NYMC Faculty Publications

A Systematic Review of Borrelia Burgdorferi Morphologic Variants Does Not Support a Role in Chronic Lyme Disease

Author Type(s)

Faculty

DOI

10.1093/cid/cit810

Journal Title

Clinical Infectious Diseases

First Page

663

Last Page

671

Document Type

Article

Publication Date

3-1-2014

Department

Pathology, Microbiology and Immunology

Second Department

Pharmacology

Keywords

Borrelia burgdorferi, Chronic Disease, Humans, Lyme Disease

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND:  Much of the controversy that surrounds Lyme disease pertains to whether it produces prolonged, treatment-refractory infection, usually referred to as chronic Lyme disease. Some have proposed that round morphologic variants of Borrelia burgdorferi, known variably as "cyst forms" and "L-forms," are responsible for the pathogenesis of chronic Lyme disease. We have undertaken a systematic review of the literature to determine if there is a documented role of these variants in Lyme disease pathogenesis or in syndromes compatible with chronic Lyme disease.

METHODS:  Two systematic literature searches were performed to identify studies in which round morphologic variants of B. burgdorferi have been described in situ in human specimens.

RESULTS:  Our primary literature search identified 6 studies that reported round morphologic variants of B. burgdorferi in specimens obtained from 32 total patients. No study described these forms in patients who had purely subjective symptom complexes (eg, fatigue or pain). No study investigated a causal relationship between morphologic variants and clinical disease or evaluated treatment of morphologic variants in vivo. Of 29 additional studies that described the morphology of B. burgdorferi from patients with Lyme disease, the organism was invariably described as having spirochetal morphology.

CONCLUSIONS:  In the context of the broader medical literature, it is not currently possible to ascribe a pathogenic role to morphologic variants of B. burgdorferi in either typical manifestations of Lyme disease or in other chronic disease states that are often labeled chronic Lyme disease. There is no clinical literature to justify specific treatment of B. burgdorferi morphologic variants.

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