Lyme Disease Guidelines: is your site for guideline response. Devoted to transparency in Lyme diagnosis and treatment Guidelines

References on Persistence of Borrelia

Persistence of The Lyme Disease Bacterium,Borrelia burgdorferi

The following references for persistence of Lyme disease (Lyme borreliosis) are listed alphabetically and chronologically:

  1. Aalto A, Sjowall J, Davidsson L, Forsberg P, Smedby O. Brain magnetic resonance imaging does not contribute to the diagnosis of chronic neuroborreliosis. Acta Radiol 2007; 48: 755-762. [white matter hyperintensities or basal ganglia lesions].
  2. AbeleDC and Anders KH. The many faces and phases of borreliosis. J Am AcadDermotol 1990; 23:401-410. [chronic Lyme borreliosis].
  3. Aberer E and Klade H. Cutaneous manifestations of Lyme borreliosis. Infection 1991; 19: 284-286. [chronic Lyme borreliosis].
  4. Aberer E, Breier F, Stanek G, and Schmidt B. Success and failure in the treatment of acrodermatitis chronica atrophicans skin rash. Infection 1996; 24: 85-87.
  5. Aberer E, Kersten A, Klade H, Poitschek C, Jurecka W. Heterogeneity of Borrelia burgdorferi in the skin. Am J Dermatopathol 1996; 18(6): 571-519.
  6. Ackermann R, Rehse-Küpper B, Gollmer E, Schmidt R. Chronic neurologic manifestations of erythema migrans borreliosis. Ann NY Acad Sci 1988; 539: 16-23.
  7. Akin E, McHugh Gl, Flavell RA, Fikrig E, Steere AC. The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to P35 with mild and brief arthritis. Infect Immun 1999; 67: 173-181.
  8. Albert S, Schulze J, Riegel H, Brade V. Lyme arthritis in a 12-year-old patient after a latency period of 5 years. Infection 1999; 27(4-5): 286-288.
  9. Al-Robaiy S, Dihazi H, Kacza J, et al. Metamorphosis of Borrelia burgdorferi organisms―RNA, lipid and protein composition in context with the spirochete’s shape. J Basic Microbiol 2010, 50 Suppl 1, S5-17.
  10. Appel MJG, Allan S, Jacobson RH, Lauderdale TL, Chang YF, Shin SJ, Thomford JW, Todhunter RJ, and Summers BA. Experimental Lyme disease +in dogs produces arthritis and persistent infection. J Inf Dis 1993; 167: 651-664.
  11. Åsbrink E, Hovmark A. Successful cultivation of spirochetes from skin lesions of patients with erythema chronicum migrans, Afzelius and acrodermatischronica atrophicans. Acta Pathol Microbiol Immunol Sect B 1985; 93: 161-163.
  12. Åsbrink E, Hovmark A, and Olsson Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. ZentralblBakteriolMikrobiolHyg A 1986; 26: 253-261. [chronic Lyme borreliosis].
  13. Asch ES, Bujak DI, Weiss M, Peterson MGE, and Weinstein A. Lyme Disease: an infectious and postinfectious syndrome. J Rheumatol 1994; 21 (3): 451-461.
  14. Aslam B, Nisar MA, Khurshid M, Farooq-Salamat MK. Immune escape strategies of Borrelia burgdorferi. Future Microbiology 2017; 12: 1219-1237.
  15. Bankhead T and Chaconas G. The role of VlsE antigenic variation in the Lyme disease spirochete: persistence through a mechanism that differs from other pathogens. Molecular Microbiology 2007; 65: 1547-1558.
  16. Barthold SW, Persing DH, Armstrong AL, and Peeples RA. Kinetics of Borrelia burgdorferi dissemination and evolution of disease following intradermal inoculation of mice. Am J Pathol 1991; 139: 263-273. [in mice]
  17. Barthold SW, deSouza MS, Janotka JL, Smith AL, and Persing DH. Chronic Lyme borreliosis in laboratory mouse. Am J Pathol 1993; 143: 951-971. [in mice]
  18. Barthold S. Lyme borreliosis. Chapter 14, In Persistent Bacterial Infections. Edited by J.P. Nataro, M.J. Blaser, and S. Cunningham-Rundles, pp 281-304. ASM Press, Washington, D.C.
  19. Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, and Luft BJ. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrob Agents Chemother 2010; 54(2): 643-651. [mice, rats, white-footed mice, hamsters, gerbils, guinea pigs, rabbits, dogs, nonhuman primates, and humans]
  20. Barthold SW. Global challenges in diagnosing and managing Lyme disease—closing knowledge gaps. Testimony before House Committee on Foreign Affairs, United States Congress, 17 July 2012.
  21. Battafarano DF, Combs JA, Enzenauer RJ, Fitzpatrick JE (1993) Chronic septic arthritis caused by Borrelia burgdorferi. Clin Orthop 297: 238-241. doi: 10.1097/00003086-199312000-00038. [Patients with chronic septic Lyme arthritis of the knee for seven years, despite multiple antibiotic trials and synovectomies. Bb documented in synovium and synovial fluid.]
  22. Baum E, Hue F, Barbour AG (2012) Experimental infections of the reservoir species Peromyscus leuopus with diverse strains of Borrelia burgdorferi, a Lyme disease agent. MBio 3: e00434-12. doi: 10: 10.1128/mbio.00434-12.
  23. Bayer ME, Zhang L, Bayer MH. Borrelia burgdorferi DNA in the urine of treated patients with chronic Lyme disease symptoms. A PCR study of 97 cases. Infection 1996; 24: 347-353. [97 patients who had been treated with antibiotics for extended periods of time and had symptoms of chronic Lyme were PCR-positive.]
  24. de Leeuw BHCGM, Maraha B, Hollemans L, Sprong H, Brandenburg AH, Westenend PJ, Kusters JG. Evaluation of Borrelia real time PCR DNA targeting OspA, FlaB and 5S-23S IGS and Borrelia 16S rRNA-qPCR. Journal of Microbiological Methods (2014).
  25. Benjamin J and J Luft. Chronic Lyme disease; an evolving syndrome. 9th Annual International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. 1996.
  26. Berglund J, Stjernberg L, Ornstein K, Tykesson-Joelsson K, Walter H. 5-y follow-up study of patients with neuroborreliosis. Scand. J. Infect. Dis. 2002; 34(6): 421-425.
  27. Berndtson K. Review of evidence for immune evasion and persistent infection in Lyme disease. Int J of General Medicine 2013; 6: 291-306. [Lyme disease spirochetes are adapted to persist in immune competent hosts; they are can remain infective despite aggressive antibiotic challenge.]
  28. Bloom BJ, Wyckoff PM, Meissner HC, and Steere AC. Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatric Infect. Dis. J. 1998; 17(3): 189-196.
  29. Bradley JF, Johnson RC, Goodman JL (1994) The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Intern Med 120: 487-489.doi: 10.7326/0003-4819-120-6-199403150-00007 [human]
  30. Bransfield R, Brand S, and Sherr V. Treatment of patients with persistent symptoms and a history of Lyme disease. N Engl Med 2001; 345: 1424-5.
  31. Breier F, Khanakah G, Stanek G, Aberer E, Schmidt B, and Tappeiner G. Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144: 387-392.
  32. Bockenstedt LK, J Mao, E Hodzic, SW Barthold, and D Fish. Detection of attenuated, non-infectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment. J Infect Dis 2002; 186: 1430-1437. [Bb persistence in mice]
  33. Bockenstedt LK, Gonzalez DG, Hamberman AM, Belperron A (2012) Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy. J Clin Invest 122: 2652-2660. doi: 10.1172/jci58813.
  34. Breier F, Kkhkanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, and Tappeiner G. Isolation and polymerase chain reaction of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcereating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144: 387-392.
  35. Brorson O and Brorson S-H. Transformation of cystic forms of Borrelia burgdorferi to normal mobile spirochetes. Infection. 1997; 25: 240-246. [change in physical characteristics; change of spirochetes to other pleomorphic forms, i.e., cell wall deficient forms, namely cysts.]
  36. Brorson O and Brorson S. In vitro conversion of Borrelia burgdorferi to cystic forms in spinal fluid, and transformation to mobile spirochetes by incubation in BSK-H medium. Infection. 1998; 26: 144-150. [change in physical characteristics; change of spirochetes to other pleomorphic forms, i.e., cell wall deficient forms, namely cysts.]
  37. Brorson O and Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to metronidazole. APMIS 1999; 107: 566-576.
  38. Brorson O and Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to tinidazole. International Microbiol 2004; 7: 139-142.
  39. Brorson O and Brorson SH. An in vitro study of the activity of telithromycin against mobile and cystic forms of Borrelia afzelii. Infection 2006; 34: 26-28.
  40. Brorson O Brorson SH, Scythes J, MacAllister J, Wier A, and Margulis L. Destruction of spirochete Borrelia burgdorferi round-body propagules (RBs) by the antibiotic tigecycline. Proc Natl Acad Sci USA 2009; 106: 18656-61
  41. Brown JP, Zachary JF, Teuscher C, Weis JJ, and Wooten M. Dual role of interleukin-10 in murine Lyme disease: regulation of arthritis severity and host defense. Infect Immun 1999; 67: 5142-5150. [suppression of harmful immune responses: defense stratagem of burgdorferi]
  42. Burrascano J. Failure of aggressive antibiotic therapy to protect the placenta from invasion by burgdorferi in a pregnant patient with Lyme borreliosis.  6th Annual International Science Conference on Lyme Disease and other Tick-borne Diseases.1993.
  43. Cabello FC, Godfrey HP, and Newman SA. Hidden in plain sight: Borrelia burgdorferi and the extracellular matrix. Trends in Microbiology 2007; 15: 350-354. [sequestration]
  44. Cabello FC, Godfrey HP, Bugrysheva JV, Newman SA. Sleeper cells: the stringent response and persistence in the Borreliella (Borrelia) burgdorferi enzootic cycle. Environ Microbiol 2017; 19; 3846-3862. Doi: 10.1111/1462-2920.13897
  45. Cadavid D, O’Neill T, Schaefer H, and Pachner AR. Localization of Borrelia burgdorferi in the nervous system and organs in a nonhuman primate model of Lyme disease. Lab Invest 2000; 80: 1043-1054.
  46. Cadavid D, Y Bai, E Hodzic, K Narayan, SW Barthold, and Pachner AR. Cardiac involvement in non-human primates infected with the Lyme disease spirochete Borrelia burgdorferi. Lab Invest 2004; 84: 1439-1450. [in monkeys]
  47. Cameron D, Gaito A, Harris N et al. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti-Infect. Ther 2004; 2 (Suppl. 1), S1-S13.
  48. Cameron D. Results from Lyme disease treatment trial. Columbia University/LDA Conference, Lyme & Other Tick-Borne Diseases: Emerging Tick-Borne Diseases. October 28, 2005; Philadelphia, Pennsylvania.
  49. Cameron DJ. Generalizability in two clinic trials of Lyme disease. Perspectives and Innovation 2006; 3(12). [].
  50. Cameron D. Severity of Lyme disease with persistent symptoms. Insights from a double-blind placebo-controlled clinical trial. Minerva Med 2008; 99: 489-496.
  51. Cameron DJ. Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients. Med Hypotheses (2009), doi:10.1016i/j.mehy.2009.01.017
  52. Cameron DJ. Proof that Lyme disease exists. 2010. [].
  53. Cameron DJ. Proof that chronic Lyme disease exists. Interdisciplinary Perspect Infect Dis 2010. doi:10.1155/2010/876450.
  54. Cameron DJ, Johnson LB, and Maloney EL. Evidence assessments and guideline recommendations in Lyme disease. The clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Review of Anti-infective Therapy. 2014; 12: 1103-1135
  55. Caskey JR, Ember ME. Persister development by burgdorferi populations in vitro. Antimicrobial Agents and Chemotherapy 2015 [online first 2015 July 27]
  56. Chancellor MB, McGinnis DE, Shenot PJ, Kiilholma P, and Hirsch IH. Urinary dysfunction in Lyme disease. J Urol 1993; 149: 26-30.
  57. Chang YK, Ku YW, Chang CF, Chang CD, McDonough SP, Divers T, Pough M, and Torres A. Antibiotic treatment of experimentally Borrelia burgdorferi-infected ponies. Vet Microbiol 2005; 107: 285-294. [persistence in ponies]
  58. Chao L-L, Lu C-F, and Shih C-M. Molecular detection and genetic identification of Borrelia gariniiand Borrelia afzelii from patients presenting with a rare skin manifestation of prurigo pigmentosa in Taiwan. Int J Infect Dis 2013,
  59. Chary-Valckenaere I, Jaulhac B, Champigneulle J, Piement Y, Mainard D, and Pourel J. Ultrastructural demonstration of intracellular localization of Borrelia burgdorferi in Lyme arthritis. Br J Rheumatol 1998; 37: 468-470.
  60. Chmielewski T, Tylewlska-Wierzhanowska S. Inhibition of fibroblast apoptosis by Borrelia afzelii, Coxiella burnetii and Bartonella henselae. Poll Microbiol 2011; 60(3); 269-272.
  61. Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient with chronic Lyme disease. Am J Clin Pathol 1989; 91(1): 95-97.
  62. Clarke AE, Esdaile JM, Bloch DA, Lacaille D, Danoff, and Fries JF. A Canadian study of the total medical costs for patients with systemic lupus erythema and the predictors of costs. Arthrit. Rheum. 1993; 36(11): 1548-1593.
  63. Cleveland CP, Dennler PS, Duray PH. Recurrence of Lyme disease presenting as a chest wall mass:   Borrelia burgdorferi was present despite five months of IV ceftriaxone 2 g, and three months of oral cefixime 400 mg BID. The presence of Borrelia burgdorferi confirmed by biopsy and culture.  Poster presentation at V Lyme Disease Foundation International Scientific Conference. Stamford, CT, April 10-11, 1992.
  64. Cleveland CP, and Dennler S. Case history: recurrence of Lyme disease as a chest wall mass. Abstract presented at the 1993 LDF International Conference on Lyme Disease.
  65. Coyle P. Lyme Disease. Mosby Year Book, pp. 235, 1993. St Louis, [seclusion into immune privileged sites: defense strategies of B. burgdorferi]
  66. Craft J, Fischer DK, Shimamoto GT, Steere AC. Antigens of Borrelia burgdorferi recognized during Lyme disease appearance of a new immunoglobulin M response and expansion of the immunoglobulin G response late in the illness. Clin. Invest. 1986; 1978: 934-939.
  67. Crossland NA, Alvarez X, Embers ME. Late disseminated Lyme disease: associated pathology and spirochete persistence post-treatment in Rhesus macaques. American Journal of Pathology.
  68. Czub S, Duray PH, Thomas RE, Schwan TG. Cystitis induced by infection with the Lyme disease spirochete, Borrelia burgdorferi, in mice. Am J Pathol 1992; 141: 1173-1179. [persistence of burgdorferi in urinary tract of mice]
  69. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, and Golightly MG. Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte response to Borrelia burgdorferi. N Engl J Med 1988; 319(22): 1441-1446.
  70. Dejmková H, D Hulinska, D Tegzová, K Pavelka, J Gatterová, and P Vavřik. Seronegative Lyme arthritis caused by Borrelia garinii. Clin Rheumatol 2002; 21:330-334.
  71. DeLong AK, Blossom B, Maloney E, and Phillips SE. Antibiotic retreatment of Lyme disease in patients with persistent symptoms: A biostatistical review of randomized, placebo-controlled, clinical trials. Contemp Clin Trials 2012; epub ahead of print. [refutes Klempers {2001} conjecture that long-term antibiotics don’t work]
  72. de Koning J, et al. Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease. Infect. Dis. 1989; 160: 150-153. [intracellular sanctuaries of Bb]
  73. Demaershalck I, Messaoud AB, de Kesel M, Hoyois B, Lobet Y, Hoet P, Bigaignon G, Bollen A, and Godfroid E. Simultaneous presence of different Borrelia burgdorferi genospecies in biological fluids of Lyme disease patients. J Clin Microbiol 1995: 33; 602-608.
  74. Diterich I, Rauter C, Kirschning CJ, and Hartung T. Borrelia burgdorferi-induced tolerance as a model of persistence via immunosuppression. Infect Immun 2003; 71(7):3979-3987.
  75. Donahue JG, Piesman J, Spielman A (1987) Reservoir competence of white-footed mice for Lyme disease spirochetes. Am J Trop Med Hyg 36: 92-96. [persistence of Bb at least 200 days in white-footed mice]
  76. Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Inf Dis 1997; 25 (Suppl 1); S52-56.
  77. Donta ST. The existence of chronic Lyme disease. Curr Treat Op Infect Dis 2001; 3: 261-262.
  78. Donta ST. Late and chronic Lyme disease. Med Clin North Am 2002; 86: 341-349.
  79. Donta ST. Macrolide therapy of chronic Lyme disease. Med Sci Monit 2003; 9: 136-142.
  80. Dorward DW, Fischer ER, and Brooks DM. Invasion and cytopathic killing of human lymphocytes by spirochetes causing Lyme disease. Clin. Infect. Dis. 1997. 25 Suppl 1: S2-8. [intracellular sanctuaries of Bb]
  81. Dunham-Ems SM, Caimano MJ, Pal U, et al. Live imaging reveals a biphasic mode of dissemination of Borrelia burgdorferi within ticks. J. Clin Invest. 2009; 119: 3652-3665. [biofilms consist of a colony of spirochetes and cysts coated by a gelatinous, protective membrane]
  82. Dupeyron A, J Lecocq, B. Jaulhac, M-E Isner-Horobeti, P Vautravers,, J Cohen-Solal, C Sordet, and J-L Kuntz. Sciatica, disk herniation, and neuroborreliosis. A report of four cases. Joint Bone Spine 2004; 71: 433-437.
  83. Dupeyron A, J Lecocq, B. Jaulhac, M-E Isner-Horobeti, P Vautravers,, J Cohen-Solal, C Sordet, and J-L Kuntz. Sciatica, disk herniation, and neuroborreliosis. A report of four cases. Joint Bone Spine 2004; 71: 433-437.
  84. Duray PH and Johnson RC. The histopathology of experimentally infected hamsters with the Lyme disease spirochete, Borrelia burgdorferi. Proc Soc Exp Biol Med 1986; 181: 263-269.
  85. Duray PH. 1987. The surgical pathology of human Lyme disease. An enlarging picture. Am J Surg Pathol S1: 47-60. [Bb in brain].
  86. Duray PH and Steere AC. Clinical pathologic correlations of Lyme disease by stage. Ann N Y Acad Sci 1988; 539: 65-79. Duray PH, et al. Invasion of human tissue ex vivo by Borrelia burgdorferi. Infect. Dis. 2005. 191(10): 1747-1754.
  87. Durovska J, Bazovska S, Ondrisova M, and Pancak J. 2010. Our experience with examination of antibodies against antigens of Borrelia burgdorferi in patients with suspected Lyme disease. Bratist. Lek. Listy 2010; 111(3): 153-155.
  88. Dvorakova J, and Celer V. Pharmacological aspects of Lyme borreliosis.CeskaSlov Farm. 2004; 53(4): 159-164.
  89. Ekdahl KN, Henningsson AJ, Sandholm K, Forsberg P, Ernerudh J, Ekerfelt C; Immunity in borreliosis with special emphasis on the role of complement. Adv Exp Med Biol 2007; 598: 198-213.
  90. Ebel GD, Campbell EN, Goethert HK, Spielman A, and Telford SR. Enzootic transmission of deer tick virus in New England and Wisconsin sites. Am. J. Trop. Med. Hyg. 2000; 63(1-2): 36-42.
  91. Embers ME, SW Barthold, JT Borda, L Bowers, L Doyle, E Hodzic, MB Jacobs, NR Hasenkampf, DS Martin, S. Narasimhan, KM Phillippi-Falkenstein, JE Purcell, MS Ratterree, and MT Philipp (2012) Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection. PLoS ONE 7(1): e29914. doi:10.1371/journal.pone.0029914 [Bb was cultured from rhesus macaques after antibiotic treatment and confirmed by PCR.]
  92. Embers M, Barthold SW (2012) Borrelia burgdorferi persistence post-antibiotic treatment, pp. 229-252. In: The pathogenic spirochetes: strategies for evasion of host immunity and persistence. Embers ME, editor. Springer, New York.
  93. Embers ME, Hasenkampf NR, Jacobs MB, Tardo AC, Doyle-Meyers LA, Phillipp MT, Hodzic E. Variable manifestations, diverse seroreactivity and post-treatment persistence in non-human primates exposed to Borrelia burgdorferi by tick feeding. PLoS ONE 2017; 12:e0189071. [definitive proof of persistence; RNA transcriptase of Bb after treatment]
  94. Fallon BA, Schwartzberg M, Bransfield R, Zimmerman B, Scotti A, Weber CA, and Liebowitz MR. Late-stage neuropsychiatric Lyme borreliosis. Case reports. Psychosomatics 1995; 36: 295-300.
  95. Fallon BA, Das S, Plutchok JJ, Tager F, Liegner K, Van Heertum R. Functional brain imaging and neuropsychological testing in Lyme disease. Clin Infect Dis 1997; 25 (suppl 1): S57-S63.
  96. Fallon BA, et al. Repeated antibiotic treatment in chronic Lyme disease. J Spir Tick Borne Dis. 1999; 6: 94-101.
  97. Fallon BA, Keilp J, Prohovnik I, Heertum RV, Mann JJ. Regional cerebral blood flow and cognitive deficits in chronic Lyme disease. J Neuropsychiatry Clin Neurosci 2003; 15: 326-332.
  98. Fallon BA, Keilp JG, Corbera KM, Petkova K, Britton CB, Dwyer E, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology 2008; 70: 992-1003.
  99. Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, and Sackeim HA. Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy. Arch Gen Psychiatry 2009; 66: 554-563.
  100. Farshad-Amacker NA, Scheffel H, Frauenfelder T, Alkadhi Brainstem abnormalities and vestibular nerve enhancement in acute neuroborreliosis. BMC Research Notes 2013; 6: 551.  doi:10.1186/1756-0500-6-551.
  101. Feder Jr., HM and Whitaker DL. Misdiagnosis of erythema migrans. Am. J. Med. 1995; 99: 412-419.
  102. Fein L, and Tilton RC. Bone marrow as a source for Borrelia burgdorferi J Spir Tick-borne Dis 1997; 4: 58-60.
  103. Feng J, Auwaerter PG, and Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: Eradication achieved by using daptomycin, cefoperazone and doxycycline. PLoS ONE 10: e0117207.
  104. Feng J, Li T, Yee R, et al. Stationary phase persister/biofilm mircocolony of Borrelia burgdorferi causes more severe disease in a mouse model of Lyme arthritis: implications for understanding persistence, post-treatment Lyme disease syndrome (PTLDS), and treatment failure. Discovery Medicine. 2019; 27: 125-138.
  105. Ferris J, et al. Lyme borreliosis. [letter] Lancet 1995; 345: 1436-1437.
  106. Fesler MC, Middelveen MJ, Burke JM, Stricker RB. Erosive vulvovaginitis associated with Borrelia burgdorferi Journal of Investigative Medicine High Impact Case Reports. 2019; 7: 1-5 [Bbss cultured from human vulvovaginal lesion, and opens the gateway for sexual transmission.]
  107. Franz JK, O Fritze, M Rittig et al. Insights from a novel three-dimensional in vitro model of Lyme arthritis: standardized analysis of cellular and molecular interactions between Borrelia burgdorferi and synovial explants and fibroblasts. Arthritis Rheum 2001; 44: 151-162.
  108. Fraser DD, Kong LI, and Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyositis. Clinical and Experimental Rheumatology 1992; 10: 387-390.
  109. Frey M, Jaulhac B, Piemont Y, Marcellin L, Boohs PM, Vautravers P, Jesel M, Kuntz JL, Monteil H, and Sibilia J. Detection of Borrelia burgdorferi DNA in muscle of patients with chronic myalgia related to Lyme disease. Am J Med 1988; 104: 591-594.
  110. Fried MD, Duray P. Gastrointestinal disease in children with persistent Lyme disease: spirochetes isolated form the G.I. tract. IX Lyme Disease Foundation International Scientific Conference, Boston, MA, April 19-20, 1996.
  111. Gaito A, Gjivoje V, Lutz S, II, and Baxter B, II. Comparative analysis of the infectivity rate of both Borrelia burgdorferi and Anaplasmaphagocytophilum in humans and dogs in a New Jersey community. Infect. Drug Resist. 2014; 7: 199-201. [persistence of Bb in humans and dogs]
  112. Garcia-Monco JC, Benach JL. The pathogenesis of Lyme disease. Rheum Dis Clin North Am 1989; 15: 711-726.
  113. Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme disease spirochete, Borrelia burgdorferi,from ceftriaxone in vitro. J Infect Dis 1992; 166: 440-444.
  114. Giambartolomei GH, Dennis VA, and Philipp MT. Borrelia burgdorferi stimulates the production of interleukin-10 in peripheral blood mononuclear cells from uninfected humans and rhesus monkeys. Infect Immun 1998; 66: 2691-2697. [suppression of harmful immune responses: defense stratagem of burgdorferi]
  115. Girschick HJ, Huppertz HI, Rüssmann H, Krenn V, and Karch H. Intracellular persistence of Borrelia burgdorferi in human synovial cells. Rheumatol Int 1996; 16: 125-132. [intracellar sanctuaries of Bb]
  116. Goodman JL, Jurkovich P, Kodner C, and Johnson RC. Persistent cardiac and urinary tract infections with Borrelia burgdorferi in experimentally infected Syrian hamsters. J Clin Microbiol 1991; 29: 894-896. [hamsters]
  117. Grignolo MC, Buffrini L, Monteforte P, and Rovetta G. Reliability of a polymerase chain reaction (PCR) technique in the diagnosis of Lyme borreliosis. Minerva Med 2001; 92(1): 29-33. [Article in Italian]
  118. Gruntar I, et al. Conversion of Borrelia garinii cystic forms to motile spirochetes in vivo. APMIS 2001; 109(5): 383-388. [Persistence occurs when spirochetes change physical characteristics by converting to dormant cysts, and vis versa.]
  119. Halperin JJ,, Luft BJ, Anand AK, Roque CT, Alvarez O, Volkman DJ, Dattwyler RJ. Lyme neuroborreliosis: central nervous system manifestations. Neurology 1989; 39: 753-759. [hyperintensities persist after treatment]
  120. Halperin JJ. Prolonged Lyme disease treatment: enough is enough. Neurology 2008; 70(13): 986-987.
  121. Harvey WT and Salvato P. ‘Lyme disease’: ancient engine of an unrecognized borreliosis pandemic? Med Hypotheses 2003; 60: 742-759.
  122. Hassett AL, Radvanski DC, Buyske S, Savage SV, and Sigal LH. Psychiatric comorbidity and psychological factor in patients with “chronic Lyme disease.” Am. J. Med. 2009; 122(9): 843-850.
  123. Hassler D, Riedel K, Zorn J and Preac-Mursic V. Pulsed high-dose cefotaxime therapy in refractory Lyme borreliosis (letter). Lancet 1991; 338: 193.
  124. Häupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schonherr U, et al. (1993) Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis. Arthritis Rheum; 36(11): 1621-1626. [Repeated antibiotic treatment necessary to stop the progression of disease but did not completely eliminate Bb from all sites of infection. Bb cultured from ligament sample; intracellar sanctuaries for Bb]
  125. Henneberg JP, and Neubert U. Borrelia burgdorferi group: in vitro antibiotic sensitivity. Orv Hetil 2002; 143: 1195-1198.
  126. Heft PS, Brooks CS, Jett AM, White GL, Wikel SK, et al. (2002) OspE-related, OspF-related OspF-related, and Elp lipoproteins are immunogenic in baboons experimentally infected with Borrelia burgdorferi and in human Lyme disease patients. J Clin Microbiol 40: 4256-4265. doi: 10.1128/jcm.40.11.4256-4265.2002. [baboons]
  127. Hilton E, Tramontano A, DeVoti J, and Sood SK. Temporal study of immunoglobulin M seroreactivity to Borrelia burgdorferi in patients treated for Lyme borreliosis. J Clin Microbiol 1997; 35(3): 774-776.
  128. Hodzic E, Feng S, and Barthold SW. Stability of Borrelia burgdorferi outer surface protein C under immune selection pressure. J Infect Dis 2000; 181: 750-753.
  129. Hodzic E, Feng S, Holden K, Freet KJ, and Barthold SW. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrob Agents Chemother 2008; 52: 1728-1736. [in mice: following antibiotic treatment; mice remained infected with infectious spirochetes.]
  130. Hodzic E, et al. Resurgence of persisting non-cultivable Borrelia burgdorferi following antibiotic treatment in mice. PLoS 2014; 9(1): e86907. doi: 10.1371/journal.pone.0086907
  131. Holl-Weiden A, Suerbaum S, and Girschick HJ. Seronegative Lyme arthritis. Rheumatology International 2007; 11: 1091-1093.
  132. Honegr K, Hulinska D, Dostal V, Gebousky P, Hankova E, Horacek J, Vyslouzil L, and Havlasova J. Persistence of Borrelia burgdorferi sensulato in patients with Lyme borreliosis. Epidemiol Mikrobiol Immunol. 2001; 50: 10-16.
  133. Horowitz R. Chronic persistent Lyme borreliosis: PCR evidence of chronic infection despite extended antibiotic therapy – a retrospective review. 13th International Scientific Conference on Lyme Disease and Other Tick-Borne Disorders. CT, USA, 24-26 March 2000.
  134. Horowitz R. Why can’t I get better? Solving the mystery of Lyme and chronic disease. St. Martin’s Press, New York.
  135. Hudson BJ, Stewart M, Lennox VA, Fukunaga M, Yabuki M, Macorison H, Kitchener-Smith J. Culture-positive Lyme borreliosis. Med J Aust 1998; 168(10): 500-502.
  136. Hulínská D, Krausova M, Janovská D, Rohácová H, Hancil J, Mailer H. Electron microscopy and the polymerase chain reaction of spirochetes from the blood of patients with Lyme disease. Cent Eur J Public Health 1993; 1(2): 81-85.
  137. Hulinska D, Votypka J, and Valesova M. Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis. Int J Med Microbiol VirolParasitolInfecdt Dis 1999; 289(3): 301-318.
  138. Hunfeld KP, Ruzic-Sabljic E, Norris DE, Kraiczy P, and Strle F. In vitro susceptibility testing of Borrelia burgdorferisensulato isolates cultured from patients with erythema migrans before and after antimicrobial chemotherapy. Antimicro Agents Chemother 2005; 49: 1294-1301.
  139. Imai DM, Barr BC, Daft B, Bertone JJ, Feng S, Hodzic E, Johnston JM, Olsen KJ and Barthold SW. Lyme neuroborreliosis in 2 horses. Vet Pathol 2011; 48: 1151-1157.
  140. International Lyme and Associated Diseases Society (ILADS). Evaluation of antibiotic treatment in patients with persistent symptoms of Lyme disease.
  141. James FM, JB Engiles, and J Beech. Meningitis, cranial neuritis, and radiculoneuritis associated with Borrelia burgdorferi infection in a horse. J Am Vet Med Assoc 2010; 237: 1180-1185. [Horse was seropositive for Bb, and PCR assay of CSF for burgdorferi DNA was positive; horse was treated with doxycycline, responded well, then relapsed, treated with oxytetracycline and later died; diagnosis consistent with neuroborreliosis.]
  142. Johnson RC, Marek N, Kodner C. Infection of Syrian hamsters with Lyme disease spirochetes. J. Clin. Microbiol. 1984; 20: 1099-1101.
  143. Johnson L and Stricker JB. Treatment of Lyme disease: a medicolegal assessment. Expert Rev Anti-Infect Ther 2004. 2: 533-557.
  144. Johnson L, Shapiro M, Mankoff J. Removing the mask of average treatment effects in chronic Lyme disease research using Big Data and subgroup analysis. Healthcare 2018, 6, 124; doi:10.3390/healthcare6040124.
  145. Kaiser R. Clinical courses of acute and chronic neuroborreliosis following treatment with ceftriaxone. Nervenarzt. 2004(June); 75(6): 553-557.
  146. Kalish RA, Leong JM, and AC Steere. Association of treatment-resistant chronic Lyme arthritis with HLA-DR4 and antibody reactivity to OspA and OspB of Borrelia burgdorferi. Infect Immun 1993; 61: 2774-2779.
  147. Kalish RA, McHugh G, Granquist J, Shea B, Ruthazer R, Steere AC. Persistence of immunoglobulain M or immunoglobulin G antibody responses to Borrelia burgdorferi 10-20 years after active Lyme disease. Clin Infect Dis 2001; 33: 780-785.
  148. Karma A, Stenborg T, Summanen P, Immonen I, Mikkila H, and Seppala I. Long-term follow-up of chronic Lyme neuroretinitis. Retina 1996; 16: 505-509.
  149. Keat AC, and Hughes R. Infectious agents in reactive arthritis. CurrOpinRheumatol 1993; 5: 414-419.
  150. Keller TL, Halperin JJ, and Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology 1992; 43: 32-42.
  151. Kersten A, Poitschek C, Rauch S, and Aberer E. Effects of penicillin, ceftriaxone, and doxycycline on morphology of Borrelia burgdorferi. Antimicrob Agents Chemother 1995; 39: 1127-1133.
  152. Keszler K, and Tilton RC. Persistent PCR positivity in a patient being treated for Lyme disease.  Journal of Spirochetal and Tick-Borne Diseases 1995; 2: 57-58.
  153. Kirsch M,, Ruben FL, Steere AC, Duray PH, Norden CW, Winkelstein A. Fatal adult respiratory distress syndrome in a patient with Lyme disease. JAMA 1988; 259(18) 2737-2739.
  154. Klemann W, Huismans BD, and Heyl S. Prolonged antibiotic therapy in PCR persistent Lyme disease. Grin Verlag 2011. ISBN 978-3-640-82803-6
  155. Klempner MS, Noring R, and Rogers RA. Invasion of human skin fibroblasts by the Lyme disease spirochetes, Borrelia burgdorferi. J Infect Dis 1993; 167: 1074-81.
  156. Klempner MS, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 85-92.
  157. Kraiczy P, Hellwage J, Skerka C, Becker H, Kirschfink M,, Simon MM, et al. Complement resistance of Borrelia burgdorferi correlates with the expression of BbCRASP-1, a novel linear plasmid-encoded surface protein that interacts with human factor H and FHL-1 and is unrelated to Erp proteins. J Biol Chem 2004; 279: 2421-2429.
  158. Krupp LB, Masur D, Schwartz J, Coyle PK, Langenback IJ, and Fernquist SK. Cognitive functioning in late Lyme borreliosis. Arch Neurol 1999; 48: 1125-1129.
  159. Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology 2003; 60: 1923-1930.
  160. Krüger H, Helm E, Schuknecht B, and Scholz S. Acute and chronic neuroborreliosis with and without CNS involvement: a clinical, MRI, and HLA study of 27 cases. J Neurol 1991; 238: 271-280.
  161. Kullberg BJ, Berende A, van der Meer JW. The challenge of Lyme disease: tired of the Lyme wars. Neth J Med 2011; 69: 98-100. [refutes Klempers {2001} conjecture that long-term antibiotics don’t work]
  162. Latov N, Wu AT, Chin RL, Sander HW, Alaedini A, and Brannagran TH. Neuropathy and cognitive impairment following vaccination with the OspA protein of Borrelia burgdorferi. J PeripherNerv Syst 2004; 9: 165-167.
  163. LavoiePE. Failure of published antibiotic regimens in Lyme borreliosis: observations on prolonged oral therapy. Abstract. Lyme Borreliosis International Conference, Sweden, 1990.
  164. LavoiePE. Protocol from Rakel’s: explains persistence of infection despite “standard” courses of antibiotics. Lyme Times, LymeDiseaseResourceCenter, 1992; 2: 25-27. Reprinted from Conn’s Current Therapy, 1991.
  165. Lawrence C, Lipton RB, Lowy RD, and Coyle PK. Seronegative chronic relapsing neuroborreliosis. Eur Neurol 1995; 35(2): 113-117. [Patient’s CSF was positive for complex anti-Bb antibodies, burgdorferi nucleic acids and free antigen despite aggressive antibiotic therapy.]
  166. Lawrenz MB, Hardham JM, Owens RT, Nowakowski J, Steere AC, Wormser GP, and Norris SJ. Human antibody responses to vlsE antigenic variation protein of Borrelia burgdorferi. J Clin Microbiol 1999; 37: 3997-4004.
  167. Li X, HcHugh GA, Hamle N, Sikland VI, Glickstein L, et al. (2011) Burden and viability of Borrelia burgdorferi in skin and joints of patients with erythema migrans or Lyme arthritis. Arthritis Rheum 63: 2238-2247. doi: 10.1002/art.30384. [humans]
  168. Liang FT, Steere AC, Marques AR, Johnson BJB, Miller JN, and Philipp MT. Sensitive and specific serodiagnosis of Lyme disease by enzyme-linked immunosorbent assay with a peptide based on an immundominant conserved region of Borrelia burgdorferi J Clin Microbiol 1999; 37: 3990-3996.
  169. Liang FT, Jacobs MB, Bowers LC, Philipp MT. An immune evasion mechanism for spirochetal persistence in Lyme borreliosis. J Exp Med 2002; 195: 415-422.
  170. Liegner KB. Lyme disease: the sensible pursuit of answers. J Clin Microbiol 1993; 31: 1961-1963.
  171. Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, and Kong L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi J Am Acad Dermatol 1993; 28: 312-314. [Eleven months following treatment, T-cell stimulation test with Bb antigens were strongly positive; a year later, paired serum and CSF samples were strongly positive.]
  172. Liegner KB, Duray P, Agricola M, Rosenkilde C, Yannuzzi LA, Ziska M, Tilton RC, Hulinska D, Hubbard J, and Fallon BA. Lyme disease and the clinical spectrum of antibiotic responsive chronic meningoencephalomyelitides. J Spir and Tick-Borne Dis 1997; 4: 61-73. [live culture of Bb after antibiotic treatment]
  173. Livengood JA and Gilmore RD, Jr. Invasion of human neuronal and glial cells by an infectious strain of Borrelia burgdorferi. Microbes and Infection. 2006; 8: 2832-2840. [intracellular sanctuaries of Bb]
  174. Hodzic E, Feng S Holden K, Freet, KJ, and Barthold SW. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrobial Agents and Chemotherapy 2008; 52: 1728-1736. [Persistence of Bb in mice]
  175. Hodzic E. Lyme borreliosis: is there a pre-existing (natural) variation in antimicrobial susceptibility among Borrelia burgdorferi strains? Bosn J Basic Sci 2015; 15 (3): 1-13. DOI:
  176. Lovrich SD, Callister SM, Schmitz JL, Alder JD, Schell RF. Borreliacidal activity of sera from hamsters infected with the Lyme disease spirochete. Infect Immun 1991: 59: 2522-2528. [persistence in hamsters]
  177. Hudson BJ, Stewart M, Lennox VA, Fukunaga M, Yabuki M, Macorison H, Kitchener-Smith J. Culture-positive Lyme borreliosis. Med J Aust. 1998; 168(10): 500-502.
  178. Kohleer J, Kern U, Kasper J, Rhese-Küpper B, Thoden U. Chronic central nervous system in Lyme borreliosis. Neurology 1988; 38: 863-867.
  179. Kollikowski HH, Schwendemann G, Schulz M, Wilhelm H, Lehmann HJ. Chronic borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy. J Neurol. 1988; 235: 140-142.
  180. Lawrence C, Lipton RB, Lowy FD, and Coyle PK. Seronegative chronic relapsing neuroborreliosis. Eur. Neurol. 1995; 35(2): 113-117.
  181. Lee SH, Vigliotti JS, Vigliotti VS, James W, Moorcroft TA, and Lantsman K. DNA sequencing diagnosis of off-season spirochetemia with low bacterial density in Borrelia burgdorferi and Borrelia miyamotoi Int. J. Mol. Sci. 2014, 15, 11364-11386; doi:10.3390/ijms150711364.
  182. Lewis K. Persister cells, dormancy and infectious disease. Nature Reviews Microbiology 2007; 5: 48-56.
  183. Livengood JA, and Gilmore, RD, Jr. Invasion of human neuronal and glial cells by an infectious strain of Borrelia burgdorferi. Microbes and Infection 2006; 8: 2832-2840.
  184. Ljostad J, Mygland Å (2013) Chronic Lyme; diagnostic and therapeutic challenges. Acta Neurol Scan Suppl 196: 38-47. doi: 10.1111/ane.12048.
  185. Logigian EL, Johnson KA, Kijewski MF, Kaplan RF, Becker JA, Jones KJ, Garada BM Holman BL, Steere AC. Reversible cerebral hyoperfusion in Lyme encephalopathy. Neurology 1997; 49: 1661-1670.
  186. Logigian EL, Johnson KA, Kijewski MF, Kaplan RF, Becker JA, Jones KJ, Garada BM Holman BL, Steere AC. Reversible cerebral hyoperfusion in Lyme encephalopathy. Neurology 1997; 49: 1661-1670.
  187. López-Andreu JA, Ferrís J, Canosa CA, Sala-Lizárraga JV. Treatment of late Lyme disease: a challenge to accept. J Clin Microbiol 1994; 32:1415-1416.
  188. Luft BJ, Steinman CR, Neimark HC, Muralidhar B, Rush T, Finkel MF, Kundel M, and Dattwyler RJ. Invasion of the CNS by Borrelia burgdorferi in acute disseminated infection. JAMA 1992; 267: 1364-1367.
  189. Lyme Disease Foundation. The controversies surrounding Lyme disease diagnosis and treatment and why it is not uncommon for patients to experience persistent symptoms despite receiving conventional (short-term) antibiotic therapy for Lyme disease.
  190. Ma Y, Sturrock A, and Weis JJ. Intracellular localization of Borrelia burgdorferi within human endothelial cells. Infect Immun 1991; 59: 671-678.
  191. MacDonald AB and Miranda JM. Concurrent neocortical borreliosis and Alzheimer’s disease. Human Pathol 1987; 18: 759-761.
  192. MacDonald AB. Concurrent neocortical borreliosis and Alzheimer’s disease: demonstration of a spirochetal cyst form. Ann NY Acad Sci 1988; 539: 468-470.
  193. MacDonald AB, Berger BW, and Schwan TG. Clinical implications of delayed growth of the Lyme disease spirochete, Borrelia burgdorferi. Acta Trop 1990 48; (2): 89-94.
  194. MacDonald AB. In situ DNA hybridization study of granulovacuolar degeneration in human Alzheimer autopsy neurons for flagellin b transcriptomes of Borrelia burgdorferi. Alzheimer’s Dis Dementia 2006; 2 (Suppl. 1): S207.
  195. MacDonald AB. Plaques of Alzheimer’s disease originate from cysts of Borrelia burgdorferi. Med Hypotheses 2006; 67: 592-600. doi:10.1016/j.mehy.2006.02.035.
  196. MacDonald AB. Cystic borrelia in Alzheimer’s disease and in non-dementia neuroborreliosis. Alzheimer’s Dementia 2006; 2 (Suppl. 1):S433.
  197. MacDonald AB. Transfection “Junk” DNA ― A link to the pathogenesis of Alzheimer’s disease? Med Hypotheses 2006; 66: 1140-1141.
  198. MacDonald Alzheimer’s neuroborreliosis with trans-synaptic spread of infection and neurofibrillary tangles derived from intraneuronal spirochetes. Med Hypotheses 2007; 68: 822-825. [7 of 10 cases of Alzheimer’s disease had B. burgdorferi in their brains].
  199. MacDonald, AB. Borrelia burgdorferi tissue morphologies and imaging methodologies. Eur J Clin Microbiol Infect Dis 2013. DOI 10.1007/s10096-013-1853-5 [shows non-spiral forms of Bb]
  200. Magni R, Benjamin HE, Shah K, Lepene B, Mayuga C, Douglas TA, et al. Application of nanotrap technology for high sensitivity measurement of urinary outer surface protein A carboxyl-terminus domain in early stage Lyme borreliosis. J Transl Med 2015; 13: 346. DOI: 10.1186/s12967-015-0701-z
  201. Mahmoud AAF. The challenge of intracellular pathogens (editorial).  N Engl J Med 1992; 326: 761-762.
  202. Malane MS, Grant Kels JM, Feder Hm Jr. et al. Diagnosis of Lyme disease based on dermatologic manifestations. Ann Intern Med 1991; 114:490-498. [chronic Lyme borreliosis].
  203. Malawista SE, Barthold SW, and Persing DH. Fate of Borrelia burgdorferi DNA in tissues of infected mice after antibiotic treatment.  J Infect Dis 1994; 170: 1312-1316.
  204. Malawista SE. Resolution of Lyme arthritis, acute or prolonged: a new look. Rheuma 2000 (May 29 issue).
  205. Manak MK, González-Villaseñor LI, Crush-Stanton S, and Tilton RC. Use of PCR assays to monitor the clearance of Borrelia burgdorferi DNA from blood following antibiotic therapy. J Spir Tick-Borne Dis 1997; 4: 11-20.
  206. Maraspin V, Ruzic-Sabljic E, Strle F, Cimperman J, Jereb M, Preac-Mursic V. Alpc Adria Microbiol J. Persistence of Borrelia burgdorferi after treatment with antibiotics.1995; 3: 211-216.
  207. Maraspin V, Cimperman J, Lotrič-Furlan S, Ružić-Sabljić E, Jurca T, Picken RN, and Strle F. Solitary borrelial lymphocytoma in adult patients. Wien KlinWochenschr 2002; 114: 515-523.
  208. Marlovits S, Khanah G, Striessniq G, Vécsei V, and Stanek G. Emergence of Lyme arthritis after autologous chondrocyte transplantation. Arthritis Rheum. 2004; 50: 259-264.
  209. Masters EJ, Lynxwiler P, and Rawlings J. Spirochetemia after continuous high-dose oral amoxicillin therapy. Infect Dis Clin Practice 1995; 3: 207-208. [Following six months of treatment, patient relapsed and Bb was cultured from blood.]
  210. Matera G, Labate A, Quirino A, Lamberti AG, Borzà G, Barreca GS, Mumoli L, Peronace C, GiancottiA,Gambardella A, Focà A, Quattrone A. Chronic neuroborreliosis by garinii: an unusual case presenting with epilepsy and multifocal MRI lesions. New Microbiologica 2014; 37: 393-397. [Bb in brain]
  211. Mattman LH. Cell wall deficient forms: stealth pathogens. 2nd CRC Press, Inc,, Boca Raton, FL. 1993. [change in physical characteristics; change of spirochetes to other pleomorphic forms, i.e., cell wall deficient forms, namely cysts.]
  212. Meier P, Blatz R, Gau M, Spencker FB, Wiedermann P. [Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis][German]. KlinMonatsblAugenheilkd 1998; 213(6): 351-354.
  213. Middelveen, MJ, McClain SA, Bandoski C, Israel JR, Burke J, MacDonald AB, Sapi E, Wang Y, Franco A, Mayne PJ, Stricker RB. Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report. Research 2014; 1: 875.
  214. Middelveen MJ, Sapi E, Burke J, Filush KR, Franco A, Fesler MC, Stricker RB. Persistent Borrelia infection in patients with ongoing symptoms of Lyme disease. Healthcare 2018; 6: 33. doi:10.3390/healthcare6020033.
  215. Miklossy J. Alzheimer’s disease ― a spirochetosis?  NeuroReport 1993; 4: 841-848.
  216. Miklossy J, Kasas S, Janzer RC, Ardizzoni F, and Loos H. Further morphological evidence of a spirochetal etiology of Alzheimer’s disease. NeuroReport 1994; 5: 1201-1204.
  217. Miklossy J, Gern L, Darekar P, Janzer RC, Loos H. Senile plaques, neurofibrillary tangles and neuropil threads contain DNA? J Spirochetal and Tick-borne Dis 1995; 2: 1-5.
  218. Miklossy JM, Khalili K, Gern L, Ericson RL, Darekar P, Bolle L, Hurlimann J, and Paster BJ. Borrelia burgdorferi persists in the brain in chronic Lyme neuroborreliosis and may be associated with Alzheimer’s disease. J Alzheimers Dis 2004; 6; 639-649.
  219. Miklossy J, Rosemberg S, and McGeer PL; Beta amyloid deposition in the atrophic form of general paresis. In Alzheimer’s Disease: New advances. Proceedings of the 10th International Congress on Alzheimer’s Disease. Edited by: Iqbal K, Winblad B, and Avila J; 2006: 429-433.
  220. Miklossy J, Kris A, Radenovic A, Miller L, Forro L, Martins R, Reiss K, Darbinian N, Darekara P, Mihaly L, and Khalili K. Beta amyloid deposition and Alzheimer’s type changes induced by Borrelia Neurobiol Aging 2006; 27: 228-236.
  221. Miklossy J. Chronic inflammation and amyloidogenesis in Alzheimer’s disease ― role of spirochetes. J Alzheimers Dis 2008; 13: 381-391.
  222. Miklossy, J. 2008. Biology and neuropathology of dementia in syphilis and Lyme disease. In Handbook of Clinical Neurology, Vol. 89. C. Duyckaerts, I. Litvan (eds.). Elsevier, Amsterdam, Netherlands. p. 825-844. [Persistence of burgdorferi is evident in dementia patients.]
  223. Miklossy J, Kasas S, Zurn AD, McCall S, Yu S, and McGeer PL. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation 2008; 5: 40-57.
  224. Miklossy, J. 2011. Alzheimer’s disease – a neurospirochetosis. Analysis of the evidence following Koch’s and Hill’s criteria. 2011; 8: 90 ( [91% of the brains of Alzheimer’s patients sampled were positive for spirochetes; 25% of Alzheimer’s patients analyzed had burgdorferi spirochetes in their brains. Persistence occurs when spirochetes change physical characteristics by converting to dormant cysts.]
  225. Miklossy J (2012) Chronic or late Lyme neuroborreliosis: analysis of evidence compared to chronic or late neurosyphilis. Open Neurol J 6: 146-157.
  226. Miklossy J. Bacterial amyloid and DNA are important constituents of senile plaques. Further evidence of the spirochetal and biofilm nature of senile plaques. Journal of Alzheimer’s Disease. 2016; 53: 1459-1473.
  227. Miller JC, K Narayan, B Stevenson, and AR Pachner. Expression of Borrelia burgdorferierp genes during infection of non-human primates. MicrobPathol. 2005; 39: 27-33. [in monkeys]
  228. Montgomery RR, Nathanson MH, and Malawista SE. The fate of Borrelia burgdorferi within endothelial cells.  Infect Immun 1991; 59: 671-678. [persistence in mice]
  229. Montgomery RR, MH Nathanson, and SE Malawista. The fate of Borrelia burgdorferi, the agent for Lyme disease, in mouse macrophages. Destruction, survival, recovery. J Immunol 1993; 150: 909-915. [in mice macrophages]
  230. Moody KD, Barthold SW, and Terwilliger GA. Lyme borreliosis in laboratory animals: effect of host species and into passage of Borrelia burgdorferi. Am J Trop Med Hyg 1990; 43: 87-92.
  231. Moody KD, Barthold SW, Terwilliger GA, Beck DS, Hansen GM, et al. (1990) Experimental chronic Lyme borreliosis in Lewis rats. Am J Trop Med Hyg 42: 65-74. [rats]
  232. Moody KD, Adams RL, and Barthold SW. Effectiveness of antimicrobial treatment against Borrelia burgdorferi infection in mice. Anticrob Agents Chemother 1994; 38: 1567-1572.
  233. Moriarty TJ, Norman MU, Colarusso P, Bankhead T, Kubes P, and Chaconas G. 2008. Real-time high resolution 3D imaging of the Lyme disease spirochete adhering to and escaping from the vasculature of a living host. PLoSPathog 4(6):e1000090. doi:10.1371/journal.ppat.1000090.
  234. Moses JM, RS Riseberg, and JM Mansbach. Lyme disease presenting with persistent headache. Pediatrics 2003; 112: 477-449.
  235. Müller KE (2012) Damage of collagen and elastic fibres by Borrelia burgdorferi — known and new clinical and histopathological aspects. Open Neurol J (Suppl 1-M11) 6: 179-186. [Bb damages collagen and elastic fibres in ligaments and tendons, and weakens connective tissue, including ruptures of tendons, and prolapsed intervertebral discs.]
  236. Mursic VP, Wanner G, Reinhardt S, Wilske B, Busch U, and Marget W. Formation and cultivation of Borrelia burgdorferi spheroplast L-form variants. Infection 1996; 24(4): 335.
  237. Nanagara R, Duray PH, and Schumacher HR, Jr. Ultrastructural demonstration of spirochetal antigens in synovial fluid and synovial membrane in chronic Lyme disease: possible factors contributing to persistence of organisms.  Hum Pathol 1996; 27(10): 1025-1034. [intracellar sanctuaries of Bb]
  238. Nocton JJ, Dressler F, Rutledge BJ, Rys PN, Persing DH, and Steere AC. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. N Eng J Med 1994; 330: 229-234. [Of 19 Lyme arthritis patients treated with either parenteral antibiotics or long courses of oral antibiotics, PCR confirmed Bb detected in synovial fluid of 37% of patients.]
  239. Nocton JJ, Bloom BJ, Rutledge BJ, Persing DJ, Logigian EL, Schmid CH, and Steere AC. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in cerebrospinal fluid in Lyme neuroborreliosis. J. Infect Dis 1996; 174: 623-627.
  240. Norgard MV, Riley BS, Richardson JA, et al. 1995. Dermal inflammation elicited by synthetic analogs of Treponema pallidum and Borrelia burgdorferi Infect Immun 63: 1507-1515.
  241. Oksi J, Mertsola J, Reunanen M, Marjamaki M, Viljanen MK. Subacute multiple-site osteomyelitis caused by Borrelia burgdorferi. Clin Infect Dis 1994; 19(5): 891-896.
  242. Oksi J, Uksila J, Marjamäki M, Nikoskelainen J, and Viljanen MK. Antibodies against whole sonicated Borrelia burgdorferi spirochetes, 41-kilodalton flagellin, and P39 protein in patients with PCR- or culture-proven late Lyme borreliosis. J Clin Microbiol 1995; 33: 2260-2264.
  243. Oksi J, Kalimo H, Marttila RJ, Marjamäki M, Sonninen P, Nikoskelainen J, and Viljanen MK. Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature. Brain 1996; 119(6): 2143-2154.
  244. Oksi J, Nikoskelainen J, and Viljanen MK. Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis.  Eur J Clin Microbiol Int Dis 1998; 17: 715-719.
  245. Oksi J, Marjamäki M, Nikoskelainen J, and Viljanen MK. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med 1999; 31(3): 225-232. [40% (13/32) patients had clinical relapses that were PCR or culture-confirmed.]
  246. Pacheco e Silva AC. Espirochetose dos centrosnervosMemorias do hospicio de Juguery. 1927, III-IV (3-4): 1-27.
  247. Pachner AR, Duray P, Steere AC. Central nervous system manifestations of Lyme disease. Arch Neurol 1989; 46: 790-795.
  248. Pachner AR, Delaney E, and O’Neill T. Neuroborreliosis in the nonhuman primate: Borrelia burgdorferi persists in the central nervous system. Ann Neurol 1995; 38: 667-9. [in monkeys].
  249. PachnerAR, J Basta, E Delaney, D Hulinska. Localization of Borrelia burgdorferi in murine Lyme borreliosis by electron microscopy. Am J Trop Med Hyg 1995; 52: 128-133.
  250. Pachner AR, Cadavid D, Shu G, Dail D, Pachner S, Hodzic E, and Barthold SW. Central and peripheral nervous system infection, immunity, and inflammation in the NHP model of Lyme borreliosis. Ann Neurol 2001; 50: 330-338. [in monkeys]
  251. PachnerAR, D Dail, K Narayan, K Dutta, and D Cadavid. Increased expression of B-lymphocyte chemoattractant, but not pro-inflammatory cytokines, in muscle tissue in rhesus chronic Lyme borreliosis. Cytokine 2002; 19: 297-307. [in monkeys]
  252. PachnerAR, Basta J, Delaney E, and Hulinska D. Localization of Borrelia burgdorferi in murine Lyme borreliosis by electron microscopy. Am J Trop Med Hyg 1995; 52: 128-133.
  253. Pahl A, Kühbrandt U, Brune K, Röllinghoff M, and Gessner A. Quantitative detection of Borrelia burgdorferi by real-time PCR.  J Clin Microbiol 1999; 37: 1958-1963.
  254. Pal GS, Baker JT, and Wright DJM. Penicillin resistant Borrelia encephalitis responding to cefotaxime. Lancet 1988; 338: 50-51.
  255. Reimers CD, de Koing J, Neubert U, PreacMursic V, Koster JG, Muller Felber W, PongratzDE, and Duray PH. Borrelia burgdorferi myositis: report of eight patients. J Neurol 1993; 240(5): 278-283.
  256. Petrovic M, Vogelaers D, Van Renterghem L, Carton D, De Reuck J, and Afschrift M. Lyme borreliosis – review of the late stages and treatment of four cases. Acta Clin Belg. 1998; 53: 178-183.
  257. Pfister HW, PreacMursic V, Wilske B, Schielke E, Sorgel F, Einhaupl KMJ. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. Infect Dis 1991; 163(2): 311-318. [In one patient, Bb as isolated from the cerebrospinal fluid 7.5 months after ceftriaxone therapy and, thus, showing that extended therapy is necessary.]
  258. Phillips SE, Mattman LH, Hulinska D, and Moayad H. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those aggressively treated. Infection 1998; 26: 364-67.
  259. Phillips SE, Harris NS, Horowitz R, Johnson L, Stricker RB. Lyme disease: scratching the surface. Lancet 2005; 366: 1771.
  260. Phillips SE, Burrascano JJ, Harris NS, Johnson L, Smith PV, Stricker RB. Chronic infection in ‘post-Lyme borreliosis syndrome. Int J Epidemiol 2005; 34: 1439-1440.
  261. Picha D, Moravcová L, Holecková D, Zd’ársky E, Valesová M, et al. (2008) Examination of specific DNA by PCR in clinical relapse of disseminated Lyme borreliosis. Int J Dermatol 47: 1004-1010. doi: 10.1111/j.1365-4632.2008.03709.x [in human urine]
  262. Picken RN, Strle F, Picken MM et al. Identification of three species of Borrelia burgdorferisensulato ( garinii, B. afzelii) among isolates from acrodermatischronica atrophicans lesions. J Invest Dermatol 1998; 110; 211-214. [chronic Lyme borreliosis].
  263. Preac-Mursic V, Wilske B, Schierz G, et al. Repeated isolation of spirochetes from the cerebrospinal fluid of a patient with meningoradiculitisBannwarth syndrome. Eur J Clin Microbiol 1984; 3: 564-565.
  264. Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, and Prokop J. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection 1989; 17(6): 355-359.
  265. Preac-Mursic V, Patsouris E, Wilske B, Reinhardt S, Gross, and Mehraein P. Persistence of Borrelia burgdorferi and histopathological alterations in experimentally infected animals: a comparison with histopathological findings in human Lyme disease. Infection 1990; 18: 332-341. [gerbils]
  266. Preac-Mursic V, Pfister HW, Spiegel H, Burk K, Wilske B, Reinhardt S, and Boehmer R. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophthalmol 1993; 13(3): 155-161. [Patient with blurred vision treated with two separate month-long cycles of tetracycline had symptoms persist for several years. Bb cultured from iris biopsy.]
  267. PreacMursic V, Wanner G, Reinhardt S, Wilske B, Busch U, Marget W. Formation and cultivation of Borrelia burgdorferi spheroplast-L-form variants.  Infection 1996; 24: 218-226.
  268. PreacMursic V, Marget W, Busch U, Rigler DP, Hagl S. Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of Lyme borreliosis.  Infection 1996; 24(1): 9-16. [Bb was isolated by culture in five patients, four of whom had previously tested antibody-negative.]
  269. Priem S, Burmester GR, Kamradt T, Wolbart K, Rittig MG, et al. (1998) Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy. Ann Rheum Dis 57(2): 118-121.doi: 10.1136/ard.57.2.118 [After antibiotic treatment, synovial membrane still demonstrates spirochetes.][Although PCR was negative in synovial fluid and urine, PCR confirmed Bb in synovial membrane of four previously treated patients with Lyme arthritis; intracellular sanctuaries of Bb]
  270. Reid MC, Schoen RT, Evans J, Rosenberg JC, and Horowitz RI (1998) The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study. Ann Intern Med 128(5): 354-362.
  271. Reimers CD, de Koning J, Neubert U, PreacMursic V, Koster JG, Muller Felberl W, PongratzDE, and Duray PH. Borrelia burgdorferi myositis: report of eight patients. J Neurol 1993; 240(5):278-283.
  272. Richie JA, Coburn J. 2015. A short-term Borrelia burgdorferi infection model identifies tissue tropisms and blood stream survival by adhesion proteins. Infection and Immunity.
  273. Rittig MG, Häupl T, Krause A, Kressel M, Groscurth P, Burmester GR. Borrelia burgdorferi-induced ultrastructural alterations in human phagocytes: a clue to pathogenicity?  J Pathol 1994; 173: 269-282.
  274. Roberts ED, Bohm RP, Jr., Cogswell FB, Lanners HN, Lowrie RC, Jr., et al. (1995) Chronic Lyme disease in the rhesus monkey. Lab Invest 72: 146-160. [rhesus monkey]
  275. Roberts ED, Bohm RP, Jr., Lowrie RC, Jr., Habicht G, Katona L, Piesman J, and Philipp MT. Pathogenesis of Lyme neurobororeliosis in the rhesus monkey: the early disseminated and chronic phases of disease in the peripheral nervous system. J Infect Dis 1998; 178: 722-732.
  276. Rohácová H, Hancil J, Hulinská D, Mailer H, Havlik J. Ceftriaxone in the treatment of Lyme neuroborreliosis. Infection. 1996 (Jan-Feb); 24(1): 88-90.
  277. Roelcke U, Barnett W, Wilder-Smith E, Sigmund D, and Hacke W. Untreated neuroborreliosis: Bannwarth syndrome evolving into acute schizophrenia-like psychosis.  J Neurol 1992; 239: 129-131.
  278. Ruzic-Sablijic E, Strle F, and Cimperman J. The Ixodes ricinustick as a vector of Borrelia burgdorferi in Slovenia.  Eur J Epidemiol 1993; 9: 396-400.
  279. Sala-Lizarraga JA, Salcede-Vivo J, Ferris J, Lopez-Andreu JA. Lyme borreliosis [Letter] Lancet 1990; 345: 1436-1437.
  280. Sapi E, and MacDonald A. Biofilms of Borrelia burgdorferi in chronic cutaneous borreliosis. Am. J. Clin. Pathol. 2008; 129: 988-989. [biofilms consist of a colony of spirochetes and cysts coated by a gelatinous, protective membrane]
  281. Sapi E, Kaur N, Anyanwu S, Luecke DF, Datar A, Patel S, Rossi M, Stricker RB. Evaluation of in vitro antibiotic susceptibility of different morphologic form of Borrelia burgdorferi. Drug Resist. 2011; 4: 97-113. Epub 2011 May 3. [biofilms consist of a colony of spirochetes and cysts coated by a gelatinous, protective membrane]
  282. Sapi E, Bastian SL, Mpoy CM, Scott S, Rattelle A, Pabbati N, Poruri A, Buruga D, Theophilus PAS, Pham TV, Datar A, Dhaliwai NK, MacDonald A, Rossi MJ, Sinha SK, and Luecke DF. 2012. Characterization of biofilm formation by Borrelia burgdorferi in vitro. PLOS One 7(10): e48277. doi: 10.1371/journal.pone.0048277 [biofilms consist of a colony of spirochetes and cysts coated by a gelatinous, protective membrane]
  283. Sapi E, Pabbati N, Datar A, Davies EM, Rattelle A and Kuo BA. Improved culture conditions for the growth and detection of Borrelia from human serum. Int J Med Sci 2013; 10: 362-376.
  284. Schoen RT, Aversa JM, Rahn DW, and Steere AC. Treatment of refractory chronic Lyme arthritis with arthroscopic synvectomy. Arthritis Rheum 1991; 34(8): 1056-1060.
  285. Schlesinger P, Duray P, Burke B, Steere A, and Stillman A. Maternal-fetal transmission of the Lyme disease spirochete Borrelia burgdorferi. Ann Intern Med 1985; 103: 67-68.
  286. Schmidli J, Hunziker T, Moesli P, and Schaad UB. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis. J Inf Dis 1988; 158(4): 905-906.  [Bb was cultured from joint fluid after treatment.]
  287. Schmitz JL, Schell RF, Lovrich SD, Callister SM and Coe JE; Characterization of the protective antibody response to Borrelia burgdorferi in experimentally infected LDH hamsters. Infect Immun 1991; 59: 1916-1921.
  288. Schwan TG, Burgdorfer W, Schrumpf ME, Karstens RH (1988) The urinary bladder: a consistent source of Borrelia burgdorferi in experimentally infected white-footed mice (Peromyscus leucoupus). J Clin Microbiol 26: 893-895. [white-footed mice]
  289. Schwan TG, Karstens RH, Schrumpf ME, Simpson WJ. Changes in antigenic reactivity of Borrelia burgdorferi, the Lyme disease spirochete, during persistent infection in mice. Can J Microbiol 1991; 37: 450-454. [Bb lasts at least 480 days in mice—for life]
  290. Schwann TG, Piesman J, Golde WT, Dolan MC, Ros PA. Induction of an outer surface protein on Borrelia burgdorferi during tick feeding. Proc Natl. Acad. Sci. USA. 1995; 92: 2909-2913. [change in physical characteristics by altering immunogenicity]
  291. Seiler KP, and Weis JJ. Immunity to Lyme disease: protection, pathology and persistence. CurrOpin Immunol 1996; 8: 503-509.
  292. Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, et al. The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study. Ann Int Med 1994; 121: 560-567.
  293. Sharma B, Brown Av, Matluck NE, Hu LT and Lewis K. Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells. Antimicrob. Agents Chemotherapy. 2015; 59: 4616-4624. doi:10.1128/AAC.00864-15
  294. Sherr “Bell’s palsy of the gut” and other GI manifestations of Lyme and associated disease. Practical Gastroenterology. April 2006.
  295. Silverman S, Dukes EM, Johnston SS, Brandenburg NA, Sadosky A, and Huse DM. The economic burden of fibromyalgia: comparative analysis rheumatoid arthritis. Current Medical Research and Opinion 2009; 25(4) 829-840.
  296. SinghSK and HJ Girschick. Molecular survival strategies of the Lyme disease spirochete Borrelia burgdorferi. Lancet Infect Dis 2004; 4: 575-583. [ burgdorferi survives in brachytophic tissue (ligament, tendon), fibroblasts, synovial cells, endothelial cell [linings of blood and heart vessels, and lymph vessels], deep invaginations of cell membranes, myocytes, joints, eyes, and bones.]
  297. Skogman BH, Croner S, Nordwall M, Eknefelt M, Ernerudh J, and Forsberg P. Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatic Infect. Dis. J. 2008; 27(12): 1089-1094.
  298. SonnesynSW, Manivel JC, Johnson RC, Goodman JL (1993) A guinea pig model for Lyme disease. Infect Immun 61: 4777-4784. [guinea pig]
  299. Stanek G, Klein J, Bittner R, and Glogar D. Isolation of Borrelia burgdorferi from the myocardium of a patient with long standing cardiomyopathy. N Engl J Med 1990; 322: 249-252.
  300. Steere AC, Duray PH,, and Butcher EC. Spirochetal antigens and lymphoid cell surface markers in Lyme synovitis. Comparison with rheumatoid synovium and tonsillar lymphoid tissue. Arthritis Rheum 1988; 31: 487-495.
  301. Steere AC, Bernardi VP, Weeks KE,, Logigan EL, Ackermann R. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J. Infect. Dis. 1990(June); 161(6): 1203-1209.
  302. Steere AC, Taylor E, McHugh GL, and Logigian EL. The overdiagnosis of Lyme disease. J. Med. Ass. 1993 269(14): 1812-1816.
  303. Steere AC, Levin RE, Molloy PJ, Kalis RA, Abraham JH, Liu NY, and Schmid Treatment of Lyme arthritis. Arthritis Rheum 1994; 37: 878-888.
  304. Stein SL, Solvason HB, Biggart E, and Spiegel D. A 25-year-old woman with hallucinations, hypersexuality, nightmares, and a rash. Am J Psychiatry 1996; 153: 545-551.
  305. Straubinger RK, Straubinger AF, Jacobson RH, Chang Y, Summers BA, Erb HN, and Appel MJG. Two lessons from the canine model of Lyme disease: migration of Borrelia burgdorgferi in tissues and persistence after antibiotic treatment. J Spir Tick-Borne Dis 1997; 4: 24-31. [In dogs: 30-day treatment diminished but failed to eliminate persistent infection in dogs. Antibody titers fell, but after antibiotic treatment was discontinued antibody levels began to rise again, presumably in response to proliferation of the surviving pool of spirochetes.]
  306. Straubinger RK, Summers BA, Chang YF, and Appel MJG (1997) Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment. J Clin Microbiol 35: 111-116. [dogs]
  307. Straubinger RK. PCR-based quantification of Borrelia burgdorferi organisms in canine tissues over a 500-day postinfection period. J Clin Microbiol 2000; 38: 2191-2199. [All 8 infected dogs previously treated with 30-day antibiotics were PCR positive from tissue samples after necrosis; 25 tissue samples per dog were used. Interestingly, the number of burgdorferi organisms detected in skin biopsy samples was inversely proportional to the antibody levels measured by enzyme-linked immunosorbent assay.]
  308. Straubinger RK, StraubingerAF, Summers BA, and Jacobson RH (2000) Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: an experimental study. J Infect Dis 181: 1069-1081.doi: 10.1086/315340
  309. Straubinger RK. Lyme borreliosis in dogs in recent advances in canine infectious diseases. Edited by L.E. Carmichael. International Veterinary Information Services. 2000.
  310. Stricker RB, Winger EE. Decrease CD57 lymphocyte subset in patients with chronic Lyme disease. Immunology Letters. 2001. 76: 43-48.
  311. Stricker RB, Burrascano JJ, and Winger EE. Long-term decrease in the CD57 lymphocyte subset in a patient with chronic Lyme disease.  Ann Agric Environ Med 2002; 9: 111-113.
  312. Stricker RB, Lautin A, and Burrascano JJ. Lyme disease: point/counterpoint. Expert Rev Anti-Infect Ther 2005: 3: 155-165.
  313. Stricker RB. Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with Lyme disease. Clin Infect Dis 2007; 45: 149-157.
  314. Stricker RB and Johnson L. Persistent Borrelia burgdorferi infection after treatment with antibiotics and anti-tumor necrosis factor-a. J Infect Dis 2008; 197: 1352-1353.
  315. Stricker RB, Green CL, Savely VR, Chamallas SN, and Johnson L. Benefit of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease. Int J Gen Med 2011; 4: 639-646. [refutes Klempers {2001} conjecture that long-term antibiotics don’t work]
  316. Stricker RB, Johnson L. Lyme disease: the next decade. Infect. Drug Resist. 2011; 4: 1-9. Epub 2011. Jan 7. [biofilms consist of a colony of spirochetes and cysts coated by a gelatinous, protective membrane]
  317. Stricker RB, Johnson L. 2013. Persistent infection in chronic Lyme disease: does form matter? Res J Infect Dis 1:2. [Current experiments support persistent spirochetal infection as the cause of chronic Lyme disease.]
  318. Stricker RB, Johnson L. Borrelia burgdorferiaggrecanase activity: more evidence for persistent infection in Lyme disease. Frontiers in Cellular and Infection Microbiology. or
  319. Stricker RB, Fesler MC. 2018. Chronic Lyme disease: a working case definition. American Journal of Infectious Diseases. 14: 1.44. doi: 10.3844/ajidsp.2018.1.44.
  320. Strle F, Preac-Mursic V, Cimperman J, Ruzic E, Maraspin V, and Jereb M. Azithromycin versus doxycycline for treatment of eythema migrans: clinical and microbiological findings. Infection 1993; 21(2): 83-88.
  321. Strle F, Cheng Y, Cimperman J, Maraspin V, Lotric-Furlan S, Nelson JA, Picken MM, Ruzic-Sabljic E, and Picken R. Persistence of Borrelia burgdorferisensulato in resolved erythema migrans lesions.  Clin Inf Dis 1995; 23: 380-389.
  322. Strle F, Maraspin V, Lotric-Furlan, Ruzic-Sabljic E, and Cimperman J. Azithromycin and doxycycline for treatment of Borrelia culture-positive erythema migrans. Infection 1996; 24: 64-68. [Skin-positive despite repeated antibiotic treatments.]
  323. Summers BA, Straubinger AF, Jacobson RH, Chang YF, Appel MJG, and Straubinger RK. Histopathological studies of experimental Lyme disease in the dog. J Comparative Pathol 2005; 133: 1-13.
  324. Sung SY, McDowell JV, Carlyon JA, and Marconi RT. Mutation and recombination in the upstream homology box-flanked ospE-related genes of the Lyme disease spirochetes result in the development of new antigenic variants during infection. Infect Immun 2000; 68; 1319-1327.
  325. Timmaraju A, Theophilus PAS, Balasubramanian K, Shakih S, Leucke DF, Sapi E. 2015. Biofilm formation by Borrelia burgdorferi FEMS Microbiology Letters 2015.
  326. Treib J, Fernandez A, Haass A, Grauer MT Holzer G, Woessner R. Clinical and serologic follow-up in patients with neuroborreliosis. Neurology. 1998; 51: 1489-1491.
  327. Valesová M, et al. Detection of Borrelia in the synovial tissue from a patient with Lyme borreliosis by electron microscopy. Rheumatol. 1989;16(11): 1502-1505. [intracellar sanctuaries of Bb]
  328. Valesová H, Mailer J, Havlik J, Hulínská, D, Hercogová. Long-term results in patients with Lyme arthritis following treatment with ceftriaxone. Infection. 1996 (Jan-Feb); 24(1): 98-102.
  329. Vartiovaara Living with Lyme. Lancet 1995; 345: 842-844.
  330. Vázquez M, Sparrow SS, and Shapiro ED. Long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease. Pediatrics 2003; 112(2): e93-e97.
  331. Walberg P, Granlund H, Nyman D, Panelius J, and Seppälä I. Treatment of late Lyme borreliosis. J Infection 1994; 29: 255-261.
  332. Waniek C, Prohovnik I, Kaufman MA, and Dwork AJ. Rapid progressive frontal-type dementia associated with Lyme disease.  J Neuropsychiatry Clin Neurosci 1995; 7: 345-347. ( burgdorferi detected at autopsy).
  333. Wang P, Gartenhaus R, Sood SK, DeVoti J, Singer C, Dorante G, and Hilton E. Detection of Borrelia DNA in circulating monocytes as evidence of persistent Lyme disease. J Spir and Tick-Borne Dis 2000; 7: 16-19.
  334. Weber K, Bratzke H-J, Neubert U, Wilske B, and Duray PH. Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. Pediatr Infect Dis J 1988; 7: 286-289.
  335. Weber K. Treatment failure in erythema migrans: a review. Infection 1996; 24: 73-75.
  336. Weder B, Wiedersheim P, Matter L, Steck A, Otto F. Chronic progression neurological involvement in Borrelia burgdorferi J Neurol 1987; 234: 40-43.
  337. Weis JJ, Yang L, Seiler KP, and Silver RM. Pathological manifestations in murine Lyme disease: association with tissue invasion and spirochete persistence.  Clin Infect Dis 1997 Suppl 1: S18-24.
  338. Wienecke R, Zoechling N, Neubert U. Molecular subtyping of Borrelia burgdorferi in erythema migrans and acrodermatitis chronica atrophicans. J Invest Dermatol 1994; 103; 19-22. [chronic Lyme borreliosis].
  339. Xu Q, Mcshan K, and Liang Modification of Borrelia burgdorferi to overproduce OspA or VlsE alters its infectious behaviour. Microbiology 2008; 154: 3420-3429.
  340. Yang L, Weis JH, Eichwald E, Kolbert CP, Persing DH, and Weis JJ. Heritable susceptibility to severe Borrelia burgdorferi-induced arthritis is dominant and is associated with persistence of large numbers of spirochetes in tissues. Infect Immun 1994; 62: 492-500.
  341. Young D, Hussell T, and Dougan G. Chronic bacterial infections: living with unwanted guests. Nat Immunol 2002 Nov; 3(11): 1026-1032.
  342. Yrjänäinen H, Hytönen J, Söderström KO, Oksi J, Hartiala K, Viljanen MK (2006) Persistent joint swelling and Borrelia-specific antibodies in Borrelia garinii-infected mice after eradication of vegetative spirochetes with antibiotic treatment. Microbes Infect 8: 2044-2051.doi: 10.1016/j.micinf.2006.03.008 [persistence if Bb in mice]
  343. Yrjänäinen H, Hyotenen J, Song SR, Oksi J, Hartiala K, et al. (2007) Anti-tumor necrosis factor-alpha treatment activates Borrelia burgdorferi spirochetes in 4 weeks after ceftriaxone treatment in C3H/He mice. J Infect Dis 195: 1489-1496. doi: 10.1086/513873. [mice]
  344. Yrjänäinen H. Borrelia burgdorferi evades the effects of ceftriaxone treatment in mouse model. MedicaOdontologica 2009 [thesis]
  345. Yrjänäinen H, Hytönen J, Hartiala P, Oksi J, Viljanen MK (2010) Persistence of borrelial DNA in the joints of Borrelia burgdorferi-infected mice after ceftriaxone treatment. APMIS 118(9): 665-673.doi: 10.1111/j.1600-0463.2010.02615.x [Borrelia burgdorferi DNA in joints and tissue adjacent to the joint is the niche of persisting burgdorferi in ceftriaxone-treated mice.]
  346. Zhang JR, Hardham JM, Barbour AG, and Norris SJ. Antigenic variation in Lyme disease borreliae by promiscuous recombination of VMP-like sequence cassettes. Cell 1997; 89: 275-285. [antigenic variation: a defense stratagem of burgdorferi]
  347. Zhang Y (2014) Persisters, persistent infections and the Yin-Yang model. Emerging Microbes and Infections 3, e3; doi:10.1038/emi.2014.3.
  348. Ziska MH, Donta ST, and Demarest FC. Physician preferences in the diagnosis and treatment of Lyme disease in the United States. Infection 1996; 24: 182-186.

Compiled by: John D. Scott, B.Sc. (Agr.), M.Sc.

08 August  2019                                                                                                                                                                                        Research Scientist (Acarology)

Governor General Medalist

Submit Comments to IDSA