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Molecular Testing of Serial Blood Specimens from Patients with Early Lyme Disease During Antibiotic Treatment Reveals Changing Borrelia Burgdorferi Genotypes

Computer illustration of Borrelia burgdorferi bacteria, the cause of Lyme disease in humans. These spiral-shaped spirochaete bacteria are passed on to humans by tick bites, commonly Ixodes ricinus in Europe and Ixodes pacificus in North America. Getty Images

rheumatology

Computer illustration of Borrelia burgdorferi bacteria, the cause of Lyme disease in humans. These spiral-shaped spirochaete bacteria are passed on to humans by tick bites, commonly Ixodes ricinus in Europe and Ixodes pacificus in North America. Getty Images

By Johns Hopkins Lyme Disease Research Center

Summary

This pilot study showed a direct molecular Lyme disease diagnostic test could be used to identify and genotype Borrelia burgdorferi during antibiotic treatment in early Lyme disease patients. Patients studied were shown to be simultaneously infected with different B. burgdorferi genotypes and the ratios of genotypes shifted during antibiotic treatment. Findings suggest that the host immune system or differential antibiotic susceptibility might have played a role in the observed genotypic shift.

Why was this study done?

The aim of this first of its kind study was to use a direct molecular assay to identify and genotype Borrelia burgdorferi during antibiotic treatment. The study determined how long after initiating antibiotic therapy B. burgdorferi could be detected in blood from patients with early Lyme disease. The study also observed if ratios of simultaneously infecting Bb genotypes changed significantly over time.

How was this study done?

Direct detection PCR and electrospray ionization mass spectrometry were used to identify and genotype B. burgdorferi from collected whole blood specimens collected over time from clinically diagnosed early Lyme disease patients before and during 21 days of antibiotic therapy.

What were the major findings?

This study demonstrates the utility of a direct molecular test that can both detect and genotype Borrelia burgdorferi from serially collected specimens. Direct molecular diagnostic tests have the advantage of being able to measure response to treatment by demonstrating clearance of the pathogen(s), whereas current antibody-based tests cannot distinguish active infection from prior exposure, or measure response to treatment.

Our findings suggest the host immune system or differential antibiotic susceptibility might have played a role in the observed genotypic shift. Findings suggest some B. burgdorferi genotypes may reside in parts of the body that are not readily cleared and bacterial remnants may continue to leak into the circulatory system following antibiotic treatment.

A direct test could enable improved diagnosis of early Lyme disease patients, provide a tool for testing new antibiotics and monitoring treatment success, and further our understanding of infection by B. burgdorferi genotypes and their impact on the human immune system and illness severity.

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This research supported by:

This research was supported by Bay Area Lyme Foundation and the Steven and Alexandra Cohen Foundation.

Publication Information

Molecular Testing of Serial Blood Specimens from Patients with Early Lyme Disease during Treatment Reveals Changing Coinfection with Mixtures of Borrelia burgdorferi Genotypes
Michael R. Mosel, Heather E. Carolan, Alison W. Rebman, Steven Castro, Christian Massire, David J. Ecker, Mark J. Soloski, John N. Aucott, Mark W. Eshoo
Antimicrobial Agents and Chemotherapy Jun 2019, 63 (7) e00237-19; DOI: 10.1128/AAC.00237-19

About the Johns Hopkins Lyme Disease Research Center

Our mission is to understand and urgently address the varied manifestations of Lyme disease and translate our pioneering multidisciplinary research into improved patient care, education, and health outcomes.

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