Instructor

Monica E. Embers, PhD
Associate Professor in the Division of Immunology
Director of Vector-borne Disease Research
Tulane National Primate Research Center

Description

This module presents human Lyme disease as a systemic infection with inflammatory pathology. The recommended treatment by two medical associations is covered, with an overview of antibiotic efficacy and a description of antibiotic tolerant-persisters. Findings from nonhuman primate studies are presented, as well as treatment goals and new strategies for eradication of the Lyme disease pathogen.

Learning objectives

  1. To review the treatment guidelines for Lyme disease (IDSA and ILADS)
  2. To define and describe antibiotic tolerance vs. antibiotic resistance
  3. To highlight key studies on antibiotic efficacy
  4. To consider new strategies aimed at curing the infection

Accreditation Statement

This session, Antibiotic efficacy for treatment of Lyme disease, is approved for 0.5 enduring AAFP Prescribed credits.

The AAFP has reviewed One Health Medical Education for a Changing Climate, and deemed it acceptable for AAFP credit. Term of approval is from 01/01/2025 to 12/31/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.


Evidence-based bibliography for further study

  • Bockenstedt, L., et al. (2002). “Detection of Attenuated, Noninfectious Spirochetes in Borrelia burgdorferi-Infected Mice after Antibiotic Treatment.” The Journal of Infectious Diseases 186(10): 1430-1437.
  • Hodzic, E., et al. (2008). “Persistence of Borrelia burgdorferi following antibiotic treatment in mice.” Antimicrobial Agents & Chemotherapy 52(5): 1728-1736.
  • Barthold, S. W., et al. (2010). “Ineffectiveness of tigecycline against persistent Borrelia burgdorferi.” Antimicrobial Agents & Chemotherapy 54(2): 643-651.
  • Embers, M. E., et al. (2012). “Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.” PLoS ONE 7(1): e29914.
  • Bockenstedt, L. K., et al. (2012). “Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy.” The Journal of Clinical Investigation 122(7): 2652-2660.
  • Hodzic, E., et al. (2014). “Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice.” PLoS ONE 9(1): e86907.
  • Wormser, G. P., et al. (2012). “Critical analysis of treatment trials of rhesus macaques infected with Borrelia burgdorferi reveals important flaws in experimental design.” Vector Borne Zoonotic Dis 12(7): 535-538.
  • Wormser, G., et al. (2000). “Practice Guidelines for the Treatment of Lyme Disease.” Clinical Infectious Diseases 31(s1): 1-14.
  • Shor S, Green C, Szantyr B, Phillips S, Liegner K, Burrascano JJ Jr, Bransfield R, Maloney EL. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel). 2019 Dec 16;8(4):269. doi: 10.3390/antibiotics8040269. PMID: 31888310; PMCID: PMC6963229.
  • Embers, M. E., et al. (2017). “Variable manifestations, diverse seroreactivity and post-treatment persistence in non-human primates exposed to Borrelia burgdorferi by tick feeding.” PLoS ONE 12(12): e0189071.
  • Crossland, N. A., et al. (2018). “Late Disseminated Lyme Disease: Associated Pathology and Spirochete Persistence Posttreatment in Rhesus Macaques.” The American Journal of Pathology 188(3): 672-682.








Monica E. Embers, PhD

About the Instructor

Monica Embers, PhD

Director of Vector-borne Disease Research, Tulane National Primate Research Center

Dr. Embers is currently an Associate Professor in the Division of Immunology and the Director of Vector-borne Disease Research at the Tulane National Primate Research Center. Her research program regarding Lyme disease and its infectious cause Borrelia burgdorferi specializes in animal models. The research is centered around three major efforts: (1) identifying treatments that can eradicate B. burgdorferi infection; (2) detection of persistent Lyme disease spirochetes in human (autopsy) tissues; and (3) immunodiagnosis for B. burgdorferi infection and cure. By transmitting Lyme disease to mice and nonhuman primates by tick, and studying the natural course of infection, her group aims to attain a better understanding of the clinical quandaries of human Lyme disease, including effective diagnosis and treatment. Due to the many similarities between Bartonellosis and Lyme disease, her team has begun to develop research models for Bartonella infection. The goals of Bartonella research involve developing improved treatment strategies, understanding the pathophysiology of co-infection, and interrogating tick vector transmission of these pathogens.