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The persistence of Borrelia burgdorferi in patients treated with antibiotics is described. The diagnosis of
Lyme disease is based on clinical symptoms, epidemiology and specific IgG and IgM antibody titers to B. burgdorferi in serum. Antibiotic therapy may abrogate the antibody response to the infection as shown in our patients. B. burgdorferi may persist as shown by positive culture in MKP-medium; patients may have subclinical or clinical
disease without diagnostic antibody titers to B. burgdorferi. We conclude that early stage of the
disease as well as chronic
Lyme disease with persistence of B. burgdorferi after antibiotic therapy cannot be excluded when the serum is negative for antibodies against B. burgdorferi.