The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

• Published in: Antibiotics (Basel) 2019-10, Vol.8 (4), p.183
• Main Authors: Sapi, Eva, Kasliwala, Rumanah S, Ismail, Hebo, Torres, Jason P, Oldakowski, Michael, Markland, Sarah, Gaur, Gauri, Melillo, Anthony, Eisendle, Klaus, Liegner, Kenneth B, Libien, Jenny, Goldman, James E
• Format: Article
• Language: English
• Subjects: Alginates; Alginic acid; Animal cognition; Antibiotic resistance; Antibiotics; Antigens; Arachnids; Autopsies; Autopsy; Biofilms; Borrelia burgdorferi; CD3 antigen; Chronic illnesses; Confocal microscopy; Convulsions & seizures; Cytogenetics; Deoxyribonucleic acid; Diseases; DNA; DNA sequencing; Drug resistance; Fluorescence; Fluorescence in situ hybridization; Gene sequencing; Genetic aspects; Genetic research; Genomes; Genomics; Health aspects; Health services; Human body; Infections; Inflammation; Liver; Lyme disease; Lymphocytes; Lymphocytes T; Markers; Memory; Metagenomics; Microbial drug resistance; Microscopy; Neuropsychology; Nucleotide sequence; Patients; persisters; Physiological aspects; Polymerase chain reaction; Public health; Reimbursement; Spasticity; spirochete; T cells; Tissues; Vector-borne diseases; Whole genome sequencing; Women
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics8040183

Whether the causative agent of Lyme disease, can persist for long periods in the human body has been a controversial question. The objective of this study was to see if we could find in a Lyme disease patient after a long clinical course and after long-term antibiotic treatment. Therefore, we investigated the potential presence of antigens and DNA in human autopsy tissues from a well-documented serum-, PCR-, and culture-positive Lyme disease patient, a 53-year-old female from northern Westchester County in the lower Hudson Valley Region of New York State, who had received extensive antibiotic treatments during extensive antibiotic treatments over the course of her 16-year-long illness. We also asked what form the organism might take, with special interest in the recently found antibiotic-resistant aggregate form, biofilm. We also examined the host tissues for the presence of inflammatory markers such as CD3+ T lymphocytes. Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics. We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy. The aggregates contained a well-established biofilm marker, alginate, on their surfaces, suggesting they are true biofilm. We found DNA by FISH, polymerase chain reaction (PCR), and an independent verification by WGS/metagenomics, which resulted in the detection of sensu stricto specific DNA sequences. IHC analyses showed significant numbers of infiltrating CD3+ T lymphocytes present next to biofilms. In summary, we provide several lines of evidence that suggest that can persist in the human body, not only in the spirochetal but also in the antibiotic-resistant biofilm form, even after long-term antibiotic treatment. The presence of infiltrating lymphocytes in the vicinity of biofilms suggests that the organism in biofilm form might trigger chronic inflammation.