The impact of immune responses on diagnosis and treatment of Lyme

The Impact of Immune Responses on Diagnosis and Treatment of Lyme Disease

0.5 CME. This module covers a general overview of persistent infection in reservoir and incidental hosts, and immune evasion strategies utilized by the Lyme disease pathogen. Landmark studies on immune suppression by Borrelia are presented. An overview of diagnostic test modalities is discussed, along with recent findings on the variability of antibody responses in humans. Finally, the correlation of treatment success with immune responses is described.

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 covers a general overview of persistent infection in reservoir and incidental hosts, and immune evasion strategies utilized by the Lyme disease pathogen. Landmark studies on immune suppression by Borrelia are presented. An overview of diagnostic test modalities is discussed, along with recent findings on the variability of antibody responses in humans. Finally, the correlation of treatment success with immune responses is described.

Learning objectives

To provide a general overview of immune evasion and suppression by the Lyme disease spirochete
To describe current diagnostic tests and how variable responses to infection affect their accuracy
To review antibiotic treatment mechanisms and new research showing how immune response may affect treatment outcome

Accreditation Statement

This session, The impact of immune responses on diagnosis and 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

Embers, M. E., et al. (2004). “Survival strategies of Borrelia burgdorferi, the etiologic agent of Lyme disease.” Microbes & Infection 6(3): 312-318.
Chung, Y., et al. (2013). “Borrelia burgdorferi elicited-IL-10 suppresses the production of inflammatory mediators, phagocytosis, and expression of co-stimulatory receptors by murine macrophages and/or dendritic cells.” PLoS ONE 8(12): e84980.
Hovius, J. W., et al. (2008). “Salivating for knowledge: potential pharmacological agents in tick saliva.” PLoS Med 5.
Embers, M. E., et al. (2016). “A Five-Antigen Fluorescent Bead-based Assay for Diagnosis of Lyme Disease.” Clinical and Vaccine Immunology.
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.
Elsner, R. A., et al. (2015). “Suppression of Long-Lived Humoral Immunity Following Borrelia burgdorferi Infection.” PLoS Pathog 11(7): e1004976.
Aucott, J. N., et al. (2013). “Development of a foundation for a case definition of post-treatment Lyme disease syndrome.” International Journal of Infectious Diseases 17(6): e443-e449.
Blum, L. K., et al. (2018). “Robust B Cell Responses Predict Rapid Resolution of Lyme Disease.” Front Immunol 9: 1634.

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.