LYMPHOPROLIFERATIVE RESPONSES TO BORRELIA-BURGDORFERI IN THE DIAGNOSIS OF LYME ARTHRITIS IN CHILDREN AND ADOLESCENTS

To assess the contribution of the lymphocyte proliferation assay in re sponse to borrelial antigens to establishing a diagnosis of Lyme arthr itis (LA) the response to two strains of Borrelia burgdorferi was test ed in peripheral blood lymphocytes of 103 children and adolescents wit h arthritis, among them 55 with LA and 48 control patients. Patients w ith LA had a significantly higher response to borrelial antigens than control patients. However, there were several patients with false posi tive and false negative test results. Specificity and sensitivity of t he test were 78% and 77%. In patients with LA the test may turn positi ve after antibiotic therapy and remain positive for up to 19 months af ter the disappearance of arthritis. The test does not aid in prognosis or follow up. In one patient with seronegative LA specific lymphocyte proliferation and polymerase chain reaction for borrelial fla sequenc es in urine were positive.Conclusion Rarely the lymphocyte proliferati on assay may aid in finding the correct diagnosis when clinical presen tation and anti-borrelial serology do not match.