The laboratory diagnosis of ocular Lyme borreliosis

Background: A study was carried out to evaluate indirect enzyme-linked immu nosorbent assay (ELISA), immunoblot analysis, and polymerase chain reaction (PCR) in the diagnostic work-up of ocular Lyme borreliosis. Methods: Twenty patients with ocular Lyme borreliosis were examined. IgG an d IgM antibodies to Borrelia burgdorferi were measured by ELISA in serum, a nd in cerebrospinal fluid (CSF) when indicated, and immunoblot analysis of B. burgdorferi IgG antibodies in serum was performed. A nested PCR was used to detect a segment of a gene coding for B. burgdorferi endoflagellin. The samples used in PCR testing were serum and CSF and in isolated cases conju nctiva and vitreous. Results: Seventeen patients had elevated Borrelia antibodies in serum or CS F by ELISA. Seven patients, including two with negative ELISA, had a positi ve immunoblot. Seven of the 13 patients in whom PCR was examined during cli nically active disease had a positive PCR result. Immunoblot analysis gave a negative result from the sera of five PCR-positive patients. Conclusions: For efficient diagnosis of ocular Lyme borreliosis, immunoblot analysis and PCR should be used in addition to ELISA. A positive PCR seems to be associated with a negative immunoblot.