Studies that report unexpected positive blood cultures for Lyme borrelia – are they valid?

Abstract

Positive blood cultures for Lyme borrelia have been well documented in untreated patients with early Lyme disease. In this report we review the validity of three studies that reported the recovery of Borrelia burgdorferi sensu lato from the blood of a high proportion of patients for whom no evidence was presented, and no claim was made, that the patients had untreated early Lyme disease. In two of the studies the patients had been treated extensively with antibiotics for Lyme disease before the cultures were obtained. Critical evaluation of the three reports suggests that they are invalid. Indeed, two subsequently published studies could not reproduce the results of one of the reports. In a published analysis of another of the reports, investigators from the Centers for Disease Control and Prevention concluded that the cultures were likely to have been contaminated. When the biologic plausibility of recovering borrelia from blood is extremely low, the level of scientific rigor required of a study that claims a positive result should be particularly high.

Critical analysis of a doxycycline treatment trial of rhesus macaques infected with Borrelia burgdorferi

“…In other studies, in vitro cultures have been successful irrespective of whether the cells of B. burgdorferi originated in a human [5], in an animal [20,22,23], or in a tick [20,24]. Of course, like with PCR (especially nested PCRs) and IFA testing, false positive in vitro cultures have been reported [25,26]. The results of the study reviewed here, and that of other studies, are, however, consistent with persistence of spirochetal remnants [27,28].…”

Canine Bacterial Zoonosis

“…Due to lack of standardization, Lyme Borreliosis PCR testing is not considered part of routine clinical practice. There is a continuous interest in novel approaches to diagnostics, including Borrelial antigen identification, nucleic acid amplification, and genomic sequencing (Wormser et al, 2005;Li et al 2011;Steere et al 2016;Wormser et al 2017;Branda et al 2018;Trevisan et al 2020).…”

Novel targets and strategies to combat borreliosis

“…While still a matter of dispute (Auwaerter and Melia 2012;Baker and Wormser 2017;Wormser et al 2017), there are several reports of antibiotic treatment unable to fully eradicate B. burgdorferi from blood and tissues (Rudenko et al 2016). The phenomenon of tolerance to otherwise lethal doses of antibiotics and the antibiotic resistance is often attributed to so-called B. burgdorferi persisters.…”