Serologic tests for Lyme disease; Interlaboratory variability

Article Abstract:

Lyme disease is a recurrent inflammatory disorder associated with skin lesions, reddening of the skin, inflammation of several joints, and involvement of the heart and nervous system. It is caused be the spirochete, Borrelia burgdorferi, which is transmitted to humans by the tick, Ixodes dammini. Antibodies, or specialized immune proteins, are produced after infection with the spirochete. These antibodies specifically bind to B. burgdorferi and can be measured in the blood by various immunological tests. Blood tests for detecting antibodies to B. burgdorferi are the most common laboratory method used to diagnose Lyme disease. The two tests used are the enzyme-linked immunoabsorbent assay, ELISA, and indirect immunofluorescence assay. However, studies have shown that these antibody blood tests are insensitive, and widely variable results are produced by different laboratories. The extent of variability was assessed by sending blood samples from nine patients with Lyme disease to nine different laboratories, which were operated by state, university, hospital, and national institutions. A second sample of each patient's blood was sent to the same nine laboratories two weeks later. There was wide variability in the results reported by the laboratories, with one university laboratory detecting B. burgdorferi antibodies in 18 of 18 samples, and one state laboratory detecting the antibodies in only 8 of 18 blood samples. These findings demonstrate that standards are needed for B. burgdorferi antibody testing. It is recommended that B. burgdorferi antibody blood tests not be used as the sole criterion for diagnosing Lyme disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Immunofluorescence, Fluorescent antibody technique

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Serologic tests for antibody to Borrelia burgdorferi. Another Pandora's box for Medicine?

Article Abstract:

Lyme disease is a recurrent inflammatory disorder associated with skin lesions, reddening of the skin, inflammation of several joints, and involvement of the heart and nervous system. It is caused by the spirochete, Borrelia burgdorferi, which is transmitted to humans by the tick, Ixodes dammini. Antibodies, or specialized immune proteins, are produced after infection with the spirochete. These antibodies specifically bind to B. burgdorferi and can be measured in the blood by various immunological tests. Although B. burgdorferi antibody blood tests may be useful in diagnosing Lyme disease, they have been associated with several problems, such as low sensitivity in the early stages of the disease, reactivity with spirochetes other than B. burgdorferi, wide variation in results between testing laboratories, and positive results in persons without Lyme disease. Two immunological tests used to detect B. burgdorferi antibodies in the blood are the immunofluorescent-antibody (IFA) and enzyme-linked immunosorbent assay (ELISA), both of which have been shown to be widely variable in their results. Consequently, clinicians and scientists have urged caution in using B. burgdorferi antibody blood testing for diagnosing Lyme disease, particularly with the increasing use of these immunological blood tests for B. burgdorferi antibody. It is recommended that B. burgdorferi antibody blood tests not be used as the sole criterion for diagnosing Lyme disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immunoassay, editorial

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Lymphoproliferative responses to Borrelia burgdorferi in Lyme disease

Article Abstract:

Lyme disease is an infection caused by the bacterium Borrelia burgdorferi, which is transmitted by a tick bite. The diagnosis of Lyme disease is made by clinical features, such as a history of a tick bite, the presence of a characteristic rash, arthritis, and by testing the blood for antibodies to B. burgdorferi (an immune reaction to infection). The antibody test is not felt to be reliable, as some patients with clinical Lyme disease will have low antibody levels. Efforts to find alternative tests to confirm the diagnosis of Lyme disease are ongoing. Some patients with Lyme disease were reported to have proliferation of lymphocytes, a class of white blood cells, so a study was done comparing the lymphoproliferative response of known Lyme disease patients with healthy controls. Because the presumably healthy controls lived in endemic Lyme disease areas, umbilical cord blood from two newborns was included in the control group. Exposure of the blood of these subjects to B. burgdorferi induced a lymphoproliferative response in 11 of 12 known Lyme disease patients and 8 of 12 healthy controls (including both newborns). Although the response was greater in the Lyme patients than in the controls, measurement of lymphoproliferative response to Borrelia burgdorferi is not a reliable indicator of Lyme disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Borrelia burgdorferi, Lymphocytes

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