КЛІНІЧНИЙ ВИПАДОК ЗАХВОРЮВАННЯ, ПІДОЗРІЛОГО НА ХВОРОБУ ЛАЙМА, З НЕЗВИЧАЙНИМИ РЕЗУЛЬТАТАМИ СЕРОЛОГІЧНОГО ОБСТЕЖЕННЯ

Abstract

The article p examination: positive results of IgM and IgG antibodies to B. burgdorferi, obtained by the method of blot analysis (WB), and negative results of examination by the method of enzyme immunoassay (ELISA), which resents a case of a disease suspected of Lyme disease with unusual results of serological were made later in two other laboratories. The advantages of the two-stage diagnosis of Lyme disease with the sequential use of ELISA and WB and the possible consequences of the diagnosis of the disease using only one laboratory technique are considered. Attention is drawn to differences in the interpretation of WB results according to the criteria of the Center for Disease Control (CDC, USA) and manufacturers of alternative test systems. Factors that can contribute to false-positive examination results are considered: depending on the patient (the presence of concomitant rheumatic, infectious diseases) and on the erroneous interpretation of the results of laboratory tests (considering weakly positive bands as a positive result, the presence of several bands within one, neglecting a slight shift of the band in relation to its location in control, etc.). Attention is also drawn to the impacton the results of the study of the presence of «anamnestic» antibodies in a certain percentage of people living inareas endemic for Lyme disease. Based on the above theoretical propositions, a thorough analysis was carried out regarding the compliance of the clinical manifestations of the case of the disease considered in the article with the criteria of the early localized form of Lyme disease. On the basis of the criteria found in scientific publications, a clinical and epidemiological comparison of the patient’s data with the results of laboratory examination was carried out regarding their reliability. A conclusion is made regarding the need to rely on clinical data when diagnosing Lyme disease, and to consider laboratory examination results as additional confirmation of the diagnosis. It is emphasized that the high specificity (98%) of the laboratory examination is ensured only due to the two-stage research method with the sequential use of ELISA and WB. In case of questionable WB results, clinical and epidemiological data should be compared with the results of laboratory examination for their reliability. Keywords: Borrelia burgdorferi, diagnosis, IgM IgG immunoblot, Lyme disease, serology