Neural tissue invasion alone can produce all the symptoms of Lyme disease according to Dr. Donta. It is known that some of these persist inside cells. Dr. Donta theorized that recurrent disease and persistence of Bb can be explained by the intracellular localization of Bb. He stated he knows of no other plausible explanation for the persistence of any organism other than in an intracellular location. There are many good examples of intracellularly localizing persistent organisms but no examples of extracellular persistence are known.
Organisms can persist in endosomes and endolysosomes within cells.
In this location they can remain protected from the action of most antibiotics and antibodies. He suggests that treatment of chronic Lyme disease needs antibiotics that enter the cells. Macrolide antibiotics enter cells but have been less effective than expected. Doxycycline and tetracycline also enter the cell so using hydroxychloquine along with them may also improve treatment outcomes. He also stated that amantadine 100mg three times daily has been helpful in some Lyme patients.