Lyme bacteria can 'hide' from antibiotics: study

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Lyme bacteria can 'hide,' study says

Oakland Tribune, Apr 21, 2008 by Suzanne Bohan

http://findarticles.com/p/articles/mi_qn4176/is_20080421/ai_n25351873

A recent study from the University of California, , provides the

first evidence that the bacteria causing Lyme disease can evade

antibiotics by " hiding out " in tissue throughout the body and remain

infectious long after treatment ends.

" Lyme disease is a tough nut to crack, " said Barthold, the

study's lead researcher and director of the university's Center for

Comparative Medicine. " The bacterium causing Lyme disease has evolved to

evade the body's immune system, so it's not surprising that it can also

evade antibiotics. "

The study found the hidden bacteria, however, appeared dormant, although

they still produced proteins potentially capable of continuing Lyme

disease symptoms, he said.

The article appeared in the March issue of the journal Antimicrobial

Agents and Chemotherapy, and the research was funded by the National

Institutes of Health.

The findings provide critical data in the quest to offer relief for

those certain they're suffering from the sometimes crippling symptoms of

Lyme disease years after their initial infection and subsequent

treatment. Patients with these chronic symptoms often report joint

inflammation and arthritis, memory loss, mood changes and sleep

disorders, among other health problems.

Some also fear they face a similar fate as those with untreated Lyme

disease -- including carditis, also called heart inflammation, and nerve

damage.

The Centers for Disease Control and Prevention lists Northern California

as an active region for Lyme disease transmission, although it's most

prevalent in the Northeastern and Great Lake states. The bacteria are

spread primarily by Western black-legged ticks in California and deer

ticks in other regions of the country.

" There's no doubt about it, it's here, " Barthold said. But in a novel

ecological twist, when young ticks feed on a certainspecies of lizard,

something in the lizard's blood clears the Lyme disease- causing

bacteria from the tick, so most adult ticks in California aren't

infectious. Barthold said it's a key reason for the region's lower rate.

While some patients and their doctors advocate continued use of

antibiotics for weeks, months or even years to combat the condition, the

CDC and other major medical organizations state that evidence doesn't

support more than two rounds of antibiotics, and that more aggressive

treatment can prove harmful.

That leaves those with chronic symptoms long after initial treatment

paying costly bills should they pursue continued antibiotic

administration. Many insurers decline to cover long-term treatment for

the condition, citing a lack of proven effectiveness.

Patients also report coping with anxiety and frustration over the

limited medical options available to them for relieving their symptoms.

Numerous Lyme disease advocacy groups have formed to call for better

diagnosis and treatment protocols.

The UC researchers infected three groups of mice with Borrelia

burgdorferi, the bacterium that causes Lyme disease. Mice showed

comparable symptoms of Lyme disease as humans and responded similarly to

antibiotic treatment.

One group of mice received antibiotics during the first three weeks of

infection, while another got antibiotics four months later. The third

group received only a placebo.

When the treatments were completed, the placebo group showed continued

infection in a standard lab test, while the two antibiotics groups

showed no trace of the bacteria using the same test.

Nonetheless, researchers still found small numbers of Borrelia

persisting in collagen-rich tissue in the antibiotic-treated mice that

the lab tests missed. Collagen, a connective tissue, is found throughout

the body, including in the skin, ligaments, tendons and the heart

muscle. Barthold said it requires a tissue sample to find any hidden

bacteria.

" It's an invasive procedure the medical practice simply doesn't do, " he

said.

In addition, ticks that fed on the antibiotic-treated mice still picked

up the Lyme disease bacteria and transferred them to uninfected mice.

These mice, however, didn't develop Lyme disease, since the hidden

bacteria don't replicate like normal bacteria.

Testing in doctors' offices for this elusive type of Borrelia would

provide limited value at this stage, Barthold added, since there's no

known way to clear it out. He agrees with CDC guidelines warning against

long-term antibiotic treatment.

" If the first round of antibiotics hasn't eliminated them, it's not

likely that a longer regimen of antibiotics would be any more

successful, " Barthold said. " It's more likely that a completely

different class of antibiotics would be needed to accomplish that. "

But the findings do provide another explanation for the persistent

symptoms reported by those treated for Lyme disease, particularly people

who didn't swiftly get antibiotics following an infection.

Barthold said it appears these elusive Borrelia don't replicate, and

instead remain dormant, as microbes causing herpes, tuberculosis and

syphilis often do. He said it is unknown at this stage if these Borrelia

may re-emerge and cause recurrent disease, although that's an area he

and others intend to study.

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*1: *Antimicrob Agents Chemother. <javascript:AL_get(this, 'jour',

'Antimicrob Agents Chemother.');> 2008 May;52(5):1728-36. Epub 2008 Mar

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Persistence of Borrelia burgdorferi following antibiotic

treatment in mice.

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Center for Comparative Medicine, School of Medicine, University of

California at , One Shields Avenue, , CA 95616, USA.

The effectiveness of antibiotic treatment was examined in a mouse

model of Lyme borreliosis. Mice were treated with ceftriaxone or

saline solution for 1 month, commencing during the early (3 weeks)

or chronic (4 months) stages of infection with Borrelia burgdorferi.

Tissues from mice were tested for infection by culture, PCR,

xenodiagnosis, and transplantation of allografts at 1 and 3 months

after completion of treatment. In addition, tissues were examined

for the presence of spirochetes by immunohistochemistry. In contrast

to saline solution-treated mice, mice treated with antibiotic were

consistently culture negative, but tissues from some of the mice

remained PCR positive, and spirochetes could be visualized in

collagen-rich tissues. Furthermore, when some of the

antibiotic-treated mice were fed on by Ixodes scapularis ticks

(xenodiagnosis), spirochetes were acquired by the ticks, as

determined based upon PCR results, and ticks from those cohorts

transmitted spirochetes to naïve SCID mice, which became PCR

positive but culture negative. Results indicated that following

antibiotic treatment, mice remained infected with nondividing but

infectious spirochetes, particularly when antibiotic treatment was

commenced during the chronic stage of infection.

PMID: 18316520