To the Editor: The article by Feder et al. on the proper therapy of chronic Lyme disease addresses a very timely concern.

 To the Editor: The article by Feder et al. on the proper therapy of chronic Lyme disease 
addresses a very timely concern. Unfortunately, the authors' statement that there are no 
"scientific data" that support persistent B. burgdorferi infection in the face of negative 
serologic test results is erroneous. In 1988, we reported on 17 patients who had all had 
erythema migrans, received inadequate antibiotic therapy, had vigorous T-cell blastogenesis
to borrelia antigens, and were seronegative on the basis of enzyme-linked immunoassay. 1,2 
The majority of these patients had improvement after definitive antibiotic therapy. 
Seronegative infection was confirmed by other laboratories using polymerase-chain-reaction, 
PCR, assays to document the presence of microbes in seronegative patients. 3,4 Abrogation of 
a humoral response by removal of the bulk of microbial antigens has been seen in other settings, 
including infection with Treponema pallidum. Although the use of repeated courses of antibiotics 
for a putative borrelia infection is unsupported and may cause serious morbidity,5 persons with 
evidence of previously inadequately treated Lyme disease may be seronegative and may benefit 
from adequate antibiotic therapy. Fortunately, erythema migrans is now more readily recognized, 
and occult Lyme disease is rarer. In the absence of antibiotic treatment, most persons become 
seropositive.
David J. Volkman, M.D., Ph.D.
State University of New York at Stony Brook
Stony Brook, NY 11794
volkmans@optonline.net
References
1. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative late 
Lyme borreliosis: dissociation of specific T- and B-lymphocyte responses to Borrelia burgdorferi. 
N Engl J Med 1988;319:1441-1446.[Abstract]
&nbs p; 2. Volkman D. Prophylaxis after tick bites. Lancet Infect Dis 
2007;7:370-371.[CrossRef][ISI][Medline]
3. Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in 
cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology 1992;42:32-42.[Free Full Text]
4. Oksi J, Uksila J, Marjamäki M, Nikoskelainen J, Viljanen MK. Antibodies against whole 
sonicated Borrelia burgdorferi spirochetes, 41-kilodalton flagellin, and P39 protein in patients 
with PCR- or culture-proven late Lyme borreliosis. J Clin Microbiol
1995;33:2260-2264.[Abstract]
5. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients 
with persistent symptoms and a history of Lyme disease. N Engl J Med 2001;345:85-92.[Free Full 
Text




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