Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients

Abstract

Two-tier serology is often used to confirm a diagnosis of Lyme disease. One hundred and four patients with physician diagnosed erythema migrans rashes had blood samples taken before and after 3 weeks of doxycycline treatment for early Lyme disease. Acute and convalescent serologies for Borrelia burgdorferi were interpreted according to the 2-tier antibody testing criteria proposed by the Centers for Disease Control and Prevention. Serostatus was compared across several clinical and demographic variables both pre- and post-treatment. Forty-one patients (39.4%) were seronegative both before and after treatment. The majority of seropositive individuals on both acute and convalescent serology had a positive IgM western blot and a negative IgG western blot. IgG seroconversion on western blot was infrequent. Among the baseline variables included in the analysis, disseminated lesions (p < 0.0001), a longer duration of illness (p < 0.0001), and a higher number of reported symptoms (p = 0.004) were highly significantly associated with positive final serostatus, while male sex (p = 0.05) was borderline significant. This variability, and the lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Furthermore, these findings underline the difficulty for rheumatologists in identifying a prior exposure to Lyme disease in caring for patients with medically unexplained symptoms or fibromyalgia-like syndromes.

Development of a Multiantigen Panel for Improved Detection of Borrelia burgdorferi Infection in Early Lyme Disease

“…Cohort 1 included 79 patients who had been physician diagnosed with early Lyme disease based on the presence of an EM (see Table S1 in the supplemental material), and five patients with untreated late Lyme disease presenting with Lyme arthritis, with all samples being collected through Johns Hopkins University in a region of of Maryland where Lyme disease is endemic (27,28). In this prospective study, patients meeting all entrance requirements were enrolled, prescribed a 3-week course of doxycycline at the baseline visit, examined 3 weeks later upon completion of antibiotic treatment (posttreatment visit), and then followed for four additional visits (one month posttreatment, 3 months posttreatment, 6 months posttreatment, and 1 year posttreatment).…”

“…Two-tiered serologic testing following CDC guidelines (12) was performed by Quest Diagnostics as previously described (28). Specifically, the first tier utilized the Zeus ELISA Borrelia VlsE1/pepC10 IgG/IgM test system (Alere, Waltham, MA).…”

Mielite Extensa como Manifestação de Neuroborreliose

“…1 Por outro lado, a seroconversão IgG é rara e muito variável, não sendo relevante para a confirmação do diagnóstico. 15 No presente caso, o diagnóstico de Mielite por Borrelia spp. é corroborado pelo exame citoquímico, serológico e pela detecção de ADN da Borrelia spp.…”

Absence of Borrelia burgdorferi in the myocardium of subjects with normal left ventricular systolic function: a study using PCR and electron microscopy

“…However, Lyme borreliosis is primarily a clinical diagnosis and serological analysis is thus rather supportive in the diagnostic process 17 . In our study, ELISA detected IgM antibodies against Bb in 2 subjects and IgG antibodies in 6 individuals, while WB revealed IgM as well as IgG positivity in 7 patients.…”