Pd. Mitchell et al., COMPARISON OF 4 IMMUNOSEROLOGIC ASSAYS FOR DETECTION OF ANTIBODIES TOBORRELIA-BURGDORFERI IN PATIENTS WITH CULTURE-POSITIVE ERYTHEMA MIGRANS, Journal of clinical microbiology, 32(8), 1994, pp. 1958-1962
In view of the significant sequelae associated with Lyme borreliosis,
there is a need for timely and accurate diagnosis of erythema migrans
(EM). Although Borrelia burgdorferi can be cultured from biopsies of E
M lesions, immunodiagnostic testing is more widely available. Four imm
unoserologic methods were studied by using the sera of 51 patients wit
h EM lesions that were culture positive for B. burgdorferi. Nineteen p
atients had single primary lesions, and thirty-two had multiple second
ary lesions. At the time of biopsy, 40 patients, 8 with primary lesion
s and all patients with secondary lesions, were seropositive by an imm
unoglobulin M (IgM) indirect fluorescent-antibody (IgM IFA) test (Bion
Enterprises). Twenty-three patients were seropositive by a whole-cell
fluorescence enzyme immunoassay (EIA) (BioWhittaker, Inc.), twenty-tw
o were positive by immunoblotting (ViroStat, Inc.), and one was positi
ve by a P39 recombinant EIA (P39 EIA) (General Biometrics, Inc.). Sera
from various patient control groups were tested: rheumatoid arthritis
(n = 19), infectious mononucleosis (n = 20), systemic lupus (n = 22),
syphilis (n = 13), streptococcal sequelae (n = 20), and healthy subje
cts (n = 16). None of these sera reacted with the IgM IPA test or P39
EIA. Fifteen reacted with the fluorescence EIA. We conclude that the I
gM IFA test is an effective and reliable assay for the diagnosis of EM
, particularly for patients with secondary lesions. Immunoblot, fluore
scence EIA, and P39 EIA lack the sensitivity to reliably diagnose EM.