Lyme Arthritis: Pathogenesis, Clinical Presentation, and Management

Puius, Yoram A.; Kalish, Robert A.

doi:10.1016/j.idc.2007.12.014

Cited by 60 publications

(39 citation statements)

References 41 publications

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“…For example, patients who develop arthritis, which typically begins after 1 month of untreated infection, often do not respond fully to a first course of 28 days of antibiotics (49). The majority of these patients have evidence of B. burgdorferi DNA in their synovial fluid and will respond to additional 1-or 2-month courses of antibiotics (13,16). A smaller minority of patients referred to as "antibiotic-resistant Lyme arthritis" patients will continue to have arthritis with synovial fluid that is PCR negative for B. burgdorferi DNA.…”

Section: Discussionmentioning

confidence: 99%

“…If treatment is delayed, the pathogen spreads throughout the body and can cause meningitis, arthritis, and carditis. Meningitis and carditis are mostly self-limited, but Lyme arthritis can persist for years (13,14). A substantial proportion of patients receiving their first course of antibiotics for Lyme arthritis do not respond fully to a 28-day course of treatment.…”

mentioning

confidence: 99%

“…A substantial proportion of patients receiving their first course of antibiotics for Lyme arthritis do not respond fully to a 28-day course of treatment. In such cases, retreatment with additional courses of antibiotics is recommended (13,15,16). B. burgdorferi avoids immune attack by antigenic variation of surface components and by decreasing exposure of antigens (17)(18)(19).…”

mentioning

confidence: 99%

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Borrelia burgdorferi, the Causative Agent of Lyme Disease, Forms Drug-Tolerant Persister Cells

Sharma

Brown

Matluck

et al. 2015

Antimicrob Agents Chemother

148

174

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bBorrelia burgdorferi is the causative agent of Lyme disease, which affects an estimated 300,000 people annually in the United States. When treated early, the disease usually resolves, but when left untreated, it can result in symptoms such as arthritis and encephalopathy. Treatment of the late-stage disease may require multiple courses of antibiotic therapy. Given that antibiotic resistance has not been observed for B. burgdorferi, the reason for the recalcitrance of late-stage disease to antibiotics is unclear. In other chronic infections, the presence of drug-tolerant persisters has been linked to recalcitrance of the disease. In this study, we examined the ability of B. burgdorferi to form persisters. Killing growing cultures of B. burgdorferi with antibiotics used to treat the disease was distinctly biphasic, with a small subpopulation of surviving cells. Upon regrowth, these cells formed a new subpopulation of antibiotic-tolerant cells, indicating that these are persisters rather than resistant mutants. The level of persisters increased sharply as the culture transitioned from the exponential to stationary phase. Combinations of antibiotics did not improve killing. Daptomycin, a membrane-active bactericidal antibiotic, killed stationary-phase cells but not persisters. Mitomycin C, an anticancer agent that forms adducts with DNA, killed persisters and eradicated growing and stationary cultures of B. burgdorferi. Finally, we examined the ability of pulse dosing an antibiotic to eliminate persisters. After addition of ceftriaxone, the antibiotic was washed away, surviving persisters were allowed to resuscitate, and the antibiotic was added again. Four pulse doses of ceftriaxone killed persisters, eradicating all live bacteria in the culture.

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“…The bone and joint involvement in LB may become apparent at any age, but it has been more frequently seen in children at an early or late stage of the disease [23,24]. In our study, it was diagnosed in two young adults that complained of arthralgia in one joint only (the knee), followed by joint swelling, symptoms that developed 20 days after the tick bite.…”

Section: Discussionmentioning

confidence: 65%

Serological, clinical and epidemiological aspects of Lyme borreliosis in Mures County, Romania

Ţilea¹,

Tripon²,

Voidăzan³

et al. 2014

Romanian Review of Laboratory Medicine

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“…9 Likewise, Lyme disease can affect the wrist in approximately 30% of cases, whereas the small joints of the hand are affected less than 15% of the time, although this etiology can be easily ruled out with serum titer tests. 10 The diagnosis of Lyme disease is confirmed with a standard 2-tier serologic series-an enzymelinked immunosorbent assay with a confirmatory Western blot test for any positive or uncertain enzyme-linked immunosorbent assays. 10 Negative immunoglobulin G serology effectively rules out Lyme disease.…”

mentioning

confidence: 99%

Diagnostic Considerations for Monoarticular Arthritis of the Hand and Wrist

Umberhandt

Isaacs

2012

The Journal of Hand Surgery

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Lyme Arthritis: Pathogenesis, Clinical Presentation, and Management

Cited by 60 publications

References 41 publications

Borrelia burgdorferi, the Causative Agent of Lyme Disease, Forms Drug-Tolerant Persister Cells

Serological, clinical and epidemiological aspects of Lyme borreliosis in Mures County, Romania

Diagnostic Considerations for Monoarticular Arthritis of the Hand and Wrist

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