In a 2021 autopsy of a 69 year old woman, Borrelia burgdorferi was found 15 years after initial antibiotic treatment.

The Patient’s Case

At age 54, the patient contracted Lyme disease. She developed a tell-tale erythema migrans rash and tested positive via antibody testing. Ten days of doxycycline resolved her symptoms in the short term.

Two years later, she developed REM sleep behavior disorder. Four years after that, she developed cognitive problems that worsened over time. An MRI of her brain showed mild atrophy and white matter hyperintensities (lesions), and brain SPECT scans showed decreased perfusion (flow of blood and other fluid) in parts of the brain. Neurocognitive testing suggested neurodegeneration.

She tested positive for Lyme again via Western Blot, with 9 out of 10 bands. She was treated at age 60 with intravenous ceftriaxone for 8 weeks, which led to a 60% improvement in her neurocognitive symptoms. She was given amoxicillin for 6 months after but began to decline again, and subsequent treatment with minocycline yielded no benefit. Her cognition deteriorated further, and she continued to test positive for Lyme via Western Blot.

Her further deterioration was unsurprising, as doxycycline, ceftriaxone, amoxicillin, and minocycline are ineffective against B. burgdorferi persister cells (biofilms and round bodies), as shown here.

A second MRI of her brain showed more hyperintensities (lesions) possibly due to “small vessel ischemia or demyelinating disorders like Lyme disease,” and a PET scan showed other findings consistent with Alzheimer’s disease. She was diagnosed with neurodegenerative dementia, and her symptoms favored a clinical diagnosis of dementia with Lewy bodies.

The autopsy backed up the clinical findings, finding dementia with Lewy bodies accompanied by features of Alzheimer’s disease. The amygdala (part of the brain) and spinal cord were PCR positive for B. burgdorferi DNA, and an intact B. burgdorferi spirochete was found in tissue of the spinal cord.

Potential Link Between Borrelia burgdorferi and Neurodegenerative Diseases

The authors of the study cautioned that the autopsy results don’t clarify whether or not Borrelia had anything to do with her neurodegenerative disorder, though past studies suggest it’s a possibility.

Multiple studies have found spirochetal infections to be associated with neurodegenerative syndromes (study one, two, three), including B. burgdorferi (study one, two, three, four–the latter two dating back to the eighties).

Amyloid plaques are protein deposits mainly found in the brain; when occurring in large numbers, they are a characteristic of Alzheimer’s disease. A 2010 study found that amyloid plaques may help combat microbial infection, and others have found that Borrelia can induce amyloid production, suggesting a possible cause of Alzheimer’s (one, two, three).

The patient’s initial positive response to the IV ceftriaxone suggests a microbial infection was being treated, or that inflammation was dampened. Her decline after stopping ceftriaxone suggests either:

  1. the presence of persister cells (antibiotic resistant) of Borrelia (biofilms and round bodies)
  2. a neurodegenerative process had been triggered prior to infection
  3. an unrelated neurodegenerative disorder was present at the time B. burgdorferi infected the central nervous system

Though it was unclear whether or not Lyme was responsible for her neurodegenerative disease, in a 2018 case review three Lyme patients had their dementia completely reversed by 2-4 weeks of intravenous ceftriaxone, and at the time the study had been released, they had remained asymptomatic of both Lyme and dementia for 5-7 years.

The authors of the autopsy study felt the methodologies they used for detecting Borrelia were a major improvement over existing ones, and that they should strengthen results in future studies directed at determining whether or not a link exists between B. burgdorferi and Lewy Body Dementia. They also felt that given the difficulty in recovering spirochetes from living people after antibiotic treatment–despite symptoms and B. burgdorferi DNA persisting–having reliable methods of detecting persistent organisms in post-mortem tissue would go a long way towards finally resolving the long standing question of persistence.

Key takeaways:

  • Despite multiple courses of antibiotic treatment, Lyme spirochetes and DNA were found in the brain and spinal fluid of a patient with dementia during autopsy.
  • It was unclear from the autopsy whether Lyme caused the patient’s dementia. However, past studies suggest it’s a possibility.
  • In a 2018 study, three patients had their dementia completely reversed by 2-4 weeks of intravenous ceftriaxone. At the time of the study’s release, they had remained asymptomatic of Lyme and dementia for 5-7 years.
  • The authors of the autopsy felt that the methods they used to detect Lyme during the autopsy were a major improvement over existing ones, and believed they will help to determine the link between Lyme and dementia.
  • Furthermore, the authors believed that when used in autopsies, these new methods may help settle the debate within the medical community of whether or not Lyme persists.