Abstract
In mouse models, it has been demonstrated that infection with Borrelia burgdorferi may cause temporary immunosuppression and thus result in the lack of serum IgG responses (Elsner et al. 2015a). Moreover, studies pointed to specific deficits in the T-dependent B cell responses against B. burgdorferi (Elsner et al. 2015b). The long-term presence of IgM antibodies in humans and the reliability of the serological testing, however, needs to be questioned and discussed in each patient, as the IgM detection was observed to persist for 10–20 years in healthy individuals (Steere et al. 2016). It is of extreme importance to distinguish untreated patients with Lyme disease and patients who were already adequately treated but remained serologically positive. Untreated Lyme disease patients are at high risk of developing persistent pathological changes, such as arthritis or neurological disease (Rebman and Aucott 2020). In these patients, the serological positivity is accompanied by objective clinical findings, such as joint inflammation, joint swelling, or cognitive deficiency (Rebman and Aucott 2020). Moreover, B. burgdorferi can also be PCR-detected in the synovial fluid and/or the patients may display pathology in cerebrospinal fluid analysis or brain imaging (Rebman and Aucott 2020; Strizova et al. 2020). The untreated patients include patients with missed B. burgdorferi diagnosis, but also patients who obtained inadequate antibiotic treatment, that is, inappropriate choice, wrong dosage, insufficient duration, or inappropriate route of application (Nemeth et al. 2016).
In patients receiving appropriate antibiotic treatment, there is so far no convincing scientific evidence of pathogen persistence or chronicity of Lyme disease (Feder et al. 2007; Halperin 2014; Nemeth et al. 2016). We agree that untreated Lyme disease with the presence of IgM antibodies is a significant threat. However, in our previous report, we aimed to highlight that the antibiotic treatment in healthy individuals with IgM positivity against B. burgdorferi or in patients with post-treatment Lyme disease syndrome may be as dangerous as untreated Lyme disease. To date, there are already many reports on deaths and severe damages in patients who had no evidence of Lyme disease. These patients were treated with antibiotics because of the serological positivity against B. burgdorferi and nonspecific objectively unverified symptoms. In patients who died, either an underlying undiagnosed condition or a severe complication of long-term antibiotic treatment was confirmed by postmortem examination (Patel et al. 2000, Strizova et al. 2019, Goodlet and Fairman 2018). Therefore, a serology should not represent the primary or even a stand-alone diagnostic tool to justify the adequacy of antibiotic therapy (Nemeth et al. 2016; Steere et al. 2016; Strizova et al. 2020).