Persistence of borrelia burgdorferi in ligamentous tissue from a patient with chronic lyme borreliosis

Abstract

Objective. To document the persistence of Borreliu burgdorferi in ligamentous tissue samples obtained from a woman with chronic Lyme borreliosis.Methods. Spirochetes were isolated from samples of ligamentous tissue, and the spirochetes were characterized antigenetically and by molecular biology techniques. The ligamentous tissue was examined by electron microscopy. Humoral and cellular immune responses were analyzed.Results. Choroiditis was the first recognized manifestation of Lyme disease in this patient. Despite antibiotic therapy, there was progression to a chronic stage, with multisystem manifestations. The initially signifi- cant immune system activation was followed by a loss of the specific humoral immune response and a decrease in the cellular immune response to B burgdorferi over the course of the disease. "Trigger finger" developed, and a portion of the flexor retinaculum obtained at surgery was cultured. Viable spirochetes were identified. Ultramorphologically, the spirochetes were situated between collagen fibers and along fibroblasts, some of which were deeply invaginated by these organisms. The cultured bacteria were identified as B burgdorferi by reactions with specific immune sera and monoclonal antibodies, and by polymerase chain reaction amplification and Southern blot hybridization techniques.Conclusion. To our knowledge, this is the first report of the isolation of B burgdorferi from ligamentous tissue. This suggests that tendon tissues serve as a specific site of spirochete residence in human hosts.

Lyme Arthritis: Current Concepts and a Change in Paradigm

“…B. burgdorferi organisms contain several surface molecules that facilitate binding to proteoglycan components of the extracellular matrix of synovial tissues. Indeed, B. burgdorferi organisms have been shown to persist in the connective tissues of chronically in-fected mice and humans (10,11,67). The presence of spirochetes at these sites is likely required for the inflammatory response leading to arthritis in individuals not receiving antimicrobial therapy.…”

Cutting Edge: T Cell-Mediated Pathology in Murine Lyme Borreliosis

“…Although isolation of spirochetes from cardiac tissue (6, 7) and synovium (8,9) of human patients clearly establish that inflammation is triggered by infection, other host factors clearly regulate the severity and longevity of disease. Early studies revealed high concentrations of proinflammatory cytokines IL-1 (10), IL-6 (11), and TNF-␣ (12,13).…”

CD14 Signaling Reciprocally Controls Collagen Deposition and Turnover to Regulate the Development of Lyme Arthritis

“…The ability of spirochetes to embed themselves in dense collagen bundles may offer protection from both antibodies and antibiotics. [52][53][54][55] Putting all this information together, we can speculate that CD14 not only helps in the activation of MMP-9 necessary for degradation of existing collagen but also may limit the continued production of collagen. Control of these fibrotic processes by CD14 not only leads to higher neutrophil recruitment and clearance of spirochetes but also deprives B. burgdorferi of "hide-outs" within joints.…”