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It seems that Lyme disease infection (borreliosis) can persist despite antibiotic treatment in early stages.

Is there any definite proof of this in medical literature? If there is, why is Post-Treatment Lyme Disease Syndrome still considered a thing?

Alfonso Embid-Desmet
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The answer is "of course," but one must be careful about defining terms.

Certainly the infection can persist for years in untreated patients. That qualifies as "chronic." There is no question that chronic Lyme disease exists as part of the natural history of Lyme disease.

If you're asking whether the infectious agent can persist after what is normally a curative dose of antibiotics, the answer is also "of course." A "normally curative dose" isn't going to be the right dose for everyone. Some people will need more, or some people will have infection in an immunologically privileged area of their body. It only takes one failure of the normally curative dose to make the answer to this scenario "yes," so certainly that has happened at some point. How often is another question entirely.

If you are asking whether ill effects of the initial infection can persist after treatment eradicates the organism, the answer is still yes. Many infections continue to exert ill effects after eradication of the infectious agent because they have incited an autoimmune response from the body. Antibiotics don't help autoimmune disorders. But again, the right question is: how often does this happen?

If you're asking whether people who get normally curative doses of antibiotics can continue to have wacky symptoms with no trace of the infectious agent nor objectively demonstrable pathology -- well, the answer is again "of course," but ... it is not (and cannot) be proven that their symptoms are due to the Lyme infection because, as noted, there is no objectively demonstrable pathology. Maybe they were going to get those symptoms anyway. Maybe their symptoms of physical illness are really symptoms of a mental illness. There is also a big problem around the term "objectively demonstrable" -- it depends on how thoroughly the search is made.

Ask a simple question, get a complicated answer. :-)

For people who want to read more:

michaelpri
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Iron Pillow
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    There is some good stuff here, but in order for it to work on this site we ask that you include references to back up what you’re saying. – Susan Apr 27 '15 at 04:26
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    Thanks, but I was interested in knowing what corpse of studies published in peer review medical literature could be considered as proof. As a patient myself, I already know the answer :) – Alfonso Embid-Desmet Apr 27 '15 at 14:28
  • Well proof, or at least "growing evidence" – Alfonso Embid-Desmet Apr 27 '15 at 14:34
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    Hi, Iron Pillow. Nice to have your input! I really liked your answer (as a doc, I thought, as did @Susan, that there is some good stuff there), but I'm retracting my upvote for the following: "I didn't read these articles, so I have no idea if they back me up or not." References are meant to support your answer. How can you possibly use them to support your assertions if you haven't bothered to read them or know what they say? This is a health site. How would you react if you asked a doctor friend a question and he had this cavalier an approach (NB: it's free advice!) – anongoodnurse Apr 28 '15 at 04:29
  • I didn't say I used them to support my assertions. I just said people can read more there. – Iron Pillow Apr 28 '15 at 18:09
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    I agree with @anongoodnurse - a high-quality answer here on Health.SE would be expected to include supporting references. – Nate Barbettini Apr 28 '15 at 21:37
  • What about this: http://www.karger.com/Article/Abstract/117104 – Alfonso Embid-Desmet May 01 '15 at 13:00
  • http://theness.com/neurologicablog/index.php/chronic-lyme-disease/ –  May 02 '15 at 05:08
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    @JohnP -- the statement you cite does not contest my statement. One must always read carefully and pay attention to the definition of terms. Citing references is not a panacea. In fact, I would say that my statements about references are exactly what this site needs. For medical questions, the answers on StackOverflow should NEVER be the end of a question. They should only frame or suggest future research and discussions with physicians. Anyone who reads an answer here and does nothing else is asking for trouble. – Iron Pillow May 04 '15 at 22:03
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    @IronPillow - "Citing references is not a panacea." Agreed. But not citing sources is a poor practice. You state, "Anyone who reads an answer here and does nothing else is asking for trouble." True, but what does this have to do with site policy that references should be added to support answers? I'm confused. You seem to regard good answers as important. Please see this meta post. – anongoodnurse May 04 '15 at 23:14
  • Oh really, Steven Novella in Stack Exchange?, no please. – Alfonso Embid-Desmet May 05 '15 at 01:00
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Does chronic Lyme disease really exist ? Let me rewrite that question: "Does infection with Borrelia species persist in patients treated aggressively with antibiotics? (Treated beyond the IDSA Guidelines)

Yes, just so you know I recently posted well over 100 references supporting this position on my Facebook page Thomas Grier: and here are some to consider: Dr. Judith Miklossey both photographed Borrelia in the brains of dementia patients 20 years ago, but she cultured Borrelia burgdorferi and used that strain to create a Rat Brain Model of Lyme disease.

Alan MacDonald identified both Bb and Borrelia miyamotoi in the brain of a lumberjack from Twig MN who had been treated aggressively with 7 years of antibiotics. Green is B burgdorferi, Red is B miyamotoi enter image description here

Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient with chronic Lyme disease. Amer J Clin Pathol 1989;91:95-7

Cleveland CP, Dennler PS, Durray PH. Recurrence of Lyme disease presenting as a chest wall mass: Borrelia burgdorferi was present despite five months of IV ceftriaxone 2g, and three months of oral cefixime 400 mg BID. Poster presentation LDF International Conference on Lyme Disease research, Stamford, CT, April 1992 *

Diringer MN, Halperin JJ, Dattwyler RJ. Lyme meningoencephalitis: A report of a severe, penicillin resistant Borrelia encephalitis responding to cefotaxime.
Arthritis and Rheum 1987;30:705-708

Drulle John MD. Persisting Lyme disease: Chronic infection or immune phenomena? Lecture Handout 1992 *

Fried Martin D, Durray P. Gastrointestinal Disease in Children with Persistent Lyme Disease: Spirochetes isolated from the G.I. tract despite antibiotic therapy. 1996 LDF Lyme Conference Boston, MA, Abstract*

Fraser DD, Kong LI, & Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyosistis. Clin and Exp Rheum 1992;10:387-390

Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi from ceftriaxone in vitro. J. Infect Dis 1992;166:440-444

Hassler D, Riedel K, Zorn J, and Preac-Mursic V. Pulsed high dosed cefotaxime therapy in refractory Lyme Borreliosis (Letter to Editor) Lancet 1991;338:193

Haupl TH, Krause A, Bittig M. Persistence of Borrelia burgdorferi in chronic Lyme Disease: altered immune regulation or evasion into immunologically privileged sites? Abstract 149 Fifth International Conference on Lyme Borreliosis, Arlington, VA, 1992 *

Haupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schonnherr U, Kalden JR and Burmester GR: Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme Borreliosis. Arthritis and Rheum 1993;36:1621-1626

Lawrence C, Lipton RB, Lowy FD, and Coyle PK. Seronegative Chronic Relapsing Neuroborreliosis. European Neurology. 1995;35(2):113-117

Liegner KB. Lyme Disease: A persistent problem. A Guest editorial JAMA 31(8):1961-63

Liegner KB. Lyme disease: The sensible pursuit of answers (Commentary). J. Clin Microbiol 1993;31:1961-1963

Liegner KB. Spectrum of antibiotic-responsive meningoencephalmyelitides: A fatal case of CMEM. Poster presentation 1992 LDF Lyme Conference, Stamford, CT April 1992 *

Liegner Kenneth B MD. Chronic persistent infection and chronic persistent denial of chronic persistent infection in Lyme Disease. A position paper presented at the 6th Annual International Conference on Lyme Disease and other tick-borne illnesses, Atlantic City, NJ, May 5-6, 1993 *

Preac-Mursic V, Wilske B, Schierz G, et al. Repeated isolation of spirochetes from the cerebrospinal fluid of a patient with meningoradiculitis Bannwarth’ Syndrome. Eur J Clin Microbiol 1984;3:564-565

Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, and Prokop J. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme Borreliosis Infection 1989;17:335-339

Schmidli J, Hunzicker T, Moesli P, et al, Cultivation of Bb from joint fluid three months after treatment of facial palsy due to Lyme Borreliosis. J Infect Dis 1988;158:905-906

Waniek C, Prohocnik I, Haufman MA. Rapid progressive frontal type dementia and subcortical degeneration associated with Lyme disease. Poster presentation and abstract presented at the 1993 LDF State of the Art Research Symposia on Lyme Disease, Stanford, CT, April 1993 (212) 960-5872 - NY State Psychiatric Institute *

Wokke JHJ, vanGijn J, Eldersom A, Stanek G. Chronic forms of Borrelia burgdorferi infection of the central nervous system. Neurology 1987;37:1031-1034

Alfonso Embid-Desmet
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Thomas Grier
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    Good answer but you didn't directly address Post-Treatment Lyme Disease Syndrome which would get my +1 – Atl LED Jan 27 '16 at 15:49
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    The presence of bacteria doesn't equal clinical disease so you didn't actually answer the question. That's a very long list of references without links that I would have to spend the entire evening finding and reading to find out if you actually did answer the question. So as Atl said, it needs work. – Carey Gregory Jan 28 '16 at 01:13