Positive Lyme serology in subacute bacterial endocarditis: a study of four patients

Article Abstract:

Lyme disease, or borreliosis, is caused by the tick-borne bacteria Borrelia burgdorferi, which causes inflammation of one or more systems, including skin, joints, nervous system, and heart. A classic rash occurs in 70 percent of patients, but many symptoms are nonspecific and reminiscent of other systemic disorders. Detection of Lyme disease is often accomplished by measuring blood levels of antibodies formed against the bacteria. Four cases are described of patients who were diagnosed with Lyme disease on the basis of blood antibody levels. However, further testing indicated that they had bacterial endocarditis, an infection of the membrane lining the heart. The patients lived in areas with a high prevalence of Lyme disease, and one had developed the classic rash. Major symptoms included musculoskeletal complaints, fever, and malaise. Antibiotic treatment for Lyme disease provided temporary relief, but did not relieve the underlying endocarditis. Although intensive analysis of blood antibodies was suggestive of past infection with borrelia in two patients, positive results from the two remaining patients may have resulted from cross-reactivity of standard tests with other bacteria. The authors conclude that positive blood tests for Lyme disease may indicate previous exposure to the bacteria and past Lyme disease, but not active infection. In addition to laboratory testing, patients suspected of having Lyme disease require thorough clinical evaluation. Tests that actually identify B. burgdorferi, its DNA or its antigens are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Identification and classification, Endocarditis, Bacterial, Bacterial endocarditis, Borrelia

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Performance of 45 laboratories participating in a proficiency testing program for Lyme disease serology

Article Abstract:

Results of Lyme disease blood testing can differ greatly depending on the laboratory and worker performing the test. Samples were sent to 45 laboratories. Between 4% and 21% did not correctly identify the presence of Lyme disease antibody using polyvalent serum or immunoglobulin G conjugates. With lower antibody levels, 55% did not identify a case-defined serum. False positives were given by 2% to 7% of the laboratories with this rate increasing to 27% with immunoglobulin G conjugate samples. Many laboratories could not reproduce their results using split samples from the same person. Standard testing methods and increased quality assurance programs must be established before Lyme disease tests can be of value. Laboratories must have case-defined serum samples for standardization. Improved test kits with greater sensitivity and specificity will not correct test validity problems without standardizing testing techniques.

Evaluation, Diagnosis, Laboratory, Laboratory diagnosis

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Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection

Article Abstract:

Involvement of the central nervous system (CNS) may occur early in the course of infection in patients with Lyme disease. Lyme disease is an infection characterized by fever, headache and fatigue caused by the bacterium Borrelia burgdorferi. Samples of cerebrospinal fluid (CSF) from 12 patients with Lyme disease and 16 healthy individuals were tested for the presence of the bacterium. The CSF of eight of the patients with Lyme disease was infected by Borrelia burgdorferi compared to none of the healthy individuals. Of the eight patients with Borrelia burgdorferi in their CSF, only four had any symptoms of CNS infection. Four of the patients with CNS infection had skin lesions, and the other four had acute cranial neuritis, or inflammation of cranial nerves. Patients with Lyme disease should be given antibiotics that can treat infections in the CSF.

Infection, Complications and side effects, Central nervous system, Borrelia burgdorferi

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