SynthesisClinical infectious diseases : an official publication of the Infectious Diseases Society of America2014
A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease.
Synthesis in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 4 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis.German medical science : GMS e-journal · 2025Guideline
- Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis.German medical science : GMS e-journal · 2020Guideline
- Lyme Neuroborreliosis.Deutsches Arzteblatt international · 2018Pooled it
- [Neuroborreliosis - Diagnostics, treatment and course].Der Nervenarzt · 2017Pooled it
- Colonization of 3D-organotypic human skin by the Lyme Disease pathogen,bioRxiv : the preprint server for biology · 2026Article
- Antigenicity and immunogenicity of different morphological forms of Borrelia burgdorferi sensu lato spirochetes.Scientific reports · 2024Article
- Pathogenicity and virulence ofVirulence · 2023Review
- Article
- Pleomorphic Variants ofInternational journal of molecular sciences · 2023Article
- Lyme disease and the pursuit of a clinical cure.Frontiers in medicine · 2023Review
- Persistent Borrelia burgdorferiClinical microbiology reviews · 2022Review
- IsTropical medicine and infectious disease · 2022Article
- Review
- Borrelia burgdorferi, the Lyme disease spirochete, possesses genetically-encoded responses to doxycycline, but not to amoxicillin.PloS one · 2022Article
- Recent Progress in Lyme Disease and Remaining Challenges.Frontiers in medicine · 2021Review
- Lyme Disease Frontiers: ReconcilingPathogens (Basel, Switzerland) · 2019Review
- AMMI Canada position statement on the diagnosis and treatment of people with persistent symptoms that have been attributed to Lyme disease.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2019Article
- Énoncé de position de l'AMMI Canada sur le diagnostic de la maladie de Lyme et le traitement des personnes ayant des symptômes persistants attribués à cette maladie.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2019Article
- Anti-borreliae efficacy of selected organic oils and fatty acids.BMC complementary and alternative medicine · 2019Article
- Antimicrobial action of calprotectin that does not involve metal withholding.Metallomics : integrated biometal science · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMuch of the controversy that surrounds Lyme disease pertains to whether it produces prolonged, treatment-refractory infection, usually referred to as chronic Lyme disease. Some have proposed that round morphologic variants of Borrelia burgdorferi, known variably as "cyst forms" and "L-forms," are responsible for the pathogenesis of chronic Lyme disease. We have undertaken a systematic review of the literature to determine if there is a documented role of these variants in Lyme disease pathogenesis or in syndromes compatible with chronic Lyme disease.
methodsTwo systematic literature searches were performed to identify studies in which round morphologic variants of B. burgdorferi have been described in situ in human specimens.
resultsOur primary literature search identified 6 studies that reported round morphologic variants of B. burgdorferi in specimens obtained from 32 total patients. No study described these forms in patients who had purely subjective symptom complexes (eg, fatigue or pain). No study investigated a causal relationship between morphologic variants and clinical disease or evaluated treatment of morphologic variants in vivo. Of 29 additional studies that described the morphology of B. burgdorferi from patients with Lyme disease, the organism was invariably described as having spirochetal morphology.
conclusionsIn the context of the broader medical literature, it is not currently possible to ascribe a pathogenic role to morphologic variants of B. burgdorferi in either typical manifestations of Lyme disease or in other chronic disease states that are often labeled chronic Lyme disease. There is no clinical literature to justify specific treatment of B. burgdorferi morphologic variants.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.