Persistent Borrelia Infection in Chronic Lyme Disease: A Review of the Medical Literature
A powerful new review paper authored by Raphael Stricker, MD, Melissa Fesler, DNP and Lorraine Johnson in the journal Advances in Infectious Diseases titled Persistent Borrelia Infection in Chronic Lyme Disease: A Review of the Medical Literature.
Chronic Lyme disease (CLD) remains one of the most debated topics in modern medicine. At the center of the controversy is a fundamental disagreement: can the Lyme disease bacterium, Borrelia burgdorferi, persist in the body after standard antibiotic treatment—and if so, can that persistence drive ongoing, chronic symptoms?
A recent peer-reviewed review published in Scientific Research Publishing (SCIRP) takes a comprehensive look at this question by examining decades of medical literature. The findings add important context and scientific evidence to a discussion that has often been framed as polarized or unresolved.
Why Chronic Lyme Disease Is Controversial
Patients diagnosed with Lyme disease are typically treated with a defined course of antibiotics, which is often effective in resolving early infection. However, a subset of patients continues to experience symptoms such as fatigue, pain, cognitive difficulties, and neurological complaints long after treatment has ended.
Mainstream clinical guidelines often attribute these symptoms to immune dysregulation or post-infectious effects rather than ongoing infection. In contrast, other researchers and clinicians argue that Borrelia burgdorferi can survive antibiotic therapy and remain biologically active in the body.
This review directly addresses that dispute by focusing on one core question: does credible scientific evidence support persistent infection?
What the Literature Review Found
The authors analyzed published animal and human studies investigating Borrelia burgdorferi persistence. In total, 56 independent studies were identified that demonstrated evidence of ongoing infection after antibiotic treatment.
Importantly, these findings were not limited to indirect markers such as antibody levels. Instead, the review highlights direct and functional evidence of persistence, including:
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Culture: Recovery of live spirochetes from tissue after treatment
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Histology: Visualization of organisms in tissue samples
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Xenodiagnosis: Transmission of infection to uninfected ticks feeding on treated hosts
Together, these methods demonstrate that viable organisms—not just bacterial remnants—can remain present following antibiotic therapy.
Insights from Animal and Human Studies
Animal models, including mice, dogs, and non-human primates, have consistently shown that Borrelia burgdorferi can survive standard treatment regimens. These models are particularly valuable because they allow for tissue sampling and controlled conditions that are not feasible in human studies.
Human research, while more limited for ethical and practical reasons, has also produced evidence of persistent infection. The review emphasizes that findings across species and study designs are remarkably consistent, strengthening the overall conclusions.
The Role of Cysts, L-Forms, and Biofilms
One of the most compelling aspects of the review is its discussion of alternative bacterial forms that may contribute to persistence:
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Cystic or L-forms: Dormant or cell-wall-deficient forms that may be less susceptible to antibiotics
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Biofilms: Structured bacterial communities that provide physical and metabolic protection
These mechanisms are well-documented in other chronic bacterial infections and offer plausible biological explanations for why Borrelia burgdorferi might evade treatment and immune clearance.
What This Means Going Forward
The authors are careful not to overstate their conclusions. Instead, they emphasize that the existence of persistent infection is supported by substantial evidence, but the mechanisms, clinical implications, and optimal treatment strategies still require further investigation.
Future research priorities identified in the review include:
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Understanding how and why persistence occurs
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Determining which patients are most at risk
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Developing diagnostic tools that can reliably detect ongoing infection
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Exploring treatment approaches that address biofilms and atypical bacterial forms
A More Nuanced Scientific Conversation
This review contributes to a growing body of literature suggesting that the debate over chronic Lyme disease should move beyond binary arguments about belief versus disbelief. The evidence summarized here supports the need for continued, open-minded research grounded in microbiology, pathology, and clinical science.
For patients experiencing unresolved symptoms and for clinicians navigating complex cases, this work underscores an important point: the science around Lyme disease persistence is evolving, and it deserves careful, evidence-based attention.