Borrelia survive by shape-shifting.

"The premise for prolonged antibiotic therapy for Lyme disease is the notion that some spirochetes can persist despite conventional treatment courses. ... Not only is this assertion microbiologically implausible, there are no convincing published scientific data that support the existence of chronic Lyme disease," states Donald M. Poretz, MD, president of Infectious Diseases Society of America (ISDA).

Willy Burgdorfer, PhD, formerly of the National Institutes of Health, disagrees. Burgdorfer first discovered Lyme-causing spirochetes (spiral-shaped bacteria), dubbed Borrelia burgdorferi, in New York ticks in 1981. At the 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders (April 1999), Burgdorfer explained that microbiologists have studied genus Borrelia spirochetes for over 100 years. (Much of the research is no longer available in English.) In that time, some researchers reported that spirochetes in infected ticks and lice "disappeared" and later reappeared in another part of the vector's body. Instead of spiral-shaped organisms, observers noticed blebs (small particles) and granules that seemed to come from cysts. As a result, some biologists hypothesized a complex life cycle during which Borrelia bacteria change appearance. Many other researchers, including Burgdorfer himself in 1951, "found no evidence of a negative phase or complex life cycle." Then, Burgdorfer was confronted with Borrelia burgdorferi: "This relatively large Borrelia is not readily detectable in blood smears or thick drops of Lyme disease patients and susceptible host animals, yet engorgement on infected hosts results in up to 100% infected ticks." Researchers have observed B. burgdorferi spirochetes "with outer membrane-associated cysts, blebs or spherules that often contain numerous granules with surrounding trilaminar membranes." The matter inside the granules has a similar appearance and electron density to typical spirochetes.

Alan MacDonald, MD, a pathologist with St. Catherine of Siena Medical Center (Smithtown, New York), has used DNA probes in his study of B. burgdorferi. Regardless of appearance, the various forms have the same DNA as the spirochete. MacDonald and Eva Sapi, PhD, have also discovered that Borrelia spirochetes can form biofilms. "In the biofilm unit, which is a colony of spirochetes, the spiral form is often lost and is replaced by cystic forms, granular dot forms [that contain Borrelia DNA], or L-forms," says MacDonald. MacDonald describes L-forms as "sort of like soap bubbles that can stretch out and contain various boundaries, and are not as easy to identify as spirochetes."

Rather than being part of a complex life cycle, B. burgdorferi's, shape-shifting seems to be a "survival mechanism," an adaptation to unfavorable environmental conditions or threats. Burgdorfer says in an experiment by Brorson and Brorson, "B. burgdorferi converted rapidly to cystic forms when transferred to spinal fluid. No normal spirochetes were left after 24 hours of incubation at 37[degrees]C; all were converted to cysts. When these cystic forms were transferred to a rich (BSK-H) medium, the cysts were converted back to normal, mobile spirochetes after incubation for 9 to 1 7 days." Antibiotics and the digestive enzymes in a vector's gut also cause the spirochete to change form.

Given this information, is Borrelia's resistance to conventional antibiotic treatment "microbiologically implausible"?

Burgdorfer W. The complexity of arthropod-borne spirochetes (Borrelia spp). Presented at: the 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders. April 9, 1999. Available at: www.cbc.ca/ideas/features/shows/bacteria/willy.html. Accessed April 7, 2009.

Lyme Disease Research Database. Alzheimer's and Lyme disease: Are they connected? www.lyme-disease-research-database.com/alan-macdonald-transcription.html. Accessed April 4, 2009.

Poretz DM. IDSA Lyme disease letter to U.S. Senate. March 21, 2008. Available at: www.idsociety.org/WorkArea/downloadasset.aspx?id=10818. Accessed April 7, 2009.

briefed by Jule Klotter

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