“Borrelia burgdorferi’s stealth pathology makes eradication of the disseminated organism a...

“Borrelia burgdorferi’s stealth pathology makes eradication of the disseminated organism a near impossibility. Before the tick delivers its inoculum of spirochetes into the host, it injects a substance that inhibits the immune response, allowing the spirochete to gain a strong foothold. The spirochete itself secretes enzymes that help it to replicate and infect the host.

Once disseminated throughout the body, B. burgdorferi secludes itself and becomes difficult to detect through laboratory testing—and by the host’s immune system. The bacterium may hide in its host’s WBCs or cloak itself with host proteins. Furthermore, it tends to hide in areas not usually under immune surveillance, such as scar tissue, the central nervous system, the eyes, and deep in joints and other tissues.

Phase and antigenic variations allow B. burgdorferi to change into pleomorphic forms to evade the immune system and antibiotics. The three known forms are the spiral shape that has a cell wall, the cell-wall-deficient form known as the “L-form” (named not for its shape but for Joseph Lister, the scientist who first identified these types of cells), and the dormant or latent cyst form. Encapsulating itself into the inactive cyst form enables the spirochete to hide undetected in the host for months, years, or decades until some form of immune suppression initiates a signal that it is safe for the cysts to open and the spirochetes to come forth and multiply.

Each of these forms is affected by different types of antibiotics. If an antibiotic targets the bacterium’s cell wall, the spirochete will quickly morph into a cell-wall-deficient form or cyst form to evade the chemical enemy.

Borrelia burgdorferi has an in vitro replication cycle of about seven days, one of the longest of any known bacteria. Antibiotics are most effective during bacterial replication, so the more cycles during a treatment, the better. Since the life cycle of Streptococcus pyogenes (the bacterium that causes strep throat) is about eight hours, antibiotic treatment for a standard 10 days would cover 30 life cycles. To treat Lyme disease for a comparable number of life cycles, treatment would need to last 30 weeks.

Within the tick gut are hundreds of different types of pathogens. How many infect humans is unknown. Some have been identified and are known to intensify morbidity and complicate treatment of Lyme disease. Awareness of three coinfecting genuses in particular—Ehrlichia, Bartonella, and Babesia—has increased, and persistent infection with these organisms has been described. Testing for and treating these coinfections has become part of the approach for clinicians who specialize in the treatment of Lyme disease.”