Lyme Disease Dormancy: Can Bacteria Survive Antibiotics?
CAN LYME DISEASE HIDE FROM TREATMENT?
SOME BACTERIA MAY SLOW DOWN OR GO DORMANT
AND REACTIVATE LATER
Lyme disease dormancy research suggests that some forms of Borrelia burgdorferi may survive treatment by entering low-activity states.
Quick Answer: Borrelia may enter dormant states—including persister and VBNC forms—that allow survival during antibiotic exposure, at least in laboratory studies.
Clinical Insight: These survival strategies may help explain persistent symptoms in some patients, though their role in human disease is still being defined.
Feng and colleagues from Johns Hopkins University identified FDA-approved drug combinations that may be effective against B. burgdorferi persisters in vitro.
Persistence may represent one form of bacterial dormancy. “Evidence suggests dormancy consists of a continuum of interrelated states including viable but nonculturable (VBNC) and persistence states,” according to Mali.
This raises an important question: can dormant bacterial states contribute to ongoing symptoms after treatment?
In addition to dormancy, researchers have also explored Lyme disease biofilm and morphologic forms of Borrelia as another possible mechanism that may contribute to bacterial persistence.
Persister Cells and VBNC States
Mali distinguishes between two key dormant states:
- Persister cells: A small subpopulation that enters a dormant, nondividing state but can resume growth after stress resolves
- VBNC cells: Living cells that cannot grow on routine culture media and require specific signals to reactivate
Both states may allow bacteria to survive antibiotic exposure and reduce metabolic activity.
Why Dormancy Matters in Lyme Disease
Lyme disease dormancy research raises important questions about treatment response.
Persister and VBNC cells may coexist, contributing to antibiotic tolerance and possible symptom persistence.
These findings may help explain why some patients continue to experience symptoms after treatment.
Learn more about post-treatment Lyme disease syndrome (PTLDS) and the role of coinfections in persistent illness.
Future Directions
Understanding dormancy may lead to identification of proteins and pathways that regulate these states.
This could support development of therapies targeting dormant bacterial forms.
However, translating laboratory findings into clinical treatment remains a challenge.
Clinical Perspective
Lyme disease dormancy remains an area of ongoing research.
While in vitro findings are promising, further clinical studies are needed to determine how these mechanisms affect patient outcomes.
Patients with persistent symptoms may benefit from evaluation of persistent Lyme disease, review of Lyme disease symptoms, and consideration of interacting mechanisms such as biofilm formation and persister cells.
The Bottom Line
Lyme disease dormancy may allow bacteria to survive antibiotic exposure under certain conditions.
These mechanisms are a focus of ongoing research but have not been fully defined in clinical practice.
Understanding dormancy may help guide future approaches to diagnosis and treatment.
References
- Mali S, et al. J Bacteriol. 2017.
- Feng J, Auwaerter PG, Zhang Y. PLoS One. 2015.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Obviously.
You don’t reference Kim Lewis’ fantastic work on B. burgdorferi persisters at Northeastern.
I agree. Here is the link to the Northeastern article on persisters.
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