To the Editor I appreciate the Teachable Moment by Marks and colleagues1 in a recent issue of JAMA Internal Medicine on chronic Lyme disease. However, I disagree with their statement about the lack of objective evidence regarding the existence of chronic Lyme disease.
There is 16S ribosomal RNA gene sequencing–based evidence of persistent infection by Borrelia burgdorferi and related spirochetes in patients after full courses of antibiotic treatment for Lyme disease. For examples, one such case (GenBank identification No., KM052618) was discovered in a posttreatment serum sample supplied by the Centers for Disease Control and Prevention.2 The other 2 cases, both found by a Lyme-literate doctor, were caused by a mixed infection of B burgdorferi and Borrelia miyamotoi3 and by a novel strain of B burgdorferi with 2 homeologous 16S ribosomal RNA genes,4 respectively. These cases proven by gene sequencing cannot be dismissed by the usual suspect of laboratory PCR contaminations.
Lee SH. Gene Sequencing and Cases of Chronic Lyme Disease. JAMA Intern Med. 2017;177(5):739. doi:10.1001/jamainternmed.2017.0330
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