Monica E. Embers, Ph.D., Division of Bacteriology & Parasitology, Tulane National Primate Research Center, Covington, LA USA
Introduction: The etiologic agent of Lyme disease, Borrelia burgdorferi (Bb), is transmitted to humans by ticks of the genus Ixodes, resulting in a disease of protean manifestations due to the organisms’ systemic spread and promiscuous organ tropism. Those infected may exhibit a skin rash, arthritis, carditis, extreme fatigue, myalgia, and neurological dysfunction. Lyme disease is the most commonly reported vector-borne disease within all of the temperate regions of the northern hemisphere. Across Europe and North America, the number of reported cases is probably a significant underestimate of actual cases. Despite generally effective treatment with antibiotics, a faction of Lyme disease patients experience chronic symptoms after treatment, a phenomenon that can be labeled as Post-treatment Lyme Disease Syndrome (PTLDS). The efficacy and accepted regimen of antibiotic treatment for human Borreliosis has been a very contentious issue. Even with advances in diagnostics and antimicrobials, Lyme disease continues to cause significant medical and sociopolitical disagreement. Our prior results have demonstrated that B. burgdorferi spirochetes persist in nonhuman primates (NHP) after antibiotic therapy. Importantly, the question of whether these antibiotic-tolerant organisms remain infectious and cause disease has not been answered. Methods: We have repeated these experiments using tick-mediated infection of rhesus macaques. Antibiotic efficacy has thus far been evaluated by xenodiagnosis, tissue culture and histopathology.
Results: Amongst tick-inoculated monkeys, 1/10 developed an erythema migrans rash, indicating that this sign can be irregular in primates. As evidenced by serology and pathology, 1/10 tick-inoculated monkeys appeared to self-cure, and 1/10 did not appear to become infected. Interestingly, anti-tick immunity likely interfered with xenodiagnosis, irrespective of antibiotic treatment, and moderate pathology was seen in a variety of tissues from both treated and untreated monkeys. Conclusions: Disease manifestations are quite variable in the macaque, as in humans. Histological evidence of pathology post-antibiotic treatment may be representative of chronic symptoms, and we will examine those tissues for the presence of B. burgdorferi to assess the etiology.
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