Laboratory Diagnostic Techniques for Patients with Early Lyme Disease Associated with Erythema Migrans: A Comparison of Different Techniques

Abstract

Recently, a number of refinements in diagnostic modalities for detection of Borrelia burgdorferi infection have been developed. These include large-volume blood cultures, quantitative polymerase chain reaction (PCR) techniques, and 2-stage serologic testing. In the present study, we compared 6 diagnostic modalities in 47 adult patients who had a clinical diagnosis of erythema migrans. Quantitative PCR on skin biopsy-derived material was the most sensitive diagnostic method (80.9%), followed by 2-stage serologic testing of convalescent-phase samples (66.0%), conventional nested PCR (63.8%), skin culture (51.1%), blood culture (44.7%), and serologic testing of acute-phase samples (40.4%). Results of all assays were negative for 3 patients (6.4%). We conclude that the clinical diagnosis of erythema migrans is highly accurate in an area where B. burgdorferi is endemic if it is made by experienced health care personnel, but some patients with this diagnosis may not have B. burgdorferi infection. No single diagnostic modality is suitable for detection of B. burgdorferi in every patient with erythema migrans.

The emergence of Lyme disease in Canada

“…3 Bacterial culture or use of polymerase chain reaction to amplify target sequences in clinical material (such as blood, skin, synovial fluid or cerebrospinal fluid) are diagnostic methods with low to moderate sensitivity. 2,5 Public health laboratories in Canada, 6,7 the United States 2,8 and some European countries advocate a two-tiered serologic testing process, consisting of enzyme-linked immunosorbent assay followed by Western blot, to assist in diagnosis. Serologic testing is insensitive in very early Lyme disease, but the 2-tiered method is much more sensitive in detecting cases of disseminated Lyme disease.…”

“…Serologic testing is insensitive in very early Lyme disease, but the 2-tiered method is much more sensitive in detecting cases of disseminated Lyme disease. 2,5,7,9 When used alone, enzymelinked immunosorbent assay has limited specificity, but the specificity is improved by Western blotting, provided that the bands are interpreted according to criteria for positivity set by the US Centers for Disease Control and Prevention. 8 Concerns about test specificity mean that interpretation of the 2-tiered test is informed by whether the patient has had contact with an endemic area, which is defined by ecological criteria.…”

Quantitative analysis of Borrelia burgdorferi gene expression in naturally (tick) infected mouse strains

“…In light of the notion that needle exposure by no means reflects the situation of tick infection [23,25,54] and the highly improved real-time PCR technique to quantify B. burgdorferi in situ [24,27,43,46,48,62,63,64], we have now performed a detailed quantitative analysis of the spirochete burden and population dynamics in different tissues of mice following natural (tick) infection by B. burgdorferi s.s. (ZS7) for a period of 4 months postinfection (p.i.). For this purpose we have selected one cp26-encoded gene, ospC [40], and four previously described lp54-encoded genes, i.e.…”

Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology

“…In this scenario, serologic confirmation is unnecessary and can be misleading because the false-negative rate is as high as 60% in the first 2 to 4 weeks of infection. 2 Despite negative Lyme serology, the EM rash in the setting of fever, fatigue, and neurologic symptoms suggested a diagnosis of acute Lyme disease.…”