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Protocol Details

Searching for Persistence of Infection in Lyme Disease

This study is currently recruiting participants.

Summary | Eligibility | Citations | Contacts

Summary

Number

10-I-0139

Sponsoring Institute

National Institute of Allergy and Infectious Diseases (NIAID)

Recruitment Detail

Type: Participants currently recruited/enrolled
Gender: Male & Female
Min Age: 18
Max Age: 99

Referral Letter Required

No

Population Exclusion(s)

Children

Special Instructions

Currently Not Provided

Keywords

Borrelia Burgdorferi;
Xenodiagnosis;
Ticks;
Skin Biopsy

Recruitment Keyword(s)

Lyme Disease

Condition(s)

Lyme Disease;
Borrelia Burgdorferi

Investigational Drug(s)

None

Investigational Device(s)

Lyme Disease Xenodiagnosis

Intervention(s)

Procedure/Surgery: Skin Biopsy
Device: Xenodiagnosis
Procedure/Surgery: Blood Drawing

Supporting Site

National Institute of Allergy and Infectious Diseases

Background:

Lyme disease is an infection caused by Borrelia burgdorferi, a bacteria that is transmitted to humans by ticks. It can cause many different symptoms including rash, fever, headache, meningitis (infection of the central nervous system), and arthritis. While most patients improve after taking antibiotics, some patients continue to have symptoms. It is currently unknown why some patients continue to have symptoms. One possibility is that the antibiotics have not successfully gotten rid of all of the bacteria. Current tests for Lyme disease cannot tell whether the bacteria have been successfully eliminated from the body.

Xenodiagnosis is a way to look for Borrelia bacteria using the animal that usually hosts them, Ixodes scapularis (also known as the deer tick). This method takes advantage of the evolution of the bacteria and the insect that transmits the infection, which can make the insect particularly good at finding the agent. In studies of animals, xenodiagnosis may be more sensitive than current tests for detecting the presence of the Lyme disease bacteria. Researchers are interested in using xenodiagnosis to determine whether uninfected ticks that feed on humans who have been infected with Lyme disease bacteria can detect the continued presence of live bacteria.

Objectives:

- To determine whether xenodiagnosis can be used to successfully investigate the presence of Lyme disease bacteria.

Eligibility:

1. Individuals at least 18 years of age who are in one of the following categories:

2. Have had the erythema migrans rash (a symptom of Lyme infection) and received antibiotic therapy less than 4 months ago (but have not had antibiotics in the previous month).

3. Have the erythema migrans rash and received less than 2 days of antibiotic therapy.

4. Have been diagnosed with early or late Lyme disease, have received antibiotic therapy, but still have high levels of antibodies against the bacteria at least 6 months after therapy, and have not received antibiotics in the past 3 months.

5. Have been diagnosed with early or late Lyme disease, have received antibiotic therapy, and have new complaints of fatigue or other symptoms that are persistent for at least 6 months after completion of antibiotic therapy, and have not received antibiotics in the past 3 months.

6. Have been diagnosed with Lyme arthritis and have not yet received antibiotic therapy.

7. Healthy volunteers who have not had Lyme disease will also be included in this study.

Design:

- Participants will have an initial visit for a physical examination, medical history, and blood sample.

- For the first study visit, researchers will place a strip of filter paper or a small plastic container with 20 to 30 disease-free ticks on the participant s skin. If possible, the ticks will be placed at the site of a Lyme disease rash or another suspicious area, or on the nondominant forearm. Participants will be asked to keep the ticks in place, and will keep a diary card at home to record any symptoms or problems.

- The ticks will be collected 4 to 6 days after placement. At that visit, participants will have a skin biopsy taken of the area tested, a blood sample will be collected, and participants will receive a new diary card to keep until the next clinic visit.

- After 1 month, participants will provide a final blood sample, and will receive a follow-up phone call 2 months afterward.

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Eligibility

INCLUSION CRITERIA:

Criteria for the diagnosis of Lyme disease can be found at The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America (4).

1. Patients With EM (N=35), Post Treatment

-Age 18 or older

- EM diagnosed by the study physician or, with a diagnosis of EM that is thought to be highly likely by the study physician.

-Treatment with at least 1 course of antibiotics that fulfills the Infectious Diseases Society of America guidelines for the recommended therapy for Lyme disease. There must be at least 1 month and up to 4 months between the end of the therapy and the study procedures.

2. High C6 Antibody Titer (N=35)

-Age 18 or older

-Diagnosed with confirmed or probable early or late Lyme disease as per Centers for Disease Control and Prevention (CDC) case definition (http://www.cdc.gov/ncphi/disss.nndss/caseded/lyme disease 2008.htm), have received recommended antibiotic therapy and have a high C6 ELISA titer (index above 3) at least 6 months after therapy.

3. Post Lyme disease syndrome (N=20)

-Age 18 or older

-Diagnosed with confirmed or probable early or late Lyme disease fulfilling the case definition of Lyme disease by the CDC (http://www.cdc.gov/ncphi/disss.nndss/caseded/lyme disease 2008.htm)

-Received recommended antibiotic therapy, with resolution or stabilization of the objective manifestation(s) of Lyme disease.

-New complaints of fatigue, paresthesias or dysesthesias, widespread musculoskeletal pain or cognitive difficulties within 6 months of the diagnosis of Lyme disease

-Symptoms are persistent or relapsing for at least a 6-month period after completion of antibiotic therapy, causing reduction in previous levels of occupational, educational, social, or personal activities.

-No antibiotic therapy active against Lyme disease in the previous 3 months.

4. Patients With EM (N=20), On Treatment

-Age 18 or older

-EM diagnosed by the study physician and receiving antibiotic therapy for less than 48 hours.

5. Lyme Arthritis (N=10)

-Age 18 or older

-Lyme arthritis and have not received therapy.

6. Healthy Volunteers (N=30)

-Age 18 or older

-No history of Lyme disease

-Negative whole-cell Borrelia ELISA or C6 ELISA

-Living in an endemic area for Lyme disease.

EXCLUSION CRITERIA:

-History of allergy to surgical tape or Nitex nylon mesh

-History of severe reactions to tick bites (granuloma or systemic reactions)

-Inability to maintain the dressing for any reason

-Currently receiving any antibiotic or having received antibiotics in the last month (3 months for patients with post Lyme disease syndrome and high C6 titer) (except patients with EM on treatment)

-Pregnancy or lactation

-Unwillingness to use an effective method of birth control for 3 months after tick placement (women of child-bearing potential only)

-Not able to understand all of the requirements of the study or unable to give informed consent and/or comply with all aspects of the evaluation.

-Investigational therapy during the time of the study and/or in the month prior to signing the informed consent.

-Active severe skin disease, uncontrolled diabetes, cancer other than non-melanoma skin cancers, autoimmune disease requiring immunosuppressive therapy, or history of HIV, chronic viral hepatitis, or syphilis.

-Oral steroids in the previous 2 weeks (nasal steroids and replacement doses of steroids are not exclusions)

-Any other condition that, in the opinion of the investigator, would make the patient unsuitable for enrollment or could interfere with the patient participating in and completing the study.

EXCLUSION FROM SKIN BIOPSY PART OF THE PROTOCOL:

-History of forming large thick scars after skin injuries or surgery

-History of excessive bleeding after cuts or procedures

-Currently taking anticoagulants

-History of allergy to lidocaine

-Biopsies will not be done on face, neck, scalp, or over the tibia


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Citations:

Bockenstedt LK, Mao J, Hodzic E, Barthold SW, Fish D. Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment. J Infect Dis. 2002 Nov 15;186(10):1430-7. Epub 2002 Oct 23.

Hodzic E, Feng S, Holden K, Freet KJ, Barthold SW. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrob Agents Chemother. 2008 May;52(5):1728-36. Epub 2008 Mar 3.

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Contacts:

Principal Investigator

Referral Contact

For more information:

Adriana R. Marques, M.D.
National Institute of Allergy and Infectious Diseases (NIAID)
BG 10 RM 12C118
10 CENTER DR
BETHESDA MD 20814
(301) 435-7244
amarques@niaid.nih.gov

Adriana R. Marques, M.D.
National Institute of Allergy and Infectious Diseases (NIAID)
BG 10 RM 12C118
10 CENTER DR
BETHESDA MD 20814
(301) 435-7244
amarques@niaid.nih.gov

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

prpl@mail.cc.nih.gov

Clinical Trials Number:

NCT01143558

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