In Reply We appreciate the Letter in Reply from Dr Lee highlighting his research on the detection of persistent borreliosis by novel gene-sequencing methods.1 However, we contend that persistent polymerase chain reaction (PCR) positivity for Borrelia burgdorferi does not signify the presence of active infection or bacteremia that merits prolonged antibiotic treatment. To this point, Marques et al2 tested a cohort of patients with treated Lyme disease and posttreatment Lyme disease syndrome (PLTDS) for the presence of viable B burgdorferi. Using a xenodiagnostic technique wherein laboratory-raised Ixodes scapularis ticks fed on patients and subsequently attempted to infect immunodeficient mice, both ticks and mice were tested for the presence of B burgdorferi by PCR and culture. Despite detecting B burgdorferi DNA by PCR amplification in a single patient with PLTDS on 2 separate occasions, the investigators were unable to culture B burgdorferi. This supports current evidence that the association between microbiological data—especially PCR—and symptoms in patients with reported persistent Lyme disease remains unproven.3
Marks CM, Nawn JE, Caplow JA. Gene Sequencing and Cases of Chronic Lyme Disease—Reply. JAMA Intern Med. 2017;177(5):739–740. doi:https://doi.org/10.1001/jamainternmed.2017.0354
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