In Vitro Susceptibility Testing of Borrelia burgdorferi Sensu Lato Isolates Cultured from Patients with Erythema Migrans before and after Antimicrobial Chemotherapy
- From: "georgia" <jwissmille@xxxxxxx>
- Date: 13 Apr 2005 13:00:03 -0700
In Vitro Susceptibility Testing of Borrelia burgdorferi Sensu Lato
Isolates Cultured from Patients with Erythema Migrans before and after
Antimicrobial Chemotherapy
Klaus-Peter Hunfeld,1,2* Eva Ruzic-Sabljic,3 Douglas E. Norris,2 Peter
Kraiczy,1 and Franc Strle4
Institute of Medical Microbiology, University Hospital of Frankfurt,
Frankfurt/Main, Germany,1 Institute of Microbiology and Immunology,
Medical Faculty, University of Ljubljana,3 Department of Infectious
Diseases, University Medical Centre, Ljubljana, Slovenia,4 The Harry W.
Feinstone Department of Molecular Microbiology and Immunology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, Maryland2
Received 26 July 2004/ Returned for modification 7 September 2004/
Accepted 19 December 2004
Clinical treatment failures have been reported to occur in early Lyme
borreliosis (LB) for many suitable antimicrobial agents. Investigations
of possible resistance mechanisms of the Borrelia burgdorferi complex
must analyze clinical isolates obtained from LB patients, despite their
receiving antibiotic treatment. Here, borrelial isolates obtained from
five patients with erythema migrans (EM) before the start of antibiotic
therapy and again after the conclusion of treatment were investigated.
The 10 isolates were characterized by restriction fragment length
polymorphism analysis and plasmid profile analysis and subjected to
susceptibility testing against a variety of antimicrobial agents
including those used for initial chemotherapy. Four out of five
patients were infected by the same genospecies (Borrelia afzelii, n =
3; Borrelia garinii, n = 1) at the site of the EM lesion before and
after antimicrobial therapy. In one patient the genospecies of the
initial isolate (B. afzelii) differed from that of the follow-up
isolate (B. garinii). No significant changes in the in vitro
susceptibilities became obvious for corresponding clinical isolates
before the start and after the conclusion of antimicrobial therapy.
This holds true for the antimicrobial agents used for specific
chemotherapy of the patients, as well as for any of the additional
agents tested in vitro. Our study substantiates borrelial persistence
in some EM patients at the site of the infectious lesion despite
antibiotic treatment over a reasonable time period. Borrelial
persistence, however, was not caused by increasing MICs or minimal
borreliacidal concentrations in these isolates. Therefore, resistance
mechanisms other than acquired resistance to antimicrobial agents
should be considered in patients with LB resistant to treatment.
.
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