Biofilms, pleomorphic and Persister-forms
The general medical opinion is that biofilms and pleomorphic forms can only be found in laboratory conditions (in vitro), and that they are, therefore, not present in living organisms or tissues (in vivo).
However, the works of A. MacDonald and of K. Eisendle show the contrary. They were able to prove that those biofilms were present in tissues in vivo. You can find lectures and pictures from both researchers on the internet. Dr. Alan Mc Donald presented a lot of new pictures of the biofilms of borrelia at the ILADS-conference this year (2015) in Fort Lauderdale.
Every colleague initiated in this topic knows that these pleomorphic forms can hardly be detected with usual test procedures. Though, they hinder the treatment and promote the persistence of the pathogens in the organism of the infected person. The formation of biofilms is only one of many other mechanisms to escape from the immune system (see: General Information, (1)). The spiral form of borrelias does not fit into an erythrozyten (red blood cells) but maybe other persistent forms of borrelias and in bigger cells. Apparently, the existences of persistent forms are no longer denied as several studies on possible treatments have been initiated (see chapter: “General Information”, (2)).
Biofilm-building bacteria may, for example, be responsible for unusual long bacterial bronchitis in children. They play a role in the course of the illness, hinder the diagnosis and complicate the therapy (see chapter:” Antibiotic Treatment” (5)).
The problem is that it is not always possible to prove the existence of those pathogens in the material that is easily accessible to us (such as blood, urine or saliva) but rather in cells and bradytrophic tissues, i.e. with little blood supply.
Maybe it would help in the future to take more tissue samples from tendons, joint capsules, skin, and muscles and also from all biopsies taken to prove the presence of pathogens. The samples that are taken to investigate a malignant tumor could also be used for testing via microscopy, tainting and PCR for borrelia, chlamydia, yersinia and other agents. For the moment, this is not possible since the analysis for malignancy is carried out in the Institute for Pathology and the analysis of pathogens in the Institute for Microbiology. This would mean that two samples would have to be taken and sent to different institutes. In practice, it seems to be very difficult to change this process.
However, at least the samples that show an inflammatory modification of the tissue instead of a malignity should be tested on infectious pathogens. Since every infection (be it viral or bacterial) and every auto-immune reaction leads to an inflammation of the tissues, this could be a first criterion of selection.
As a first step, it would be helpful to test tissue samples (tendons, joint capsules, skin, muscle) and from any biopsy (tissue) for agents. These samples should be as native (untreated) as possible. Samples in wax can be used but those in formalin are less recommended.
The pathogen must be located exactly within the tissue sample in order to prove its presence thanks to a PCR test. This represents an additional challenge; further studies are still necessary.
Please find below some studies that could observe biofilms and pleomorphic forms in tissues (in vivo):
Meriläinen Leena et.al.: “Morphological and biochemical features of Borrelia burgdorferi pleomorphic forms”, Microbiology, Jan 2015, doi:10.1099/mic.0.000027
Jie Feng, Megan Weitner, Wanliang Shi, Shuo Zhang and Ying Zhang: Eradication of Biofilm-Like Microcolony Structures of Borrelia burgdorferi by Daunomycin and Daptomycin but not Mitomycin C in Combination with Doxycycline and Cefuroxime, 2016, Microbiol. 7:62. doi: 10.3389/fmicb.2016.00062
Pleomorphic form of Borrelia in vivo (Page 2-3, bottom)