Persistent Lyme Infection: Evidence Lyme Disease Can Persist
Research suggests that Lyme disease may persist in some patients despite standard treatment. Multiple studies indicate that Lyme disease can result in a persistent infection, leading to ongoing symptoms that may require additional evaluation and treatment.
The National Institutes of Health (NIH) conducted several clinical trials evaluating patients with persistent symptoms after Lyme disease treatment.2-4 Participants in these studies had been ill for years—an average of nearly 9 years in one trial. These studies confirmed that some patients continue to experience severe symptoms despite antibiotic therapy.
Patients reported debilitating fatigue, impaired cognitive function, chronic pain, and reduced physical functioning even after treatment.5 These findings highlight the complexity of persistent symptoms following Lyme disease.
Debate Over Persistent Lyme Infection
The possibility that persistent Lyme infection contributes to ongoing illness remains a topic of debate in medicine. Some physicians dismiss the idea that a persistent tick-borne infection could underlie a patient’s symptoms.6 Others believe that Lyme disease may continue to affect the body long after the initial infection and should be considered when evaluating chronic symptoms.7
Dr. Shor and colleagues summarized several potential biological mechanisms that may allow Lyme disease to persist.
“Potential survival mechanisms of Lyme disease persistence include immune evasion, immune modulation, and the presence of subpopulations of persister cells. Physical seclusion—within cells, collagen-rich tissues, and immunologically protected sites such as the central nervous system, joints, and eyes—is one mechanism of immune evasion. Biofilm formation represents another form of protection. Published reports document that Borrelia burgdorferi can produce biofilms in vitro, and examination of infected human tissues has demonstrated B. afzelii and B. burgdorferi embedded in biofilm structures.”7
These proposed mechanisms help explain why some patients continue to experience symptoms long after initial infection.
Persistent Lyme Infection: Evidence Lyme Disease Can Persist
Clinical Perspective
Editor’s perspective: Many patients struggle to find physicians willing to consider the possibility of a persistent infection when symptoms continue after treatment. For these individuals, acknowledging the potential for ongoing infection or immune dysfunction is an important step toward proper evaluation and care.
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References:
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-44.
- Klempner MS, Hu LT, Evans J, 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(2):85-92.
- Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60(12):1923-30.
- Fallon BA, Keilp JG, Corbera KM, et al. A randomized placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.
- Rebman AW, Aucott JN, Weinstein ER, et al. Living in Limbo: Contested Narratives of Patients With Chronic Symptoms Following Lyme Disease. Qual Health Res. 2017;27(4):534-546.
- Wormser GP, McKenna D, Karmen CL, et al. Prospective Evaluation of Symptoms in Lyme Disease Patients With Erythema Migrans. Clin Infect Dis. 2020.
- Shor S, Green C, Szantyr B, et al. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel). 2019.
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
