Abstract
Laboratory diagnosis of Lyme borreliosis is based on the detection of specific IgG and IgM antibodies against relevant antigens of Borrelia burgdorferi. Serological diagnosis usually is performed by a two-step procedure. Where immunoassays for antibody screening exhibit high sensitivity, second-line tests, e.g. Western-blot or line-blot assays,show high specificity, and are used for confirmation of positive screening results. In addition to serology, in certain cases Borrelia spp. can be detected directly, for instance in synovial fluid from patients with Lyme arthritis by PCR or bacterial culture. With the development of multiplex technology, e.g. bead-based immunoassays, multiple antibodies to distinct bacterial antigens can be detected in a single run. Detection systems used in this context, e.g. analysers based on flow cytometry, can be highly standardised and automated. Furthermore, these analysers can be connected bidirectionally to an order-entry based laboratory information system, with random access for high throughput analysis. Thus, multiplex bead assays may have the power to replace the current two-step procedure.
Highlights
In Europe, there are two common infectious diseases transmitted by ticks
Infection by FSME-virus leads to meningoencephalitis, while Lyme borreliosis is caused by the spriochetal bacterium, Borrelia burgdorferi
In the USA, almost only infection with B. burgdorferi sensu stricto results in development of Lyme borreliosis, while in Europe, borreliosis is commonly caused by infection with B. afzelii and B. garinii
Summary
In Europe, there are two common infectious diseases transmitted by ticks. Infection by FSME-virus leads to meningoencephalitis, while Lyme borreliosis is caused by the spriochetal bacterium, Borrelia burgdorferi. In the USA, almost only infection with B. burgdorferi sensu stricto results in development of Lyme borreliosis, while in Europe, borreliosis is commonly caused by infection with B. afzelii and B. garinii. There is no strict discrimination of the stages and late manifestations may occur without early disease symptoms. The main early manifestation is erythema chronicum migrans This characteristic skin disease occurs 3 to 30 days after tick-bite. In USA, arthritis (Lyme arthritis) is a common symptom of late stage borreliosis, and encephalomyelitis and acrodermatitis chronica athrophicans may occur. Serological laboratory diagnosis of Lyme disease is usually done in a two-step procedure, beginning with a screening assay to detect IgG and IgM anti-borrelia antibodies. High sensitivity usually results in low specificity of laboratory test systems, especially for IgM antibody assays.
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