Nice and easy to read paper going through lots of previous borrelia persistence papers and trying to explain it as an important part of its survival in reservoir hosts.
Abstract:
onlinelibrary.wiley.com/doi/10.1111/1462-2920.13897/fullpre-print
onlinelibrary.wiley.com/doi/10.1111/1462-2920.13897/epdf"
If the stringent response is utilized in the enzootic life cycle of borrelia as we and others
have suggested (Godfrey et al., 2002; Bugrysheva et al., 2005; Bugrysheva et al., 2015;
Drecktrah et al., 2015; Caimano et al., 2016), its mobilization in different developmental stages
and tissue types in its arthropod hosts and primary mammalian reservoirs can be expected to
have been under strong evolutionary pressure with respect to tissue tropism and timing (Radolf
et al., 2012; Caimano et al., 2016; Steere et al., 2016).
In dead-end mammalian hosts such as
humans which are not critical to the spirochete’s propagation, the spirochete’s ability to evade
immune responses and antimicrobial treatment and take up residence in refugia would, by
implication, be a side-effect of selection on other traits (a “spandrel” in the terminology of Gould
and Lewontin (1979)). Its incidental origin would make it no less of a potential clinical problem if
it were found to be involved in manifestations of late Lyme disease such as arthritis and post treatment
Lyme disease syndrome (Steere et al., 1994; Chandra et al., 2011; Arvikar and
Steere, 2015; Steere et al., 2016). "