Seronegativity with Erythema Migrans
Published in the New England Journal of Medicine this month, the research paper looked at OspC genotypes in twenty-four paired episodes of the skin rash indicative of Lyme disease. Robert B. Nadelman, MD, and colleagues could only find isolates of B. burgdorferi in twenty-two of these episodes and, of these, found twelve different OspC genotypes.
Borrelial Strains Vary Widely
Demonstrating the variety of genotypes presented by Borrelia, Nadelman, et al, found eight different strains in the initial episodes and eleven different strains in the second, paired episodes. Interestingly, no patient in the study had the same strain of bacteria in their second bout of Lyme disease symptoms as they did in their first.
Reinfection Rather than Relapse in Lyme Disease
Systemic symptoms of Lyme disease were observed in almost all patients (82%) in their first episode, with evidence of disseminated infection in 59% of the twenty-two patients studied. Patients treated successfully with antibiotics in their first episode frequently went on to be found seropositive at a later date, after erythema migrans recurred. Clinical and epidemiological evidence both, however, pointed to a reinfection with Lyme disease rather than a relapse from an insufficiently treated initial episode.
First-Line Antibiotics Effective for Lyme
The take-home message from this research appears to be that physicians should feel more confident in the efficacy of first-line antibiotics for Lyme disease. Conversely, other research released last month suggests that Borrelia burgdorferi can go into ‘stealth mode’ and evade these antibiotics by forming cysts and biofilms. Presumably, the patients experiencing reinfection in this study were not assessed for the presence of such bacterial biofilms, leaving Lyme disease conspiracy advocates concerned over the merit of the research.
Steere Wades in on Persistent Lyme Disease Infection
An editorial written by Allen C. Steere, and published alongside the paper, is sure to anger Lyme disease patients convinced that prolonged suffering is due to chronic infection:
“As concluded by the Infectious Disease Society of America, there is no evidence of persistent B burgdorferi infection in human patients after recommended courses of antibiotic therapy. Although B burgdorferi infection may persist for years in untreated patients, the weight of evidence is strongly against persistent infection as the explanation for persistent symptoms in antibiotic-treated patients with Lyme disease.”
Lyme Disease Confusion
The study’s author has previously served on cases of medical malpractice concerning Lyme disease, which may go some way towards easing the initial scepticism about the old guard of Lyme disease research protecting their own interests. As sound as the science seems in this study, however, it is important to remember that the sample size is small, that two of the twenty-two patients with the Lyme disease rash proved seronegative, and that the tests used are themselves considered flawed by many researchers. Recent Lyme disease biofilms research certainly clouds the picture when persistent infection is dismissed as recurrent Lyme disease infection.
Robert B. Nadelman, M.D., Klára Hanincová, Ph.D., Priyanka Mukherjee, B.S., Dionysios Liveris, Ph.D., John Nowakowski, M.D., Donna McKenna, A.N.P., Dustin Brisson, Ph.D., Denise Cooper, B.S., Susan Bittker, M.S., Gul Madison, M.D., Diane Holmgren, R.N., Ira Schwartz, Ph.D., and Gary P. Wormser, M.D., Differentiation of Reinfection from Relapse in Recurrent Lyme Disease, N Engl J Med 2012; 367:1883-1890. November 15, 2012. DOI: 10.1056/NEJMoa1114362.