Concurrent infection of human brain with multiple species of Lyme disease spirochetes

Lyme disease (LD) spirochetes are well known to be able to disseminate into the tissues of infected hosts, including humans. The diverse strategies used by spirochetes to avoid the host immune system and persist in the host include active immune suppression, induction of immune tolerance, phase and antigenic variation, intracellular seclusion, and, importantly, incursion into immune privileged sites such as the brain. Invasion of immune privileged sites, like the brain allows the spirochetes not only escape from the host immune system but also can reduce the efficacy of antibiotic therapy. Here we present a case of the detection of DNA of spirochetes from Borrelia burgdorferi sensu lato complex from multiple loci of LD patients post-mortem brain. The presence of co-infection with Borrelia burgdorferi sensu stricto and Borrelia garinii in LD patients brain was confirmed by PCR. The presence of atypical spirochete morphology was confirmed by immunohistochemistry of the brain samples and also in tissues of experimental mice, infected with Borrelia by simultaneous injection of spirochetes subcutaneously and intraperitoneally. Even though both spirochete species were simultaneously present in brain, the brain regions where the two species were detected were different and non-overlapping.