SUSTAINED CELLULAR IMMUNE-RESPONSES TO BORRELIA-BURGDORFERI - LACK OFCORRELATION WITH CLINICAL PRESENTATION AND SEROLOGY

Fifty-one patients with erythema migrans were followed up prospectivel y with serial clinical evaluations, serologic determinations for antib orrelial antibodies, and lymphocyte stimulation responses to Borrelia burgdorferi antigens to determine (i) the factors associated with sust ained cellular immune responses and (ii) whether lymphocyte stimulatio n is a good indicator of prior exposure to B. burgdorferi in patients treated early after erythema migrans. Positive lymphocyte stimulation responses (>2 standard deviations above normal control values), were f ound in 15 (29%) of 51 patients 3 months after treatment for erythema migrans and in 8 (18%) of 44 patients 1 year posttreatment. Heightened lymphocyte responses were not associated with the number or duration of erythema migrans lesions prior to treatment, the mean size of the l argest erythema migrans lesion, or the number of symptoms at the time of presentation. The development of a Jarisch-Herxheimer reaction, cho ice of antibiotic, and clinical outcome also were not associated with a positive lymphoproliferation assay result. Changes in the lymphocyte stimulation indices between the two time points assessed (3 months an d 1 year posttreatment) also did not correlate with the above variable s. When serologic results and lymphoproliferative responses were evalu ated as categorical or continuous variables, there were no correlation s between values. One year after treatment for early Lyme disease, lym phocyte reactivity is not a good indicator of prior infection with B. burgdorferi.