Chronic
Persistent Lyme Borreliosis: PCR Evidence of Chronic Infection Despite Extended
Antibiotic Therapy—A Retrospective Review
Dr.
Richard Horowitz
13th International Scientific
Conference on Lyme Disease & Other Tick-Borne Disorders
Emphasis: Pediatrics & New Research
Hartford Marriott Farmington, CT 24–26 March 2000
Background:
B. burgdorferi has been
proven by PCR analysis to establish a persistent infection in the mammalian
host (Straubinger, R. Persistence of B. burgdorferi in experimentally
infected dogs after antibiotic treatment. J.Clin.Microbiol.1997 Jan;
35(l): 111-116). Use of PCR assays to monitor the clearance of B. burgdorferi
DNA from blood following antibiotic therapy has also been described (Manak
et al, Abstract, IX Annual Intl Conference on Lyme Borreliosis, April 1996).
This report describes serum PCR positivity in a cohort of chronic Lyme patients
despite prolonged treatment with multiple antibiotic regimens.
Methodology:
80 patients with Lyme
Borreliosis and/or Ehrlichiosis and Babesiosis were treated with multiple
courses of antibiotics, including tetracycline derivatives (doxycycline,
minocycline, tetracycline HCL), macrolides (azithromycin, clarithromycin)
penicillins (amoxicillin, IM benzathine penicillin), cephalosporins (cefuroxime
axetil, cefixime, IV ceftriaxone, IV cefotaxime) and metronidazole. These
drugs were used alone or in combination, with hydroxychloroquine added to
tetracycline or macrolide antibiotics in select patients. Patients with
chronic persistent symptomatology post therapy had serum PCR testing done
through MDL Laboratories in New Jersey. Between one and five specimens were
sent on each patient, with serial specimens generally on consecutive days.
Two sets of primers are utilized for the PCR reaction for each specimen:
(I) the SL primers amplify a region of the B. burgdorferi senso stricto
B31 OspA sequence; (II) The Ly primers amplify the region of the Ly1 chromosomal
gene.
Results & Conclusion:
Patients received
an average of 13 months of treatment (range: 1 month-53 months) with the
longest course reserved for a patient with a severe chronic relapsing encephalopathy.
All 80 charts reviewed showed serum PCR positivity for B. burgdorferi despite
extended courses of antibiotics, and serial PCRs were frequently necessary
to prove ongoing infection. Straubinger illustrated in the dog model that
antibiotics decreased the total number of organisms in tissue samples, but
did not eliminate the infection (Abstract, 12th Intl. Lyme Conference, April
1999), and others have shown persistent infection by PCR and culture even
in patients with negative standard blood tests for Lyme (Bayer, et al: Borrelia
burgdorferi DNA in the urine of treated patients with chronic Lyme disease
symptoms: A PCR study of 97 cases. Infection, 1996 Sep, 24: 5, 347-353;
OKSI et al: Borrelia burgdorferi detected by culture and PCR in clinical
relapse of disseminated Lyme borreliosis. Ann Med 1999 Jun; 31(3): 225-232).
This retrospective study highlights several points in chronic Lyme disease
treatment: No single antibiotic or combination of antibiotics used was able
to completely eradicate the infection, although significant clinical improvement
was seen with chronic antibiotic therapy. Overlap of clinical syndromes
may occur with Lyme disease and Babesiosis, and consecutive serial PCR specimens
(5) for B burgdorferi and B microti are often useful to differentiate between
these 2 disease states in patients with chronic persistent symptomatology.
[
