Short term antibiotics fail in 25 percent to 71 percent of patients with late stage disease, and that treatment relapses are common.
In 2014, researchers at Johns Hopkins University and Northwestern University showed that borrelia was able to form persister bacterial cells. Persisters are a subpopulation of resistant cells that can survive antibiotics or other medications.
These cells can lie dormant (either non-growing or slow-growing), and can reactivate when conditions are favourable. Certain chronic infections like tuberculosis and leprosy that are slow-growing intra Cellular infections (like Lyme) can take up to one year all longer to treat, and they illustrate the issues of persisters and relapse. For these conditions, we combine drugs that hit the different bacterial forms.
Persisters not killed by antibiotics can revert to active bacteria and cause a relapse. That is why three and even four drug regimens are necessary. Many persister infections also involve biofilm formation, as is the case with chronic gum infections (periodontitis), chronic otitis media (inner ear infections with multiple infections including Lyme disease.
Persister cells and biofilms help us understand some of the mechanisms behind relapses in Lyme disease. Lyme bacteria can withstand some of the strongest antibiotics, forming persister bacteria which can then reactivate under favourable conditions(when antibiotics are stopped).
Biofilms, the protective coating- might also be playing a large rollin contributing to borrelia’s persistence. Biofilms create a matrix, which provides a physical barrier for antibodies and antibiotics, and shields persisters from the immune system.
After PCR and culture positivity for Borrelia after short-term and long-term antibiotics, Horowitz is using new therapies using novel drugs and pulsing regimens to find cures.
Immune Evasion: Borrelia has been shown to be capable of affecting our immune system, preventing it from having a long lasting, functional antibody response. Borrelia is able to kill important immune cells in our body such as lymphocytes, and that some serum resistant strains of borrelia evade the complement pathway, which is another way our immune system helps to clear pathogens from the body.
Although this mechanism was known to exist for Borrelia burgdorferi, a recent article showed that the relapsing fever spirochete Borrelia miyamotoi is also resistant to human complement mediated killing, and may help explain persistent symptoms.
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