Cystic forms of Borrelia burgdorferi sensu lato:

 Wien Klin Wochenschr. 2002 Jul 31;114,13-14:574-9. Cystic forms of Borrelia burgdorferi
sensu lato: induction, development, and the role of RpoS. Murgia R, Piazzetta C, Cinco M.
Dipartimento di Scienze Biomediche, sez. Microbiologia, Università degli Studi di Trieste, 
Trieste, Italy.
60It has been demonstrated recently that cells of Borrelia burgdorferi sensu lato, the etiological 
agent of Lyme disease, transform from mobile spirochetes into nonmotile cystic forms in the 
presence of certain unfavourable conditions, and that cystic forms are able to reconvert to 
vegetative spirochetes in vitro and in vivo. T he purpose of this study was to investigate the 
kinetics of conversion of borreliae to cysts in different stress conditions such as starvation 
media or the presence of different antibiotics. Using the same experimental conditions we also 
investigated the possible role in cyst formation of RpoS, an alternative sigma factor that controls a 
regulon in response to starvation and transition to stationary phase. We observed that 
beta-lactams penicillin G and ceftriaxone, the antibiotics of choice in Lyme borreliosis
treatment, favoured the production of cysts when used with serum-depleted BSK medium. In 
contrast, we observed a low level of cyst formation in the presence of macrolides and 
tetracyclines. In order to elucidate the role of the rpoS gene in cyst formation we analyzed the 
reaction of the rpoS mutant strain in comparison with its wild-type in different conditions. 
Under the same stimuli, both the wild-type borrelia and the rpoS knock-out isogenic strain 
produced cystic forms with similar kinetics, thus excluding the participation of the gene in this 
phenomenon. Our findings suggest that cyst formation is mainly due to a physical-chemical 
rearrangement of the outer membrane of Borrelia burgdorferi sensu lato leading to 
membrane fusion and controlled by different regulation mechanisms.
87.5:  Acta Neurol Scand. 2002 Oct;106(4):205-8. Chronic symptoms are common in patients 
with neuroborreliosis -- a questionnaire follow-up study. Vrethem M, Hellblom L, Widlund M, 
Ahl M, Danielsson O, Ernerudh J, Forsberg P.
Division of Neurology, University Hospital, Linköping, Sweden, Division of Neurophysiology, 
University Hospital, Linköping, Sweden.
OBJECTIVES: The existence of chronic neuroborreliosis is controversial. The aim of our study 
was to investigate the existence and kind of persistent symptoms in patients previously 
treated because of neurological symptoms as a result of neuroborreliosis. MATERIALS AND 
METHODS: A total of 106 patients with neuroborreliosis, according to established criteria, and a 
control group of 123 patients with Borrelia induced erythema migrans diagnosed in a general 
practitioner office were studied. A questionnaire was sent to patients and controls concerning 
their health situation. Time from onset of neurological symptoms to the questionnaire send out 
was 32 months, mean, for the patients with neuroborreliosis and 33 months , mean, for the 
controls. RESULTS: Fifty per cent of the individuals in the patient group compared with 16% 
of the individuals in the control group showed persistent complaints after their Borrelia
infection, P < 0.0001. The most significant differences between the groups were the presence 
of neuropsychiatric symptoms such as headache, attention problems, memory difficulties and 
61depression. Paresthesia, pain and persistent facial palsy was also significantly more common 
in patients treated because of neuroborreliosis. CONCLUSION: Our study shows that 
persisting neurological symptoms are common after a neuroborreliosis infection. The 
pathological mechanisms that lay behind the development of chronic symptoms, however, are 
still uncertain

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