A Systematic Review of Borrelia burgdorferi Morphologic Variants Does Not Support a Role in Chronic Lyme Disease
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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.
Published Version (Please cite this version)10.1093/cid/cit810
Publication InfoLantos, Paul; Auwaerter, PG; & Wormser, GP (2013). A Systematic Review of Borrelia burgdorferi Morphologic Variants Does Not Support a Role in Chronic Lyme Disease. Clinical Infectious Diseases. 10.1093/cid/cit810. Retrieved from http://hdl.handle.net/10161/13964.
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Associate Professor of Medicine
I am interested in the spatial epidemiology of infectious diseases. My research utilizes geographic information systems (GIS) and geostatistical analyses to understand the spatial and spatiotemporal distribution of diseases, and their relationship with environmental and demographic factors. I currently have active studies evaluating the spatial distribution of numerous domestic and international infectious diseases, as well as studies of neighborhood health disparities in obstetrical care and bi