Lyme colitis

I am hoping that case reports of this kind will be written up in the future for publication in medical literature.

I first met this 48 year old female in the spring of 2012. For several years she had a variety of mysterious symptoms but the one of interest here relates to problems with her gastrointestinal system. Because of chronic abdominal and pelvic pain a gynecologist had preformed a laparoscopy looking for pathology and this was normal. She noted changes in her bowel movements complaining of some loose and frothy appearing stools without the presence of blood. A gastroenterologist performed an upper endoscopy, a pill-camera exam of her small bowel and a colonoscopy. All of these tests were normal. Her gastroenterologist was stumped.

She did not recall a prior history of tick bites. She lives in an urban area. Historically, she could not recall significant risk factors for tick exposure except sitting on a blanket at a picnic on one occasion.

Her general practitioner --  paying attention to other symptoms, including fatigue, neurological symptoms and cognitive symptoms ordered a Lyme test:  the two tier standard surveillance test was positive by CDC standards.

Her physical examination was unremarkable except for mild diffuse abdominal tenderness.

Standard laboratory testing, including tick-borne co-infection testing was negative.

I ordered a test which was performed by Clongen Labs which was highly instructive.
At my request, a specimen obtained via colonoscopy from a normal appearing section of colon mucosa was submitted for PCR analysis. The results were positive for Borrelia burdorferi sensu stricto.

She has a complex, multi-system case of Lyme disease and associated co-infections, the details of which will not be discussed.  The gastrointestinal symptoms completely cleared within about 3 months. Other symptoms have been more stubborn but are now much better after 6 months.

I have found similar finding in many other patients. I do not think PCR positive Lyme case reports exist in medical literature.

In some cases there are abnormal findings with colonoscopy usually diagnosed as microscopic colitis and/or collagenous colitis.

Comment:  Most gut flora withstand are intense bombardment with antibiotics because of protective biofilms.  In the case of Lyme colitis is seems likely the spirochete becomes incorporated within some of these poly-microbial biofilms. In nature, most biofilms contain a variety of microorganisms which may include bacteria, fungi and protozoans. Despite innate protection of "good flora," pathogenic bacteria like: shigella, camplobacter, toxigenic E. coli, and C. difficile respond to appropriate antibiotic therapy.

I believe Lyme colitis is a common and generally unrecognized part of multi- system Lyme disease and that further research into this area my provide further evidence of a protected niche which supports persistence of the organism in human hosts.