Long-term serological follow-up of patients treated for chronic cutaneous borreliosis or culture-positive erythema migrans

The kinetics of antibodies to Borrelia burgdorferi following. successful tr eatment of early and late cutaneous borreliosis were analysed in consecutiv e serum samples by an enzyme-linked immunosorbent assay (ELISA) technique. Twenty-three patients with culture positive erythema migrans were followed for 23+/-14 months: 41% stayed seronegative, 35% showed an isolated immunog lobulin M (IgM) response, 8% an isolated Ige response and 16% a combined Ig M and Ige responses. In general, antibody levels peaked within the first 3 months of symptom onset, whereafter a gradual decline was observed within 1 year. Twenty-two patients with chronic cutaneous borreliosis were followed for 23+/-11 months and all patients stayed IgG positive. Nearly three-quar ters showed a clear decline in Ige levels over the years, while the rest di d not. After 9+/-1 years 88% of 16 patients examined were still IgG positiv e. In conclusion, treatment of erythema migrans should be initiated on clin ical appearance as a substantial number of patients stayed seronegative. Tr eatment success may in part be monitored serologically for both seropositiv e erythema migrans and chronic cutaneous borreliosis as most patients show declining titres after successful treatment. However, continuously high tit res do not necessarily indicate treatment failure.