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Reinfection versus relapse in Lyme disease.

To the Editor: Nadelman et al. (Nov. 15 issue)1 report that patients may be reinfected with different genotypes of Borrelia burgdorferi. Their observations, however, do not provide evidence that patients with continuing symptoms (i.e., patients with what is often termed chronic Lyme disease or post–Lyme disease syndrome) are not persistently infected. Although bacteria may be cultured from initial and subsequent erythema migrans rashes, it cannot currently be determined whether such patients are or are not infected. The results of recent studies involving macaque monkeys2 show that viable organisms can be recovered months after “standard” treatments. In the corresponding editorial, the comment by Steere3 that patients with persisting symptoms no longer have a response to further antibiotic therapy is misleading, since that conclusion is based primarily on a single trial that used an unsuccessful antibiotic regimen.4 As I mentioned in a letter about that trial,5 it did not address possible reasons for the unsuccessful outcome, and there are probable pharmacologic reasons for the failure of the trial. Alternative successful regimens exist.6 It would be helpful if there was support to conduct additional controlled treatment trials, but there has been no such support thus far.