In Lyme disease, musculoskeletal symptoms can persist after treatment, which has led to the hypothesis that the causal organism itself may escape antibiotic therapy. The controversy that surrounds this question extends beyond patients, physicians, and scientists, as public health organizations struggle with how the disease should be diagnosed and treated. Is Lyme disease an infection that resolves, or is the spirochetal agent resilient and evasive? In this issue of the JCI, Bockenstedt et al. address this issue and present compelling evidence that the residues of nonviable spirochetes can persist in cartilaginous tissue long after treatment and may contribute to antibiotic-refractory Lyme arthritis.
Detectable remains of spirochete infection.