Borrelia burgdorferi-specific immune complexes in acute Lyme disease

Context Diagnosis of infection with Borrelia burgdorferi, the cause of Lyme disease (LD), has been impeded by the lack of effective assays to detect a ctive infection. Objective To determine whether B burgdorferi-specific immune complexes are detectable during active infection in LD. Design, Setting, and Patients Cross-sectional analysis of serum samples fro m 168 patients fulfilling Centers for Disease Control and Prevention survei llance criteria for LD and 145 healthy and other disease controls conducted over 8 years. Tests were performed blinded. Main Outcome Measure Detection of B burgdorferi immune complexes by enzyme- linked immunosorbent assay and Western blot. Results The B burgdorferi immune complexes were found in 25 of 26 patients with early seronegative erythema migrans (EM) LD; 105 of 107 patients with seropositive EM LD; 6 of 10 patients who were seronegative with culture-pos itive EM; 0 of 12 patients who were treated and recovered from LD; and 13 o f 13 patients with neurologic LD without EM. Among 147 controls, B burgdorf eri immune complex was found in 0 of 50 healthy individuals; 0 of 40 patien ts with persistent fatigue; 0 of 7 individuals with frequent tick exposure; and 2 of 50 patients with other diseases. Conclusion These data suggest that B burgdorferi immune complex formation i s a common process in active LD. Analysis of the B burgdorferi immune compl exes by a simple technique has the potential to support or exclude a diagno sis of early as well as active LD infection.