Lyme disease (LD) spirochetes are well known to be able to disseminate into the tissues of infected hosts, including humans. The diverse strategies used by spirochetes to avoid the host immune system and persist in the host include active immune suppression, induction of immune tolerance, phase and antigenic variation, intracellular seclusion, changing of morphological and physiological state in varying environments, formation of biofilms and persistent forms, and, importantly, incursion into immune-privileged sites such as the brain. Invasion of immune-privileged sites allows the spirochetes to not only escape from the host immune system but can also reduce the efficacy of antibiotic therapy. Here we present a case of the detection of spirochetal DNA in multiple loci in a LD patient's post-mortem brain. The presence of co-infection with Borrelia burgdorferi sensu stricto and Borrelia garinii in this LD patient's brain was confirmed by PCR. Even though both spirochete species were simultaneously present in human brain tissue, the brain regions where the two species were detected were different and non-overlapping. The presence of atypical spirochete morphology was noted by immunohistochemistry of the brain samples. Atypical morphology was also found in the tissues of experimentally infected mice, which were used as a control.

Biology Centre Czech Academy of Sciences Institute of Entomology 37005 Ceske Budejovice Czech Republic

Biology Centre Czech Academy of Sciences Institute of Parasitology 37005 Ceske Budejovice Czech Republic

Department of Immunology Faculty of Medicine and Dentistry Palacky University Olomouc 77900 Olomouc Czech Republic

Department of Immunology University Hospital Olomouc 77900 Olomouc Czech Republic

Faculty of Sciences University of South Bohemia 37005 Ceske Budejovice Czech Republic

Institute of Forensic Medicine and Medical Law University Hospital Olomouc 77900 Olomouc Czech Republic

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