Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis.

Infection. 1989 Nov-Dec;17,6:355-9.Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, Prokop J. Neurologische Klinik Grosshadern, München, FR Germany.

The persistence of Borrelia burgdorferi in patients treated with antibiotics is described. The diagnosis of Lyme disease is based on clinical symptoms, epidemiology and specific IgG and IgM antibody titers to B. burgdorferi in serum. Antibiotic therapy may abrogate the antibody response to the infection as shown in our patients. B. burgdorferi may persist as shown by positive culture in MKP-medium; patients may have subclinical or clinical disease without diagnostic antibody titers to B. burgdorferi.We conclude that early stage of the disease as well as chronic Lyme disease with persistence of B. burgdorferi after antibiotic therapy cannot be excluded when the serum is negative for antibodies against B. burgdorferi.

[Persistence:] However, some patients later developed symptoms of the disease despite antibiotic treatment, 9-11. Because of these observations it has become questionable if a definite eradication of B. burgdorferi with antibiotics is possible, p.357. ..The central nervous system invasion by spirochetes and a persistence of Treponema pallidum after penicillin G therapy is common in neurosyphilis, 22,23, p.358.[Treatment:] In view of the hitherto failure of treatment, low CSF concentration of penicillin G, survival of B. burgdorferi in patients treated with antibiotics, the moderate penicillin G susceptibility o f the organism and unpredictable progression of the disease, it seems appropriate to treat patients with substantially larger doses of antibiotics and/or longer than is provided in present treatment regimens. p.358.[Seronegativity:] As shown, negative antibody-titers do not provide evidence for successful therapy; antibody-titers may become negative despite persistence.

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