COMPARISON OF 4 IMMUNOSEROLOGIC ASSAYS FOR DETECTION OF ANTIBODIES TOBORRELIA-BURGDORFERI IN PATIENTS WITH CULTURE-POSITIVE ERYTHEMA MIGRANS

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.