THE POLYMERASE CHAIN-REACTION FOR THE DETECTION OF BORRELIA-BURGDORFERI IN HUMAN-BODY FLUIDS

Objective. To analyze clinical fluids for the presence of Borrelia bur gdorferi DNA using the polymerase chain reaction (PCR). Methods. We ut ilized a modified, nested PCR to detect the presence of Borrelia DNA i n 99 samples of serum, urine, cerebrospinal fluid (CSF), or synovial f luid obtained from 44 patients with various stages of Lyme disease and 47 control subjects. Primer specificity was corroborated by examining 2 DNA data banks, testing against DNA from other organisms, and confi rming results with a second set of nested primers. Results. Nested PCR was capable of detecting DNA from fewer than 10 organisms in 1 ml of fluid. The specificity of this technique was 96.4%, with a sensitivity of 76.7%. Although the specificity was uniformly high, the sensitivit y was dependent upon the body fluid being tested: CSF 100%, urine 100% , synovial fluid 80%, and serum 59%. The rate of false-positive result s was 3.6%. Conclusion. These data demonstrate the potential utility o f PCR in confirming the clinical diagnosis of Lyme disease as well as providing insight into the pathogenesis of various stages of this diso rder.