of Turn the Corner Foundation, and Barb Barsocchini, Dorothy Leland, and Phyllis Mervine of the California Lyme Disease Association for continuing support. There was no funding source for this article. Ethical approval was not required for this article.
RBS serves without compensation on the medical advisory panel for QMedRx Inc. He has no financial ties to the company.
LJ has no potential conflicts of interest to declare.
Appendix 1 Evidence for persistent infection following treatment of Lyme diseasea
Study/reference Study origin Persistence of B. burgdorferi shown by Sample source
Weber et al1 Europe Histology Brain, liver (autopsy)b
Schmidli et al2 Europe Culture Synovial fluid
Cimmino et al3 Europe Histology Spleen
Preac-Mursic et al4 Europe Culture Skin Bx, CSF
Pfister et al5 Europe Culture CSF
Strle et al6 Europe Culture Skin Bx
Preac-Mursic et al7 Europe Culture Iris Bx
Haupl et al8 Europe Culture Ligament Bx
Strle et al9 Europe Culture Skin Bx
Preac-Mursic et al10 Europe Culture Skin Bx, CSF
Oksi et al11 Europe Culture CSF
Oksi et al11 Europe PCR Brain Bx
Oksi et al11 Europe PCR Brain (autopsy)
Priem et al12 Europe PCR Synovial Bx/fluid
Oksi et al13 Europe Culture, PCR Blood
Breier et al14 Europe Culture Skin Bx
Hunfeld et al15 Europe Culture Skin Bx
Hudson et al16 Australia Culture, PCR Skin Bx
Steere et al17 USA Histology Synovial Bx
Kirsch et al18 USA Histology LN (autopsy)
Liegner et al19 USA Histology Skin Bx
Liegner et al19 USA PCR Blood
Battafarano et al20 USA Histology, PCR Synovial Bx/fluid
Chancellor et al21 USA Histology Bladder Bx
Nocton et al22 USA PCR Synovial fluid
Shadick et al23 USA Histology Brain (autopsy)
Masters24 USA Culture Blood
Lawrence et al25 USA PCR CSF
Bayer et al26 USA PCR Urine
Nocton et al27 USA PCR CSF
Notes: aAll patients had received a minimum of 2 to 4 weeks of antibiotic therapy; bMother treated with antibiotics during pregnancy; newborn died.
Abbreviations: PCR, polymerase chain reaction; Bx, biopsy; CSF, cerebrospinal fluid; LN, lymph node.
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