Bacteriology
Studies that report unexpected positive blood cultures for Lyme borrelia – are they valid?

https://doi.org/10.1016/j.diagmicrobio.2017.07.009Get rights and content

Highlights

  • Positive blood cultures have been documented in untreated early Lyme disease.

  • Studies that reported positive blood cultures later in infection were reviewed.

  • Critical evaluation of three such reports raises concerns over their validity.

  • Low biologic plausibility increases the need for a high level of scientific rigor.

Abstract

Positive blood cultures for Lyme borrelia have been well documented in untreated patients with early Lyme disease. In this report we review the validity of three studies that reported the recovery of Borrelia burgdorferi sensu lato from the blood of a high proportion of patients for whom no evidence was presented, and no claim was made, that the patients had untreated early Lyme disease. In two of the studies the patients had been treated extensively with antibiotics for Lyme disease before the cultures were obtained. Critical evaluation of the three reports suggests that they are invalid. Indeed, two subsequently published studies could not reproduce the results of one of the reports. In a published analysis of another of the reports, investigators from the Centers for Disease Control and Prevention concluded that the cultures were likely to have been contaminated. When the biologic plausibility of recovering borrelia from blood is extremely low, the level of scientific rigor required of a study that claims a positive result should be particularly high.

Section snippets

Funding

This publication was made possible in part by support from CTSA Grant Number UL1 TR001863 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH), to EDS. The work was also supported by the Slovenian Research Agency (grant number P3–0296, given to FS). The findings and conclusions of this paper are those of the authors and do not necessarily represent the official position of the NIH.

Disclosures

Dr. Wormser reports receiving research grants from Immunetics, Inc., Institute for Systems Biology, Rarecyte, Inc., and Quidel Corporation. He owns equity in Abbott; has been an expert witness in malpractice cases involving Lyme disease; and is an unpaid board member of the American Lyme Disease Foundation. Dr. Shapiro has received royalty payments from UptoDate; has been an expert witness in malpractice cases involving Lyme disease; and is an unpaid board member of the American Lyme Disease

Acknowledgments

The authors thank Dr. Barbara Johnson, Julia Singer, Sophia Less, Artemio Zavala and Lisa Giarratano for their assistance.

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