Controversies in Persistent (Chronic) Lyme Disease

Maloney, Elizabeth L.

doi:10.1097/nan.0000000000000195

Cited by 25 publications

(28 citation statements)

References 62 publications

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“…The most commonly prescribed antimicrobial agents for the treatment of human Lyme borreliosis, such as penicillin, amoxicillin, cefotaxime, cefuroxime, ceftriaxone, doxycycline, and erythromycin, have been shown to be effective against B. burgdorferi (67,68). It is important to mention that treatment during early infection is more effective in clearing the pathogen than treatment during later infection in humans (69) and in the mouse model (46).…”

Section: Discussionmentioning

confidence: 99%

Generality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse Strains

2019

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A basic feature of infection caused by Borrelia burgdorferi, the etiological agent of Lyme borreliosis, is that persistent infection is the rule in its many hosts. The ability to persist and evade host immune clearance poses a challenge to effective antimicrobial treatment. A link between therapy failure and the presence of persister cells has started to emerge. There is growing experimental evidence that viable but noncultivable spirochetes persist following treatment with several different antimicrobial agents. The current study utilized the mouse model to evaluate if persistence occurs following antimicrobial treatment in disease-susceptible (C3H/HeJ [C3H]) and disease-resistant (C57BL/6 [B6]) mouse strains infected with B. burgdorferi strains N40 and B31 and to confirm the generality of this phenomenon, as well as to assess the persisters’ clinical relevance. The status of infection was evaluated at 12 and 18 months after treatment. The results demonstrated that persistent spirochetes remain viable for up to 18 months following treatment, as well as being noncultivable. The phenomenon of persistence in disease-susceptible C3H mice is equally evident in disease-resistant B6 mice and not unique to any particular B. burgdorferi strain. The results also demonstrate that, following antimicrobial treatment, both strains of B. burgdorferi, N40 and B31, lose one or more plasmids. The study demonstrated that noncultivable spirochetes can persist in a host following antimicrobial treatment for a long time but did not demonstrate their clinical relevance in a mouse model of chronic infection. The clinical relevance of persistent spirochetes beyond 18 months following antimicrobial treatment requires further studies in other animal models.

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Section: Discussionmentioning

confidence: 99%

Generality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse Strains

2019

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“…Among the topics that should be priorities for investigation are health issues that are controversial among the lay public, such as Lyme disease (LD) (Halperin, Baker, & Wormser, ; Maloney, ). At least two American studies have examined information provided on the Internet about LD (Cooper & Feder, ; Shapiro, Baker, & Wormser, ).…”

Section: Introductionmentioning

confidence: 99%

Lyme disease prevention: A content analysis of Canadian patient group and government websites

Journault

Richard

Aenishaenslin

2019

Zoonoses and Public Health

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The quality of information presented on health‐related websites—in terms of comprehensiveness, accuracy and consistency—is a public health concern. To date, the consistency of information across Canadian websites devoted to Lyme disease (LD) prevention has not been evaluated. The first aim of this study was to describe the contents and recommendations of LD prevention websites provided by two types of Canadian organizations: government (n = 3) and patient groups (n = 3). A second objective was to analyse the level of convergence among these websites in terms of their prevention‐related content. Initial coding of the content resulted in information segments grouped into 114 subthemes related to nine overarching themes: tick habitat suitability, risk period, transmission, personal protection, peridomestic environmental management, tick identification and removal, early symptoms, testing and diagnosis and preventive treatment. Comparative content analyses were performed both within and between the content of websites of the two organization types. The themes most frequently addressed by both organization types were personal protection (20% of the prevention‐related content in patient group websites and 22% of the prevention‐related content in government websites), transmission (12% and 16%, respectively) and tick identification and removal (19% and 15%, respectively). Government websites’ information was generally convergent with that of patient group websites (four highly convergent themes, three moderately convergent and two divergent). Nevertheless, of particular concern were divergent messages and inaccurate information found on 11 subthemes out of 103. Examples included other possible modes of transmission and the ineffectiveness of DEET insect repellent. These results suggest the need for public health and health communications research on the issue of the quality of LD prevention information found on the Internet.

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“…The most commonly prescribed antimicrobial agents for the treatment of human Lyme borreliosis, such as penicillin, amoxicillin, cefotaxime, cefuroxime, ceftriaxone, doxycycline, and erythromycin, have shown to be effective against B. burgdorferi (72, 73). It is important to mention that treatment during early infection is more effective in clearing the pathogen than treatment during later infection in humans (74) and in the mouse model (46). Over the past several years, there have been numerous well-supported reports of Borrelia detection after completed antimicrobial therapy (46, 50, 53, 60, 75, 76).…”

Section: Discussionmentioning

confidence: 99%

The generality of post-antimicrobial treatment persistence of replicatively-attenuatedBorrelia burgdorferiin a mouse model

Hodzic

Escobar

2019

Preprint

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24A basic feature of infection caused by Borrelia burgdorferi, the etiological agent 25 of Lyme borreliosis, is that persistent infection is the rule, not the norm, in its many hosts. 26 The ability to persist and evade host immune clearance poses a challenge to effective 27 antimicrobial treatment. A link between therapy failure and the presence of persister cells 28 has started to emerge. There is growing experimental evidence that viable, but non-29 cultivable spirochetes persist following treatment with several different antimicrobial 30 agents, then resurge after 12 months. The current study utilized the mouse model to 31 evaluate if persistence and resurgence occur following antimicrobial treatment in a 32 disease-susceptible (C3H/HeN) and disease-resistant (C57BL/6) mouse strain infected 33 with B. burgdorferi strains N40 and B31, to confirm the generality of these phenomena. 34 The status of infection was evaluated at 12 and 18-months after treatment. The results 35 demonstrated that persistent spirochetes remain viable for up to 18 months following 36 treatment, but divide slowly, thereby being tolerant to the effects of antimicrobial agents, 37 as well as being non-cultivable. The phenomenon of persistence and resurgence in 38 disease-susceptible C3H mice is equally evident in disease-resistant B6 mice, and not 39 unique to any particular B. burgdorferi strain. The results also demonstrate that following 40 antimicrobial treatment, both strains of B. burgdorferi, N40 and B31, lose one or more 41 small plasmids, resulting in attenuation. The biological relevance of attenuated B. 42 burgdorferi spirochetes is probably inconsequential. The study demonstrated that non-43 cultivable spirochetes can persist in a host following antimicrobial treatment for a long 44 time but did not demonstrate their clinical relevance in a mouse model of chronic 45 infection.

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Controversies in Persistent (Chronic) Lyme Disease

Cited by 25 publications

References 62 publications

Generality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse Strains

Generality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse Strains

Lyme disease prevention: A content analysis of Canadian patient group and government websites

The generality of post-antimicrobial treatment persistence of replicatively-attenuatedBorrelia burgdorferiin a mouse model

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