collecte section Bourgogne

a more aggressive approach to eradication of LYME disease ...


Like most aspects of Lyme disease, the role of cysts and biofilms in persistent B. burgdorferi infection has 

been controversial [1,27,29]. However, the study by Bockenstedt et al., and the open-minded commentary by 

Barbour may open up new vistas on this fascinating aspect of bacterial persistence. Whether chronic Lyme 

disease arises from persisting spirochetal forms hidden in biofilms (as suggested by the monkey study of 

Embers et al., and the experimental work of Sapi et al.) or from cell wall-deficient cysts (L-forms) of B. 

burgdorferi (as suggested by the mouse study observations of Bockenstedt et al., and the interpretation of 

Barbour), persisting forms of bacteria require treatment. To date the treatment options for these bacterial 

persisters are extremely limited, but their recognition dictates a more aggressive approach to eradication of 

Lyme disease using combination antibiotic therapy modelled on treatment regimens for tuberculosis and HIV 

disease [2]. The fact that B. burgdorferi shares resistance genes with pathogenic mycobacteria supports the 

need for this therapeutic approach [30,31]. It remains to be seen which form of B. burgdorferi is the true 

culprit in chronic Lyme disease and which form of treatment is most efficacious in clearing both forms of 

bacteria from patients