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How Lyme Hides


By Karen Lee Richards*

One of the reasons Lyme disease can be so difficult to diagnose and treat is that the Borrelia burgdorferi spirochete is a master of disguise. From the moment of the tick bite or other transmission, the bacteria begin their cloak and dagger game of evasion, shape-shifting, hiding and when all else fails, subverting the body’s immune system response. Following are some of the Lyme spirochete’s best and most subversive tactics.


Sneak Attack

When a tick carrying Borrelia punctures the skin, immune modulators in the tick’s saliva coat the spirochete, effectively hiding it from the host’s immune system. It may take several weeks before the immune system recognizes the bacteria and begins producing antibodies. This is why so often antibody tests like the ELISA and the Western blot will be negative if they’re utilized too soon after a tick bite.

While clinical trials most often compare a specific intervention to either a placebo or usual care, sometimes they may compare a new medical approach to a standard one that is already available.


Normally when a pathogen invades the human body, the immune system detects it by its cell-wall proteins and develops antibodies to attack it. However, when the Borrelia spirochete enters the body, it begins changing its form by altering its outer cell wall proteins so the immune system doesn’t recognize it. Essentially it dons a disguise, allowing it to hide in plain sight.

One of the most insidious things about the spirochete’s shape-shifting ability is that each time it alters its appearance by changing its outer cell wall proteins, the immune system launches an attack. But because the spirochete has once again changed, it is not affected. Unfortunately, the toxic compounds the immune system releases in its effort to kill the invader end up causing damaging inflammation throughout the body.

Another unique disguise was revealed in 2013 when scientists confirmed that the Borrelia bacterium – unlike any other known organism – can exist without iron, a metal that all other life needs to make proteins and enzymes. Instead of iron, the bacteria substitute manganese to make an essential enzyme, thus eluding immune system defenses that protect the body by starving pathogens of iron. These studies open the door to search for new therapies to thwart the bacterium by targeting manganese.

Suspended Animation

The Lyme spirochete can exist in the human body for years in a non-metabolic state. This is basically a state of suspended animation. Spirochetes that are not metabolizing cannot absorb antibiotics, therefore, any antibiotic treatment given at this time will not be effective. This may help explain why sometimes Lyme patients who are in remission will suddenly have a relapse. When conditions are right, the spirochetes once again become active and begin to metabolize.

Lyme Hideouts

Borrelia bacteria have developed some unusual hideouts in the human body. A presentation by Dr. Mark Klempner at the 1996 LDF International Lyme Conference showed that the Lyme spirochete is able to enter and hide in human fibroblast cells – the skin cells that make scar tissue. There they are protected from the immune system and are able to thrive.

A 2011 study conducted at the UC Davis Center for Comparative Medicine discovered for the first time that Borrelia spirochetes have developed an even more novel strategy – they hide out in lymph nodes. It seems counter intuitive that bacteria should migrate to the one place where they would automatically trigger an immune response. But apparently the spirochetes have found a way to elude the body’s immune response.

The researchers found that when mice were infected with Borrelia, the live spirochetes accumulated in the animals’ lymph nodes. The lymph nodes responded, as would be expected, with a strong, rapid accumulation of B-cells – the white blood cells that produce antibodies to fight infections. At the same time, however, the Borrelia also caused the destruction of the distinct architecture of the lymph node that usually helps it to function normally. So while B-cells accumulated in large numbers and made some specific antibodies against Borrelia, they did not form “germinal centers” – structures that are needed for the generation of a highly functional and long-lived antibody response.

Biofilms – Lyme’s Coat of Armor

One of the newer discoveries related to how Lyme disease manages to hide and evade both the body’s immune system and antibiotic therapy is biofilms. Pathologist and biofilms expert Dr. Alan MacDonald describes biofilms as, “…fortress-like communities which are from inception designed to survive all manner of attack, including high-dose, long-term antibiotic therapies…”

A biofilm is a slimy, glue-like substance made up of bacteria and other micro-organisms whose cells stick to each other on a surface – in this case, the Borrelia spirochete – to form what is essentially a coat of armor. Hiding under the biofilm, the spirochete is protected from attack by antibiotics and can remain dormant for long periods of time, only to emerge and launch another attack when the environment is more favorable.

* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses.  After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.


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Last Updated: 5/1/15

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