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Clinical Review State of the Art Review

Lyme borreliosis: diagnosis and management

BMJ 2020; 369 doi: (Published 26 May 2020) Cite this as: BMJ 2020;369:m1041

Rapid Response:

Re: Lyme borreliosis: diagnosis and management

Dear Editor

In reference to the following excerpt from the Kullberg paper:

“The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment.”

As a Professor of Infectious Diseases, Jan Kullberg should be well aware of the following:

Untreated streptococcal pharyngitis can progress to rheumatic fever, causing irreversible heart damage. Untreated syphilis leads to progressive disability and dementia, and untreated human immunodeficiency virus infection progresses to AIDS with significant disability and death. So what happens to a patient with Lyme disease who goes months, years, or decades before diagnosis because of a false-negative serological test result, missing bulls-eye rash, misdiagnosis etc., etc.?

The fixation on the acute stage of infection after early treatment has long been established by the academics here in the United States who have controlled the narrative for the past thirty years. Purposely avoiding the Lyme patient who missed the narrow window of opportunity for successful short-term treatment and advances to the late debilitating stage hides the horribly disabled. [i]

It should be noted that those who have controlled the Lyme disease narrative are all defendants of a racketeering lawsuit in Texas district court. The defendants include the Infectious Diseases Society of America and eight insurance companies all denying persistent infection after extensive antibiotic treatment. Academics across the globe have been blindly following what has been established here in the U.S.

Lisa Torrey vs. IDSA Court Document (personal Dropbox storage area)

In reference to “persistent infection after extensive antibiotic treatment,” an astute fifth grader with access to PubMed could find the following short list of publications: (there are actually hundreds) [ii]

I would like to call attention to the following 1995 study from Stony Brook Lyme clinic. I understand the patient received thirteen spinal taps, multiple courses of IV and oral meds, and relapsed after each one, proven by CSF antigens and/or PCR. The only way this patient (said to be a physician) remained in remission was to keep her on open ended clarithromycin- was on it for 22 months by the time of publication.

1. Seronegative Chronic Relapsing Neuroborreliosis.

Lawrence C.a · Lipton R.B.b · Lowy F.D.c · Coyle P.K.d

aDepartment of Medicine, bDepartment of Neurology, and cDivision of Infectious Diseases, Albert Einstein College of Medicine, and dDepartment of Neurology, State University of New York at Stony Brook, New York, NY., USA

Eur Neurol 1995; 35:113–117 (DOI:10.1159/000117104)


We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.

Let’s review another early publication where persistent infection was recognized:

May 13, 1988

2. Fatal Adult Respiratory Distress Syndrome in a Patient With Lyme Disease
Michael Kirsch, MD; Frederick L. Ruben, MD; Allen C. Steere, MD; et al

JAMA. 1988;259(18):2737-2739. doi:10.1001/jama.1988.03720180063034


A dry cough, fever, generalized maculopapular rash, and myositis developed in a 67-year-old woman; she also had markedly abnormal liver function test results. Serologic tests proved that she had an infection of recent onset with Borrelia burgdorferi, the agent that causes Lyme disease. During a two-month course of illness, her condition remained refractory to treatment with antibiotics, salicylates, and steroids. Ultimately, fatal adult respiratory distress syndrome developed; this was believed to be secondary to Lyme disease.

3. Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report

The patient had active, systemic Borrelia burgdorferi infection and consequent Lyme hepatitis, despite antibiotic therapy. Spirochetes were identified as Borrelia burgdorferi by molecular testing with specific DNA probes.

4. Culture evidence of Lyme disease in antibiotic treated patients living in the Southeast.

Rudenko and colleagues reported culture confirmation of chronic Lyme disease in 24 patients in North Carolina, Florida, and Georgia. All had undergone previous antibiotic treatment

5. DNA sequencing diagnosis of off-season spirochetemia with low bacterial density in Borrelia burgdorferi and Borrelia miyamotoi infections.

Faulty/misleading antibody tests landed a sixteen year old male in a psychiatric ward when his lab results did not meet the CDC’s strict criteria for positive results. His Western blot had only four of the required five IgG bands. Subsequent DNA sequencing identified a spirochetemia in this patient’s blood so his psychiatric issues were a result of neurologic Lyme disease misdiagnosed by antiquated/misleading serology. This patient was previously treated with antibiotics.

6. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics. We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy.

7. Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease

“This pilot study recently identified chronic Lyme disease in twelve patients from Canada. All of these patients were culture positive for infection (genital secretions, skin and blood) even after multiple years on antibiotics so there was no relief from current antimicrobials. Some of these patients had taken as many as eleven different types of antibiotics.”

Persistent infection after extensive antibiotic treatment has been identified through the use of direct detection methods in academic centers and autopsy findings yet the average patient cannot obtain these tests to justify how sick they are with their chronic active infection. Serology cannot be used to gauge treatment failure or success which makes it the ideal tool for concealing persistent infection.

Serology has allowed the 30-year dogma to persevere [iii] whereas direct detection methods are exposing the exact opposite.

We are dealing with a life-altering/life-threatening infection with faulty/misleading antibody tests, inadequate treatment, no medical training and absolutely no disease control whatsoever; a public health disaster. And what was the reason for the mishandling of this coexisting pandemic you might ask?

A chronic relapsing seronegative disease does not fit the vaccine model. The rush to create a vaccine here in the United States promoted the denial of persistent infection and focusing on the acute stage of disease hides the horribly disabled.

Questions: Is there a reason why Prof Kullberg did not include my seven references of persistent infection in his BMJ article?

Respectfully Submitted,

Carl Tuttle

Hudson, NH USA

My letters to the editor have been published in JAMA, The Lancet Infectious Diseases, Arthritis & Rheumatology, and the BMJ.


[i] Under our Skin 5min extended trailer

[ii] 700 articles LYME Evidence of Persistence (personal Dropbox storage area)

[iii] Lyme Disease Is Hard to Catch And Easy to Halt, Study Finds
New York Times By GINA KOLATA Published: June 13, 2001

Competing interests: No competing interests

10 June 2020
Carl W Tuttle
Hudson, New Hampshire, USA