Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis.

 Arthritis Rheum. 1993 Nov;36,11:1621 6. Persistence of Borrelia burgdorferi in 
ligamentous tissue from a patient with chronic Lyme borreliosis. Häupl T, Hahn G, Rittig M, 
Krause A, Schoerner C, Schönherr U, Kalden JR, Burmester GR.
Department of Medicine III, University of Erlangen-Nuremberg, Germany.
OBJECTIVE. To document the persistence of Borrelia burgdorferi in ligamentous tissue 
samples obtained from a woman with chronic Lyme borreliosis. METHODS. Spirochetes were 
isolated from samples of ligamentous tissue, and the spirochetes were characterized 
antigenetically and by molecular biology techniques. The ligamentous tissue was examined by 
electron microscopy. Humoral and cellular immune responses were analyzed. RESULTS. 
Choroiditis was the first recognized manifestation of Lyme disease in this patient. Despite 
antibiotic therapy, there was progression to a chronic stage, with multisystem manifestations.
The initially significant immune system activation was followed by a loss of the specific humoral
immune response and a decrease in the cellular immune response to B burgdorferi over the 
course of the disease. "Trigger finger" developed, and a portion of the flexor retinaculum obtained 
at surgery was cultured. Viable spirochetes were identified. Ultramorphologically, the spirochetes 
were situated between collagen fibers and along fibroblasts, some of which were deeply 
invaginated by these organisms. The cultured bacteria were identified as B burgdorferi by 
reactions with specific immune sera and monoclonal antibodies, and by polymerase chain 
reaction amplification and Southern blot hybridization techniques. CONCLUSION. To our 
knowledge, this is the first report of the isolation of B burgdorferi from ligamentous tissue. This 
suggests that tendon tissues serve as a specific site of spirochete residence in human host

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