A historic case study on chronic Lyme disease

0.5 CME. This presentation provides physicians with clinically useful information that will help them assist patients with manifestations of Chronic Lyme disease.

Kenneth B. Liegner, MD

This presentation provides physicians with clinically useful information that will help them assist patients with manifestations of Chronic Lyme disease.

Learning objectives:

  1. List some of the complexities regarding the diagnosis and treatment of Lyme disease.
  2. Recognize that Lyme disease can be ‘serovariable’ (results in some individuals can be seronegative, borderline or positive despite active Lyme infection).
  3. State that Chronic Lyme disease is a bona fide entity.
  4. Recall that Borrelia burgdorferi can exist within biofilm in patients.
  5. Recognize that long-term antimicrobial treatment is necessary for some individuals, however, current methods may fail to eradicate the infection.
  6. Recognize that improved methods of treatment for Lyme disease in all of its stages are urgently needed and should be a very high priority for the international biomedical research community.

The AAFP has reviewed “A historic case study on chronic Lyme disease” and deemed it acceptable for AAFP credit. Term of approval is from 12/15/2021 to 12/14/2022. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This session is approved for 0.5 online enduring material activity AAFP Prescribed credits.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Evidence-based bibliography for further study

Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, Prokop J. Survival of Borrelia burgdorferi in Antibiotically Treated Patients with Lyme borreliosis. Infection 1989;17:355-359.

Liegner KB. Lyme Disease: The Sensible Pursuit of Answers.(Guest Commentary). J Clin Microbiol 1993;31:1961-1963.

Liegner KB. B. burgdorferi – Seek and Ye Shall Find. Expanding the Envelope. (Guest Editorial). J Spirochetal and Tick-borne Dis 1994;1:79-81.

Liegner KB, Rosenkilde CE, Campbell GL, Quan TJ, Dennis DT. Culture-confirmed treatment failure of cefotaxime and minocycline in a case of Lyme meningoencephalomyelitis in the United States. In: Program and abstracts of the Fifth International Conference on Lyme Borreliosis, Arlington, Va., May 30-June 2, 1992. Bethesda, Md.:Federation of American Societies for Experimental Biology, 1992:A11.

Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L.  Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection. J Amer Acad Derm 1993;28:312-4.

Liegner KB, Duray P, Agricola M, Rosenkilde C, Yannuzzi L, Ziska M, Tilton R, Hulinska D, Hubbard J, Fallon B. Lyme Disease and the Clinical Spectrum of Antibiotic-Responsive Chronic Meningoencephalomyelitides. J Spirochetal and Tick-borne Dis 1997;4:61-73.

Hodzic et.al. Persistence of Borrelia burgdorferi following Antibiotic Treatment in Mice. Antimicrobial Agents & Chemotherapy. May 2008, Vol. 52(5)1728-36.

Straubinger RK, Summers BA, Chang Y, Appel MJG. Persistence of Borrelia burgdorferi in Experimentally Infected Dogs after Antibiotic Treatment. J Clin Microbiol 1997;35:111-116.

Livengood JA, Gilmore RD Jr. Invasion of human neuronal and glial cells by an infectious strain of Borrelia burgdorferi. Microbes and Infection xx(2006)1-9.

Embers ME, Barthold SW et.al. Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection. PLoS One 7(1):e29914.

Klempner MS, Noring R, Rogers RA. Invasion of Human Skin Fibroblasts by the Lyme Disease Spirochete, Borrelia burgdorferi. J Infect Dis 1993;167:1074-81.

Georgilis K, Peacocke M, Klempner MS. Fibroblasts Protect the Lyme Disease Spirochete, Borrelia burgdorferi, from Ceftriaxone In Vitro. J Infect Dis 1992;166:440-4.

Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme Disease. Dissociation of T- and B-Lymphocyte Responses to Borrelia burgdorferi. N Engl J Med 1988;319:1441-6

Lawrence C, Lipton RB, Lowy FD, Coyle PK. Seronegative Chronic Relapsing Neuroborreliosis. Eur Neurol 1995;35:113-117.

Sapi E, Kasliwala RS, Ismail H, Torres JP, Oldakowski M, Markland S, Gaur G, Melillo A, Eisendle K, Liegner KB, Libien J, Goldman JE. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease. Antibiotics (Basel). 2019 Oct 11;8(4):183. doi: 10.3390/antibiotics8040183. PMID: 31614557; PMCID: PMC6963883.

Shor, S.; Green, C.; Szantyr, B.; Phillips, S.; Liegner, K.; Burrascano, J.J., Jr.; Bransfield, R.; Maloney, E.L. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics 2019, 8, 269.

Sapi E, Balasubramanian K, Poruri A, Maghsoudlou JS, Socarras KM, Timmaraju AV, Filush KR, Gupta K, Shaikh S, Theophilus PA, Luecke DF, MacDonald A, Zelger B. Evidence of In Vivo Existence of Borrelia Biofilm in Borrelial Lymphocytomas. Eur J Microbiol Immunol (Bp). 2016 Feb 9;6(1):9-24. doi: 10.1556/1886.2015.00049. PMID: 27141311; PMCID: PMC4838982.

Clinical Courier. Vol 9, No 5. August 1991. NIH State-of-the-Art Conference. NIAID/NIAMSD. ISSN 0264-6684.Diagnosis and Treatment of Lyme DiseaseLiegner, KB In the Crucible of Chronic Lyme Disease. Xlibris. 2015. www.inthecrucibleofchroniclymedisease.com

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Course Includes

  • 1 Lesson
  • 2 Quizzes
  • Course Certificate