Testing for Lyme borreliosis: could serology tell more?

Year 2020, Volume: 5 Issue: 3, 85 - 93, 30.09.2020

András Zóka Márton Gönczy Veronika Barbai Radka Nikolova Eszter Ujhelyi Zsuzsa Kienle Gabriella Bekő

Abstract

Purpose:
Remnant antibodies might be prevalent in the general population, thus recognizing relevant seropositivity might be challenging. The sequential nature of the anti-Borrelia antibody response might be diagnostically utilized. We aimed to specify details which might potentially be useful in orientating the diagnostic schedule.

Methods:
We processed the sera of 1304 patients using a recombinant antigen-based ELISA between Aprils of 2017 and 2019. Seroreactivity (when coherent with the anamnestic data) was confirmed with a line immunoassay (LIA). ELISA testing (IgG and/or IgM) was reactive in 539 cases. 107 patients with persistent symptoms tested positive or borderline with IgG ELISA.

Results:
A significant difference was observed (Mann-Whitney U-test p=0.003) between the LIA scores of patients with characteristic (arthritis, acrodermatitis, neuropathy, other objective neurologic disorder; n=83; median LIA score: 16) and non-specific symptoms (entirely subjective complaints, other known disease, lone subfebrility, uveitis; n=24; median LIA score: 6). 101 of the 107 patients tested positive for IgG against any specific protein by LIA. Those with a LIA score reaching the group median of 15 (n=51) displayed strong anti-VlsE IgG positivity or a typical late IgG antibody (against p100, p18 or p39) more often than those below (88,2% vs. 30% and 100% vs. 38% respectively, Χ2 p<0.0001).

Conclusions:
Weak LIA positivity (especially anti-VlsE IgG) in combination with the lack of late antibodies in patients with persistent symptoms might suggest the presence of remnant antibodies and prompt scrupulous differential diagnosis.

Keywords

serology, Lyme borreliosis, differential diagnosis

Supporting Institution

South-Pest Central Hospital, National Institute for Infectology and Haematology, Budapest, Hungary

Project Number

EB/14/2019 (license number by Institutional Commitee of Science and Research Ethics)

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