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Supplementing positive Lyme disease antibody screen (EIA) results and serving as an aid in the serologic diagnosis of Lyme neuroborreliosis
Lyme disease is caused by the spirochete Borrelia burgdorferi. The spirochete is transmitted to humans through the bite of Ixodes species ticks. Endemic areas for Lyme disease in the United States (US) correspond with the distribution of 2 tick species, Ixodes dammini (Northeastern and Upper Midwestern US) and Ixodes pacificus (West Coast US). In Europe, Ixodes ricinus transmits the spirochete.
Lyme disease exhibits a variety of symptoms that may be confused with immune and inflammatory disorders. Any of the following clinical manifestations may be present in patients with Lyme disease: skin lesions or cardiac or neurological disease. In the first stage of disease, inflammation around the tick bite causes skin lesions, erythema chronicum migrans (ECM)-a unique expanding skin lesion with central clearing that results in a ring-like appearance. Culture of skin biopsies obtained near the margins of ECM are frequently positive. Neurologic and cardiac symptoms may appear with stage 2 and arthritic symptoms with stage 3 of Lyme disease. In some cases, a definitive distinction between stages is not always seen. Further, secondary symptoms may occur even though the patient does not recall a tick bite or rash.
The presence of antibodies to Borrelia burgdorferi in cerebrospinal fluid (CSF) is suggestive of neurologic Lyme disease (Lyme neuroborreliosis). PCR testing also may be used to confirm late-stage neurologic disease. However, the sensitivity of PCR is low when testing CSF.
According to the manufacturerâ€™s package insert, early antibiotic treatment of Lyme disease can resolve clinical symptoms and prevent progression of the disease to later stages. However, the early administration of antibiotics may suppress the antibody response to levels that are undetectable by current laboratory tests.(1)
IgG: none detected
IgM: none detected
Currently no criteria exist for the interpretation of immunoblot testing on cerebrospinal fluid. The presence of any bands may represent either intrathecal antibody production or passive transfer of antibody from blood.
A negative result does not rule out Lyme neuroborreliosis.
Results should be interpreted in the context of clinical findings.
False-positive results may be caused by breakdown of the blood-brain barrier, or by the introduction of blood into the cerebrospinal fluid at collection.
Because clinical studies are limited, the advantage of immunoassays over PCR (or vice versa) has not been conclusively demonstrated for diagnosing central nervous system Lyme disease. If the result for the immunoassay is negative and there is a high suspicion of Lyme neuroborreliosis, consider performing the PCR assay (PBORR / Lyme Disease [Borrelia burgdorferi], Molecular Detection, PCR).
1. Steere AC: Borrelia burgdorferi (Lyme disease, Lyme borreliosis). In Principles and Practice of Infectious Diseases. Fifth edition. Edited by GL Mandell, JE Bennett, R Dolin. Philadelphia, Churchill Livingstone, 2000, pp 2504-25182
2. Package insert: Viramed Biotech AG-Borrelia B31 IgG ViraStripe, Viramed Biotech AG, Steinkirchen, Germany, 2009