Lyme disease: the next decade

Abstract

Although Lyme disease remains a controversial illness, recent events have created an unprecedented opportunity to make progress against this serious tick-borne infection. Evidence presented during the legally mandated review of the restrictive Lyme guidelines of the Infectious Diseases Society of America (IDSA) has confirmed the potential for persistent infection with the Lyme spirochete, Borrelia burgdorferi, as well as the complicating role of tick-borne coinfections such as Babesia, Anaplasma, Ehrlichia, and Bartonella species associated with failure of short-course antibiotic therapy. Furthermore, renewed interest in the role of cell wall-deficient (CWD) forms in chronic bacterial infection and progress in understanding the molecular mechanisms of biofilms has focused attention on these processes in chronic Lyme disease. Recognition of the importance of CWD forms and biofilms in persistent B. burgdorferi infection should stimulate pharmaceutical research into new antimicrobial agents that target these mechanisms of chronic infection with the Lyme spirochete. Concurrent clinical implementation of proteomic screening offers a chance to correct significant deficiencies in Lyme testing. Advances in these areas have the potential to revolutionize the diagnosis and treatment of Lyme disease in the coming decade.

Keywords:

• Lyme disease
• Borrelia burgdorferi
• L-forms
• cysts
• biofilms
• proteomics

Acknowledgements

The authors thank Drs Stephen Barthold, Robert Bransfield, Joseph Burrascano, Daniel Cameron, Allison DeLong, Brian Fallon, Chris Green, Nick Harris, Steven Harris, Robert Lane, Kenneth Liegner, Benjamin Luft, Alan Mac-Donald, Betty Maloney, David Martz, Carsten Nicolaus, Steven Phillips, Eva Sapi, Ginger Savely, Armin Schwarzbach, David Volkman, Edward Winger, and Ying Zhang for helpful discussion. We also thank Pam Weintraub and Kris Newby for their insight, and we are grateful to Pat Smith of the Lyme Disease Association, Diane Blanchard and Deb Siciliano of Time for Lyme, Staci Grodin of Turn the Corner Foundation, and Barb Barsocchini, Dorothy Leland, and Phyllis Mervine of the California Lyme Disease Association for continuing support. There was no funding source for this article. Ethical approval was not required for this article.

Disclosure

RBS serves without compensation on the medical advisory panel for QMedRx Inc. He has no financial ties to the company. LJ has no potential conflicts of interest to declare.