Post-Lyme Disease Syndrome
Many patients continue to suffer from symptoms of Lyme disease even after serological tests appear to show that antibiotic treatment has eradicated the active bacteria. The cause of Chronic Lyme disease, also referred to as persistent Lyme disease, and post-treatment Lyme disease syndrome, remains controversial as many orthodox medical institutions and doctors decry the existence of any such illness. Instead, misdiagnosis, tissue damage and systemic inflammation, mental illness, and other theories are espoused to explain the myriad symptoms patients suffer after treatment for Lyme disease infection.
Joint Pain in Lyme Disease
This new research could explain the lingering joint pain that a quarter of patients are thought to suffer after antibiotic treatment for Lyme disease cases in the US. Lyme arthritis, and persistent joint pain after Lyme disease, is believed to be less common in Europe and Asia as the Borrelia bacterial strains differ and may cause more symptoms of neuroborreliosis or skin manifestations such as acrodermatitis chronica atrophicans.
Bacterial Antigen Deposits in Cartilage
Yale researchers infected mice with impaired immune systems with Lyme disease, as well as infecting mice with normal immune systems. They then gave some of the mice antibiotic-treated drinking water and others untreated drinking water for thirty days and found that mice with normal immunity who were treated became free of the infection. The antibiotics also killed Lyme bacteria in the immunocompromised mice in all cases but one, whereas the Lyme bacteria persisted in untreated mice. The scientists then tested the knee joints of the treated mice and found remnants of the spirochaetes in all of them, showing that, although the bacteria were killed, bacterial debris remained. Interestingly, spirochaetes were also found near to the ear cartilage in most of the mice and these were found to be capable of triggering an inflammatory response without continued infection.
Post-Treatment Lyme Arthritis Triggered by Residual Bacterial Debris
The researchers’ conclusions that infection was cleared despite all mice having evidence of bacterial DNA has angered some Lyme disease advocates. It is unclear whether this residual debris is metabolically viable, especially given the scientists acknowledgement that some of the spirochaetal debris was capable of triggering an inflammatory response but not full-blown infection. This bacterial debris is not cleared by antibiotics, suggesting that those undergoing long-term intravenous antibiotics may find treatment ineffective if the cause of their persistent Lyme disease symptoms is inflammation prompted by the bacterial fragments. However, the researchers did use xenodiagnosis and bacterial culture techniques to see if the mice continued to be infected with Lyme disease bacteria, with results showing no persistence of active infection. Tissue transplants between treated, and persistently symptomatic mice and naive mice also did not result in the naive mice becoming infected with Lyme disease, suggesting active infection had been cleared.
Antibiotic-Refractory Lyme Arthritis
The Yale University researchers concluded that these deposits of bacterial antigens, but not complete bacteria, could contribute to the persistent Lyme disease arthritis that is resistant to antibiotic therapy. Such research in mice does not, of course, necessarily translate directly to human Lyme disease cases and there have been repeated calls for tests in human patients to detect residual bacterial presence after Lyme disease treatment. Meanwhile, it may be that Lyme disease researchers start looking for ways to clear the residual debris from joint tissue after infection with Borrelia so as to remove this potential trigger of inflammation and cause of persistent Lyme disease symptoms.
Linda K. Bockenstedt, David G. Gonzalez, Ann M. Haberman, and Alexia A. Belperron, Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy, J Clin Invest. 2012;122(7):2652–2660. doi:10.1172/JCI58813.