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second and third questions, we need to consider the exist. Thus, their management has to be assessed
basic principles of pathogenesis and pathophysiology. according to the best medical practice.

Postinfectious autoimmunity vs. persistent spirochetal CONCLUSION
infection still represents an open question. The
hypothesis is that PTLDS may be a result of chronic Nowadays, there are valid reasons to opt for long‑term
Borrelia burgdorferi infection in combination with other antibiotic therapy. However, it is critical to focus on
tick‑borne coinfections, and the mechanisms of “stealth the well‑designed clinical trials in order to evaluate
pathology” utilized by the Lyme spirochete in evading if a therapeutic intervention has an actual, beneficial
the host immune response establishing infection in effect in contrast to a resolution of symptoms which
diverse both have been reported. [19‑21] Additionally, it might spontaneously occur over time. The need for
has been suggested that borrelia wall‑deficient forms additional research to determine safe and effective
and biofilm formation may play a role in chronic treatments must be widely recognized by the scientific
infection. [19] Biofilms are polysaccharide‑based community to resolve this long controversy.
structures which protect bacteria and thus promote Acknowledgments
persistence while their contribution to chronic The authors are grateful to Mrs. Alexandra Bitzas for
infection pathogenesis is yet to be evaluated. Further the language improvement.
studies on the underlying mechanism in the biofilm
process would potentially facilitate the development Financial support and sponsorship
of antibiotics that may counteract this phenomenon. [19] Nil.
While clinical testing for Lyme disease remains
critical, the use of proteomics and more novel tests Conflicts of interest
are necessary. [19‑21] Recently, a human study focusing There are no conflicts of interest.
on Xenodiagnosis to detect Borrelia burgdorferi
infection has been published showing promising REFERENCES
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12 Neuroimmunol Neuroinfammation | Volume 3 | Issue 1 | January 20, 2016