Lyme Disease Clinical Trial
| Phase 1 phase 2
This study is looking to recruit 240 Participants
The most common tick-borne illness in the United States, Lyme disease is caused by Borrelia
burgdorferi bacteria that are transmitted to people by Ixodes scapularis ticks. Most cases of
Lyme disease are cured by antibiotics, but some patients continue to experience symptoms
despite the absence of detectable Lyme bacteria. Xenodiagnosis uses a vector to detect the
presence of a disease-causing microbe.. Researchers will use live, laboratory-bred ticks to
see if Lyme disease bacteria can be detected in people after completing antibiotic therapy
and if that is more common in people who continue to experience symptoms such as fatigue and
- To see if ticks can be used to detect B. burgdorferi in people who have had Lyme disease
and received antibiotic therapy and if it correlates with persistent symptoms.
- Adults at least 18 years old who have:
- Untreated erythema migrans (the Lyme disease rash); OR
- Untreated Lyme arthritis; OR
- Continuing symptoms after treatment for Lyme disease; OR
- Had Lyme disease and antibiotic treatment within the past 12 months.
- Healthy volunteers
- Participants will be screened with medical history, physical exam, and blood tests.
- Visit 1:
- Blood and urine tests, health questionnaire.
- Up to 30 laboratory-bred, pathogen-free, larval ticks (each smaller than a poppy seed)
will be placed under a dressing.
- Participants may have two small biopsies of skin .
- 4 6 days later, Visit 2:
- Dressing will be removed and ticks will be collected.
- Participants will answer symptom questions.
- If many ticks are still attached, participants will have to come back the next day. If
not enough ticks feed successfully, the procedure may be repeated.
- Participants will keep a diary of symptoms for 30 days. Over 3 months, they will be
return to the clinic 3 times to see how they feel and answer questionnaires. Test
results will be discussed.
Details for the study
Xenodiagnosis After Antibiotic Treatment for Lyme Disease
Xenodiagnosis After Antibiotic Treatment for Lyme Disease - Phase II Study
<br /> The most common tick-borne illness in the United States, Lyme disease is caused by Borrelia
<br /> burgdorferi bacteria that are transmitted to people by Ixodes scapularis ticks. Most cases of
<br /> Lyme disease are cured by antibiotics, but some patients continue to experience symptoms
<br /> despite the absence of detectable Lyme bacteria. Xenodiagnosis uses a vector to detect the
<br /> presence of a disease-causing microbe.. Researchers will use live, laboratory-bred ticks to
<br /> see if Lyme disease bacteria can be detected in people after completing antibiotic therapy
<br /> and if that is more common in people who continue to experience symptoms such as fatigue and
<br /> joint pain.
<br /> Objectives:
<br /> - To see if ticks can be used to detect B. burgdorferi in people who have had Lyme disease
<br /> and received antibiotic therapy and if it correlates with persistent symptoms.
<br /> Eligibility:
<br /> - Adults at least 18 years old who have:
<br /> - Untreated erythema migrans (the Lyme disease rash); OR
<br /> - Untreated Lyme arthritis; OR
<br /> - Continuing symptoms after treatment for Lyme disease; OR
<br /> - Had Lyme disease and antibiotic treatment within the past 12 months.
<br /> - Healthy volunteers
<br /> Design:
<br /> - Participants will be screened with medical history, physical exam, and blood tests.
<br /> - Visit 1:
<br /> - Blood and urine tests, health questionnaire.
<br /> - Up to 30 laboratory-bred, pathogen-free, larval ticks (each smaller than a poppy seed)
<br /> will be placed under a dressing.
<br /> - Participants may have two small biopsies of skin .
<br /> - 4 6 days later, Visit 2:
<br /> - Dressing will be removed and ticks will be collected.
<br /> - Participants will answer symptom questions.
<br /> - If many ticks are still attached, participants will have to come back the next day. If
<br /> not enough ticks feed successfully, the procedure may be repeated.
<br /> - Participants will keep a diary of symptoms for 30 days. Over 3 months, they will be
<br /> return to the clinic 3 times to see how they feel and answer questionnaires. Test
<br /> results will be discussed.
Lyme disease is the most common vector borne disease in the United States. Although
antibiotic therapy is clinically effective in treating the symptoms of Lyme disease for most
patients early in the course of disease, a significant number of patients who receive therapy
report persistent symptoms. The cause of persistent symptoms after antibiotic therapy for
Lyme disease is an area of great controversy. Recent studies have shown that the organism
(Borrelia burgdorferi) may persist in animals after antibiotic therapy and can be detected by
using the natural tick vector (Ixodes scapularis) to acquire the organism through feeding
(xenodiagnosis). Whether this occurs in humans is unknown. Currently available tests for
human Lyme disease do not allow determination of persistent infection after antibiotic
We performed the first study of the use of I. scapularis larva for the xenodiagnosis of B.
burgdorferi infection in humans. Our pilot study showed that xenodiagnosis was well tolerated
with no severe adverse events (AEs). The most common AE was mild itching at the site. In this
small pilot study, xenodiagnosis for B. burgdorferi was positive in 2 participants and
indeterminate in 2 participants. Further studies are needed to determine the sensitivity of
xenodiagnosis in evaluating the infection status of Lyme disease patients.
In this proposal, we want to further investigate the utility of xenodiagnosis for identifying
persistence of infection with B. burgdorferi in treated human Lyme disease. Our objectives
include assessing the link between detection of B. burgdorferi by xenodiagnosis and
persistence of symptoms in patients diagnosed with Lyme disease, within 1 year, post therapy;
compare the rate of detection of B. burgdorferi by xenodiagnosis after therapy in
participants with posttreatment Lyme disease symptoms; identify subject characteristics
related to the likelihood of detecting B. burgdorferi by xenodiagnosis including: time from
infection, time between infection and therapy, time from therapy; and continue to assess the
safety of xenodiagnosis in humans.
The results of study have the potential to resolve this long-standing controversy in Lyme
disease pathogenesis. While xenodiagnosis is unlikely to be widely used in clinical practice
due to the labor intensity and speed of testing, if our study shows a linkage between
positive xenodiagnostic testing and persistence of symptoms after B. burgdorferi infection,
it may prove to be a useful tool for testing new strategies for treatment and for correlation
with more generally applicable diagnostic markers. Understanding the pathogenesis of
persistent symptoms following Lyme disease, and identifying reliable diagnostic tests for
determining the success of antibiotic therapy, is critical to the medical management of these
Treatments and/or Procedures
Larval ticks will be obtained from Dr. Sam Telford from a laboratory maintained tick colony at Tufts Veterinary School. These ticks are hatchedfrom eggs laid by ticks that have fed only on specific pathogen free laboratory animals that were purchased from established vendors. Between 25-30 larval ticks that have been aged and are known to be ready to attach will be placed on the study participant.
Optional 2-3mm skin punch biopsies will be performed.
Peripheral blood draws will be performed.
Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.
Study participants will maintain a diary card and investigators will assess potential adverse events.
The study will continue to assess the safety of xenodiagnosis in humans.
This study is powered to detect difference in the positivity rate between symptomatic and asymptomatic individuals.
Criteria for the diagnosis and therapy for Lyme disease can be found at The clinical
assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and
babesiosis: clinical practice guidelines by the Infectious Diseases Society of America .
PATIENTS WITH LYME DISEASE, POST-THERAPY (N=100)
1. Age 18 or older
2. Lyme disease diagnosed in the previous 13 months, fulfilling the case definition of
confirmed or probable Lyme disease by the US Centers for Disease Control and
3. Completion of 1 course of antibiotics at least 3 months and up to 12 months between
the end of the therapy and the xenodiagnostic procedure.
4. Antibiotic treatment fulfills the Infectious Diseases Society of America guidelines
for the recommended therapy for Lyme disease
PATIENTS WITH POST-LYME DISEASE COMPLAINTS AT LEAST 12 MONTHS FROM INITIAL TREATMENT (N=40)
1. Age 18 or older.
2. Diagnosed with confirmed or probable Lyme disease fulfilling the case definition of
Lyme disease by the CDC
3. Received recommended antibiotic therapy for Lyme disease 5 at least 12 months between
the end of the initial antibiotic therapy and the xenodiagnostic procedure.
4. Persistent or recurrent symptoms that began or worsened within 6 months of the
diagnosis and treatment for Lyme disease.
ACUTE EM (N=40)
1. Age 18 or older.
2. EM diagnosed by the study physician.
3. Receiving antibiotic therapy for Lyme disease for less than 48 hours.
LYME ARTHRITIS (N=40)
1. Age 18 or older.
2. Lyme arthritis and have not received antibiotic therapy for the disease.
HEALTHY VOLUNTEERS (N=20)
1. Age 18 or older.
2. No prior history of Lyme disease.
3. Negative whole cell enzyme-linked immunosorbent assay (ELISA) or C6-based antibody
test for Lyme disease.
Patients with recently diagnosed (acute) EM (within 48 hours of starting antibiotic
therapy) and patients with untreated Lyme arthritis will be recruited in an attempt to
increase the chances of finding a positive result by xenodiagnosis (an attempt of a
positive control ) While patients with acute untreated EM would be the best positive
control group, it would be unethical to withhold therapy in these patients for the few days
required for tick feeding, due to the risk of dissemination of the organism and possible
morbidity. Patients with untreated Lyme arthritis will be recruited to establish whether
xenodiagnosis can be used to identify infection in late stage Lyme patients where the
bacterium is known to be present. These patients have been infected for months and will not
be harmed for delaying therapy for a few days. Lyme arthritis is a late manifestation of B.
burgdorferi infection, and hematogenous dissemination already occurred at this late stage.
Studies have shown that the presence or absence of previous antibiotic treatment is more
predictive than the duration of untreated arthritis for the success of antibiotic therapy
in Lyme arthritis. Similarly, patients who just started therapy for EM may still have live
Borrelia in the skin and xenodiagnosis may be able to recover the bacteria (but culture of
skin biopsies from patients with EM become negative very quickly - within one dose - on
While treatment for Lyme disease will not be offered under this protocol, it may be
available via different clinical research protocols or regular medical care at the study
site. If not, treatment will be prescribed by the patient s primary care. For patients with
untreated early Lyme disease (erythema migrans), antibiotics can be started at the same day
of tick placement. For patients with untreated Lyme arthritis, antibiotics can be started
after collection of xenodiagnostic ticks (usually 4-5 days, up to 7 days). For patients
with Lyme arthritis, if less than 14 ticks fed successfully and if the participant agrees,
antibiotic treatment can be delayed until after the repeat procedure.
Patients with acute EM and untreated Lyme arthritis will be able to re-enroll as Patients
with Lyme disease, post-therapy. Therefore, in case of positive results, we will be able to
compare between the procedures.
Negative control patients will include healthy volunteers from Lyme endemic areas who have
never been diagnosed with Lyme disease and have a negative B. burgdorferi ELISA and C6
1. No antibiotic therapy active against Lyme disease in the previous 3 months (except
patients with acute EM). Prophylaxis with a single dose of doxycycline 200 mg is not
2. History of allergy to surgical tape or dressing.
3. History of severe reactions to tick bites (granuloma or systemic reactions).
4. Inability to maintain the dressing for any reason.
5. Pregnancy or lactation.
6. Unwillingness to use an effective method of birth control for the duration of
participation in the study (women of child-bearing potential only) and for at least 3
months following the last tick placement.
7. Use of investigational therapy and devices during the time of the study and/or in the
month prior to signing the informed consent.
8. Active severe skin disease, uncontrolled diabetes, cancer other than non-melanoma skin
cancers, autoimmune disease requiring immunosuppressive therapy, or history of HIV,
chronic viral hepatitis, or syphilis.
9. Oral or IV steroids in the previous 2 weeks (topical, nasal, inhaled, intra-articular,
and replacement doses of steroids are not exclusions).
10. Any other condition that, in the opinion of the investigator, would make the patient
unsuitable for enrollment or could interfere with the patient participating in and
completing the study.
11. Refusal to participate in specimen collection and storage for future study related
EXCLUSION FROM SKIN BIOPSY PART OF THE PROTOCOL
1. History of forming large thick scars (keloids) after skin injuries or surgery.
2. History of excessive bleeding after cuts or procedures.
3. Currently taking anticoagulants.
4. History of allergy to lidocaine.