Survival mechanisms of B. burgdorferi persistence include:
“Immune evasion via physical seclusion within immunologically protected tissue sites such as:
the CNS [brain],
joints,
eyes,
collagen-rich tissues,
[misc] cells,
biofilms;
alterations in outer surface protein (OSP) profiles ... [by altering outer parts],
phasic variations,
immune modulation via alterations in complement, neutrophil and dendritic [brain] cell functioning,
changes in cytokine and chemokine levels”
Shor S., Green C., Szantyr B., Phillips S., Liegner K., Burrascano J.J., Jr., Bransfield R., Maloney E.L. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics. 2019;8:269. doi: 10.3390/antibiotics8040269.