Man frustrated about chronic Lyme disease
Peer-Reviewed Evidence Proving the Persistence of Lyme Disease Spirochetes (Borrelia burgdorferi) and Tick-Borne Diseases

Below is a listing of over 700 peer-reviewed scientific articles that prove the persistence of Lyme disease and other tick-borne illnesses from the International Lyme and Associated Diseases Society (ILADS).

ILADS organized the information proving chronic Lyme disease is real into 4 different categories — general, neuropsychiatric, dementia, and congenital/sexual transmission. Click or tap on a category heading below to either expand or collapse the section.

  1. Abele DC, Anders KH. The many faces and phases of borreliosis. J Am Acad Dermotol 1990; 23:401-410. [chronic Lyme borreliosis].
  2. Aberer E, Klade H. Cutaneous manifestations of Lyme borreliosis. Infection 1991; 19: 284-286. [chronic Lyme borreliosis].
  3. Aberer E, Breier F, Stanek G, and Schmidt B. Success and failure in the treatment of acrodermatitis chronica atrophicans skin rash. Infection 1996; 24: 85-87.
  4. Aberer E, Kersten A, Klade H, Poitschek C, Jurecka W. Heterogeneity of Borrelia burgdorferi in the skin. Am J Dermatopathol 1996; 18(6): 571-519.
  5. Akin E, McHugh Gl, Flavell RA, Fikrig E, Steere AC. The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to P35 with mild and brief arthritis. Infect Immun 1999; 67: 173- 181.
  6. Albert S, Schulze J, Riegel H, Brade V. Lyme arthritis in a 12-year-old patient after a latency period of 5 years. Infection 1999; 27(4-5): 286-288.
  7. Allred DR. Babesiosis: persistence in the face of adversity. Trends Parasitol. 2003;19:51– 55.
  8. Al-Robaiy S, Dihazi H, Kacza J, et al. Metamorphosis of Borrelia burgdorferi organisms―RNA, lipid and protein composition in context with the spirochete’s shape. J Basic Microbiol 2010; 50 (Suppl 1): S5-17.
  9. Appel MJG, Allan S, Jacobson RH, Lauderdale TL, Chang YF, Shin SJ, Thomford JW, Todhunter RJ, Summers BA. Experimental Lyme disease in dogs produces arthritis and persistent infection. J Infect Dis 1993; 167: 651-664.
  10. Åsbrink E, Hovmark A. Successful cultivation of spirochetes from skin lesions of patients with erythema chronicum migrans, Afzelius and acrodermatis chronica atrophicans. Acta Pathol Microbiol Immunol Sect B 1985; 93: 161-163.
  11. Åsbrink E, Hovmark A, and Olsson I. Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. Zentralbl Bakteriol Mikrobiol Hyg A 1986; 26: 253-
  12. [chronic Lyme borreliosis].
  13. Asch ES, Bujak DI, Weiss M, Peterson MGE, and Weinstein A. Lyme Disease: an infectious and postinfectious syndrome. J Rheumatol 1994; 21 (3): 451-461.
  14. Bankhead T, Chaconas G. The role of VlsE antigenic variation in the Lyme disease spirochete: persistence through a mechanism that differs from other pathogens. Molecular Microbiology 2007; 65: 1547-1558.
  15. Barthold SW, Persing DH, Armstrong AL, Peeples RA. Kinetics of Borrelia burgdorferi dissemination and evolution of disease following intradermal inoculation of mice. Am J Pathol 1991; 139: 263-273.
  16. Barthold SW, deSouza MS, Janotka JL, Smith AL, Persing DH. Chronic Lyme borreliosis in the laboratory mouse. Am J Pathol 1993; 143: 951-971.
  17. Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, and Luft BJ. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrob Agents Chemother 2010; 54(2): 643-651.
  1. Barthold SW. Global challenges in diagnosing and managing Lyme disease—closing knowledge gaps. Testimony before House Committee on Foreign Affairs, United States Congress, 17 July 2012. View Transcript
  2. Battafarano DF, Combs JA, Enzenauer RJ, Fitzpatrick JE. Chronic septic arthritis caused by Borrelia burgdorferi. Clin Orthop 1993;297: 238-241.
  3. Baum E, Hue F, Barbour Experimental infections of the reservoir species Peromyscus leuopus with diverse strains of Borrelia burgdorferi, a Lyme disease agent. Mbio. 2012;3: e00434-12.
  4. Bayer ME, Zhang L, Bayer MH. Borrelia burgdorferi DNA in the urine of treated patients with chronic Lyme disease symptoms. A PCR study of 97 cases. Infection. 1996; 24: 347-353.
  5. Bentas W, Karch H, Huppertz Lyme arthritis in children and adolescents: outcome 12 months after initiation of antibiotic therapy. J Rheumatol. 2000 Aug;27(8):2025-30.
  6. Berger TG, Schoerner C, Schell H, Simon M, Schuler G, Röllinghoff M, Gessner A. Two unusual cases of diffuse acrodermatitis chronica atrophicans seronegative for Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 2003 Jun;22(6):392-5.
  7. Bergler-Klein J, Ullrich R, Glogar D, Stanek G. [Lyme borreliosis and cardiomyopathy]. Wien Med Wochenschr. 1995;145(7-8):196-8.
  8. Berglund J, Stjernberg L, Ornstein K, Tykesson-Joelsson K, Walter H. 5-y follow-up study of patients with neuroborreliosis. Scand. J. Infect. Dis. 2002; 34(6): 421-425.
  9. Berndtson K. Review of evidence for immune evasion and persistent infection in Lyme disease. Int J of General Medicine 2013; 6: 291-306. [Lyme disease spirochetes are adapted to persist in immune competent hosts; they are can remain infective despite aggressive antibiotic ]
  10. Bloom BJ, Wyckoff PM, Meissner HC, Steere AC. Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatric Infect. Dis. J. 1998; 17(3): 189-196.
  11. Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Intern Med 1994;120: 487-489.
  12. Bransfield R, Brand S, and Sherr V. Treatment of patients with persistent symptoms and a history of Lyme disease. N Engl Med 2001; 345: 1424-5.
  13. Breier F, Khanakah G, Stanek G, Aberer E, Schmidt B, and Tappeiner G. Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144: 387-392.
  14. Bockenstedt LK, Mao J, Hodzic E, Barthold SW, Fish D. Detection of attenuated, non- infectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment. J Infect Dis 2002; 186: 1430-1437.
  15. Bockenstedt LK, Gonzalez DG, Hamberman AM, Belperron A. Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy. J Clin Invest 2012;122: 2652-2660.
  16. Breier F, Kkhkanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, Tappeiner G. Isolation and polymerase chain reaction of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcereating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144: 387-392.
  17. Brorson O, Brorson S-H. Transformation of cystic forms of Borrelia burgdorferi to normal mobile spirochetes. Infection. 1997; 25: 240-246.
  18. Brorson O, Brorson S. In vitro conversion of Borrelia burgdorferi to cystic forms in spinal fluid, and transformation to mobile spirochetes by incubation in BSK-H Infection. 1998; 26: 144-150.
  1. Brorson O, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to metronidazole. APMIS 1999; 107: 566-576.
  2. Brorson O, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to tinidazole. Int Microbiol 2004; 7: 139-142.
  3. Brorson O, Brorson SH. An in vitro study of the activity of telithromycin against mobile and cystic forms of Borrelia afzelii. Infection 2006; 34: 26-28.
  4. Brorson O, Brorson SH, Scythes J, MacAllister J, Wier A, and Margulis L. Destruction of spirochete Borrelia burgdorferi round-body propagules by the antibiotic tigecycline. Proc Natl Acad Sci USA 2009; 106: 18656-61
  5. Brown JP, Zachary JF, Teuscher C, Weis JJ, and Wooten M. Dual role of interleukin-10 in murine Lyme disease: regulation of arthritis severity and host defense. Infect Immun 1999; 67: 5142-5150.
  6. Cabello FC, Godfrey HP, and Newman SA. Hidden in plain sight: Borrelia burgdorferi and the extracellular matrix. Trends in Microbiology 2007; 15: 350-354.
  7. Cadavid D, O’Neill T, Schaefer H, and Pachner AR. Localization of Borrelia burgdorferi in the nervous system and organs in a nonhuman primate model of Lyme disease. Lab Invest 2000; 80: 1043-1054.
  8. Cadavid D, Bai Y, Hodzic E, Narayan K, Barthold SW, Pachner AR. Cardiac involvement in non-human primates infected with the Lyme disease spirochete Borrelia burgdorferi. Lab Invest 2004; 84: 1439-1450.
  9. Cameron D, Gaito A, Harris N et al. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti-Infect. Ther 2004; 2 (Suppl. 1), S1-S13.
  10. Cameron DJ. Generalizability in two clinic trials of Lyme disease. Epidemiol Perspect Innov. 2006 Oct 17;3:12.
  11. Cameron D. Severity of Lyme disease with persistent symptoms. Insights from a double- blind placebo-controlled clinical trial. Minerva Med 2008; 99: 489-496.
  12. Cameron DJ. Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients. Med Hypotheses 2009 Jun;72(6):688-91.
  13. Cameron DJ. Proof that chronic Lyme disease exists. Interdiscip Perspect Infect Dis. 2010;2010:876450.
  14. Chancellor MB, McGinnis DE, Shenot PJ, Kiilholma P, Hirsch Urinary dysfunction in Lyme disease. J Urol 1993; 149: 26-30.
  15. Chang YK, Ku YW, Chang CF, Chang CD, McDonough SP, Divers T, Pough M, Torres
  16. Antibiotic treatment of experimentally Borrelia burgdorferi-infected ponies. Vet Microbiol 2005; 107: 285-294.
  17. Chao L-L, Lu C-F, and Shih C-M. Molecular detection and genetic identification of Borrelia garinii and Borrelia afzelii from patients presenting with a rare skin manifestation of prurigo pigmentosa in Taiwan. Int J Infect Dis 2013 Dec;17(12):e1141- 7.
  18. Chakravarty KK, Webley M, Summers GD. A case of chronic Lyme arthritis in England. Ann Rheum Dis. 1991 Feb;50(2):134-5.
  19. Chary-Valckenaere I, Jaulhac B, Champigneulle J, Piement Y, Mainard D, and Pourel J. Ultrastructural demonstration of intracellular localization of Borrelia burgdorferi in Lyme arthritis. Br J Rheumatol 1998; 37: 468-470.
  20. Chmielewski T, Tylewlska-Wierzhanowska S. Inhibition of fibroblast apoptosis by Borrelia afzelii, Coxiella burnetii and Bartonella henselae. Poll Microbiol 2011; 60(3); 269-272.
  21. Chomel BB, Kasten RW, Sykes JE, Boulouis HJ, Breitschwerdt EB. Clinical impact of persistent Bartonella bacteremia in humans and animals. Ann N Y Acad Sci. 2003;990:267–278.
  22. Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient

with chronic Lyme disease. Am J Clin Pathol 1989; 91(1): 95-97.

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  2. Coblyn JS, Taylor P. Treatment of chronic Lyme arthritis with hydroxychloroquine. Arthritis Rheum. 1981 Dec;24(12):1567-9.
  3. Collares-Pereira M, Couceiro S, Franca I, Kurtenbach K, Schäfer SM, Vitorino L, Gonçalves L, Baptista S, Vieira ML, Cunha C. First isolation of Borrelia lusitaniae from a human patient. J Clin Microbiol. 2004 Mar;42(3):1316-8.
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  5. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte response to Borrelia burgdorferi. N Engl J Med 1988; 319(22): 1441-1446.
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  7. de Koning J, et al. Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease. J. Infect. Dis. 1989; 160: 150-153. [intracellular sanctuaries of Bb]
  8. de Leeuw BH, Maraha B, Hollemans L, Sprong H, Brandenburg AH, Westenend PJ, Kusters JG. Evaluation of Borrelia real time PCR DNA targeting OspA, FlaB and 5S-23S IGS and Borrelia 16S rRNA-qPCR. J Microbiol Methods 2014 Dec;107:41-6.
  9. de Souza MS, Smith AL, Beck DS, Terwilliger GA, Fikrig E, Barthold SW. Long-term study of cell-mediated responses to Borrelia burgdorferi in the laboratory mouse. Infect Immun. 1993 May;61(5):1814-22.
  10. DeLong AK, Blossom B, Maloney E, and Phillips SE. Antibiotic retreatment of Lyme disease in patients with persistent symptoms: A biostatistical review of randomized, placebo-controlled, clinical trials. Contemp Clin Trials 2012 Nov;33(6):1132-42.
  11. Demaershalck I, Messaoud AB, de Kesel M, Hoyois B, Lobet Y, Hoet P, Bigaignon G, Bollen A, Godfroid E. Simultaneous presence of different Borrelia burgdorferi genospecies in biological fluids of Lyme disease patients. J Clin Microbiol 1995: 33; 602-608.
  12. Dinerman H, Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med. 1992 Aug 15;117(4):281-5.
  13. Diterich I, Rauter C, Kirschning CJ, and Hartung T. Borrelia burgdorferi-induced tolerance as a model of persistence via immunosuppression. Infect Immun. 2003; 71(7):3979-3987.
  14. Donahue JG, Piesman J, Spielman A. Reservoir competence of white-footed mice for Lyme disease spirochetes. Am J Trop Med Hyg. 1987;36: 92-96.
  15. Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Inf Dis. 1997; 25 (Suppl 1); S52-56.
  16. Donta ST. The existence of chronic Lyme disease. Curr Treat Op Infect Dis. 2001; 3: 261-262.
  17. Donta ST. Late and chronic Lyme disease. Med Clin North 2002; 86: 341-349.
  18. Donta ST. Macrolide therapy of chronic Lyme disease. Med Sci Monit. 2003; 9: 136-142.
  19. Dorward DW, Fischer ER, and Brooks DM. Invasion and cytopathic killing of human lymphocytes by spirochetes causing Lyme disease. Clin. Infect. Dis. 1997. 25 Suppl 1: S2-8. [intracellular sanctuaries of Bb]
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frequent infection with the potential for persistence. J Infect Dis. 1996;173:1027– 1030.

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  1. Häupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schönherr U, Kalden JR, Burmester GR. Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis. Arthritis Rheum. 1993 Nov;36(11):1621-6.
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  14. Hunfeld KP, Ruzic-Sabljic E, Norris DE, Kraiczy P, and Strle F. In vitro susceptibility testing of Borrelia burgdorferi sensu lato isolates cultured from patients with erythema migrans before and after antimicrobial chemotherapy. Antimicro Agents Chemother 2005; 49: 1294-1301.
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  1. Karch H, Huppertz HI. Repeated detection of Borrelia burgdorferi DNA in synovial fluid of a child with Lyme arthritis. Rheumatol Int. 1993;12(6):227-9.
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