Laboratory diagnosis of Lyme disease: advances and challenges

Abstract

The majority of laboratory tests performed for the diagnosis of Lyme disease are based on detection of the antibody responses against B burgdorferi in serum. The sensitivity of antibody-based tests increases with the duration of the infection. Patients early in their illness are more likely to have a negative result. There is a need to simplify the testing algorithm for Lyme disease, improving sensitivity in early disease while still maintaining high specificity and providing information about the stage of infection. The development of a point of care assay and biomarkers for active infection would be major advances for the field.

Keywords: Borrelia burgdorferi; Laboratory diagnosis; Lyme disease; Serology.

Published by Elsevier Inc.

Figures

Figure 1. Current CDC Recommendations on Serologic Diagnosis of Lyme Disease: 2-Tier Algorithm

aBoth IgG and IgM WB results will be reported, but an IgM WB positive result is only significant for patients who have been ill for less than a month. ELISA: Enzyme-linked immunosorbent assay, IFA: Immunofluorescence Antibody Assay) IgM: immunoglobulin M, IgG: immunoglobulin G, WB: Western Blot. Adapted from

Figure 2. Serological Results, Clinical Presentation and Duration of Illness

Panel A shows rates of seropositivity for the C6 ELISA, WCS ELISA and 2-tier algorithm in relationship to disease presentation and time of sample (acute and convalescent) while panel B compares rates of seropositivity in relationship with duration of disease in patients with a single erythema migrans. EM: erythema migrans, LNB: Lyme neuroborreliosis, WCS: whole cell sonicate. Adapted from ,.