Monica E. Embers, PhD
Associate Professor in the Division of Immunology
Director of Vector-borne Disease Research
Tulane National Primate Research Center
This module presents human Lyme disease as a systemic infection with inflammatory pathology. The recommended treatment by two medical associations is covered, with an overview of antibiotic efficacy and a description of antibiotic tolerant-persisters. Findings from nonhuman primate studies are presented, as well as treatment goals and new strategies for eradication of the Lyme disease pathogen.
- To review the treatment guidelines for Lyme disease (IDSA and ILADS)
- To define and describe antibiotic tolerance vs. antibiotic resistance
- To highlight key studies on antibiotic efficacy
- To consider new strategies aimed at curing the infection
Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.
Evidence-based bibliography for further study
Bockenstedt, L., et al. (2002). “Detection of Attenuated, Noninfectious Spirochetes in Borrelia burgdorferi-Infected Mice after Antibiotic Treatment.” The Journal of Infectious Diseases 186(10): 1430-1437.
Hodzic, E., et al. (2008). “Persistence of Borrelia burgdorferi following antibiotic treatment in mice.” Antimicrobial Agents & Chemotherapy 52(5): 1728-1736.
Barthold, S. W., et al. (2010). “Ineffectiveness of tigecycline against persistent Borrelia burgdorferi.” Antimicrobial Agents & Chemotherapy 54(2): 643-651.
Embers, M. E., et al. (2012). “Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.” PLoS ONE 7(1): e29914.
Bockenstedt, L. K., et al. (2012). “Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy.” The Journal of Clinical Investigation 122(7): 2652-2660.
Hodzic, E., et al. (2014). “Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice.” PLoS ONE 9(1): e86907.
Wormser, G. P., et al. (2012). “Critical analysis of treatment trials of rhesus macaques infected with Borrelia burgdorferi reveals important flaws in experimental design.” Vector Borne Zoonotic Dis 12(7): 535-538.
Wormser, G., et al. (2000). “Practice Guidelines for the Treatment of Lyme Disease.” Clinical Infectious Diseases 31(s1): 1-14.
Shor S, Green C, Szantyr B, Phillips S, Liegner K, Burrascano JJ Jr, Bransfield R, Maloney EL. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel). 2019 Dec 16;8(4):269. doi: 10.3390/antibiotics8040269. PMID: 31888310; PMCID: PMC6963229.
Embers, M. E., et al. (2017). “Variable manifestations, diverse seroreactivity and post-treatment persistence in non-human primates exposed to Borrelia burgdorferi by tick feeding.” PLoS ONE 12(12): e0189071.
Crossland, N. A., et al. (2018). “Late Disseminated Lyme Disease: Associated Pathology and Spirochete Persistence Posttreatment in Rhesus Macaques.” The American Journal of Pathology 188(3): 672-682.