Risk of culture-confirmed borrelial persistence in patients treated for erythema migrans and possible mechanisms of resistance.

 Int J Med Microbiol. 2006 May;296 Suppl 40:233-41. Epub 2006 Mar 10.Risk of 
culture-confirmed borrelial persistence in patients treated for erythema migrans and possible 
mechanisms of resistance. Hunfeld KP, Ruzi·-Sablji· E, Norris DE, Kraiczy P, Strle F. Institute of 
Medical Microbiology, University Hospital of Frankfurt, Paul-Ehrlich Str. 40, D-60596 
Frankfurt/Main, Germany. K.Hunfeld@em.uni-frankfurt.de
Erythema migrans, EM, develops at the site of the tick bite in 77-90% of Lyme borreliosis, LB, 
patients and is therefore a common manifestation of early disease.Clinical treatment failures 
have been reported in early LB cases for almost every suitable antimicrobial agent. The exact 
risk of resistance to antibiotic treatment in patients with EM, however, is not known and 
there are few published cases of culture-proven treatment failure. Moreover, currently 
available diagnostic techniques cannot reliably discriminate between possible reinfection, true 
endogenous relapse and co-infection with other tick-borne pathogens. These drawbacks together 
with the phenomenon of r esistance to therapy in individual patients undoubtedly contribute to 
the inconsistencies surrounding the optimal treatment regimens for LB and are often 
misinterpreted and misused to support prolonged antibiotic treatment regimens. The question 
for the underlying mechanisms of possible antimicrobial resistance in Borrelia burgdorferi sensu 
lato remains unresolved but a better understanding of such genetic or phenotypic mechanisms 
would be helpful for the treatment of LB and other spirochetal diseases. Investigations on this 
issue, at best, should start with borrelial isolates cultured from patients before the start of 
antibiotic therapy and again after the conclusion of treatment. This task, however, remains 
challenging insofar, as culture is rarely successful under routine laboratory conditions after 
antimicrobial therapy.Here, we review recent clinical and experimental data on treatment 
resistance in EM patients suggesting that, although rare, borrelial persistence does occur at 
the site of the infectious lesion after antibiotic treatment. Borrelial persistence, however, is 
unlikely to result from acquired resistance against antimicrobial agents that were used for initial 
specific chemotherap

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