The diagnosis of Lyme disease is
based primarily on clinical findings, and it is often
appropriate to treat patients with early disease solely
on the basis of objective signs and a known exposure.
Serologic testing may, however, provide valuable
supportive diagnostic information in patients with
endemic exposure and objective clinical findings that
suggest later stage disseminated Lyme disease. When
serologic testing is indicated, CDC recommends testing
initially with a sensitive first test, either an
enzyme-linked immunosorbent assay (ELISA) or an indirect
fluorescent antibody (IFA) test, followed by testing
with the more specific Western immunoblot (WB) test to
corroborate equivocal or positive results obtained with
the first test. Although antibiotic treatment in early
localized disease may blunt or abrogate the antibody
response, patients with early disseminated or late-stage
disease usually have strong serological reactivity and
demonstrate expanded
WB immunoglobulin G (IgG) banding
patterns to diagnostic
B. burgdorferi
antigens. Antibodies often persist for months or years
following successfully treated or untreated infection.
Thus, seroreactivity alone cannot be used as a marker of
active disease. Neither positive serologic test results
nor a history of previous Lyme disease assures that an
individual has protective immunity. Repeated infection
with
B. burgdorferi
has been documented.
B. burgdorferi
can be cultured from 80% or more of biopsy specimens
taken from early erythema migrans lesions. However, the
diagnostic usefulness of this procedure is limited
because of the need for a special bacteriologic medium
(modified Barbour-Stoenner-Kelly medium) and protracted
observation of cultures. Polymerase chain reaction (PCR)
has been used to amplify genomic DNA of
B. burgdorferi
in skin, blood, cerobro-spinal fluid, and synovial
fluid, but PCR has not been standardized for routine
diagnosis of Lyme disease.
References:
Berger BW,
Johnson RC, Kodner C, Coleman L. Cultivation of Borrelia
burgdorferi from erythema migrans lesions and
perilesional skin. J Clin Microbiol 1992;30:359-361.
Brettschneider S, Bruckbauser H, Klugbauer K, Hofmann H.
Diagnostic value of PCR for detection of Borrelia
burgdorferi in skin biopsy and urine samples from
patients with skin borreliosis. J Clin Microbiol
1998;36:2658-2665.
Centers
for Disease Control and Prevention. Recommendations for
Test Performance and Interpretation from the Second
National Conference on Serologic Diagnosis of Lyme
Disease. MMWR Aug 11, 1995;44:590-591. (Also available
in PDF format [214 KB, 16 pages].)
Dressler
F, Whelan JA, Reinhart BN, Steere AC. Western blotting
in the serodiagnosis of Lyme disease. J Infect Dis
1993;167:392-400.
Johnson,
BJ, Robbins KE, Bailey RE, et al. Serodiagnosis of Lyme
disease: accuracy of a two-step approach using a
flagella-based ELISA and immunoblotting. J Infect Dis
1996;174:346-353.
Nocton JJ,
Dressler F, Rutledge BJ, et al. Detection of Borrelia
burgdorferi by polymerase chain reaction in synovial
fluid from patients with Lyme arthritis. N Engl J Med
1994;44:1203-1207.
Nowakowski J, Schwartz I, Nadelman RB, et al.
Culture-confirmed infection and reinfection with
Borrelia burgdorferi. Ann Intern Med 1997;127:130-132.
Tugwell
P, Dennis DT, Weinstein A, et al. Clinical guideline 2:
laboratory evaluation in the diagnosis of Lyme disease.
Ann Intern Med 1997; 127:1109-1123. |
