Herremans T, Van Burgel TD, Brandenburg AH, Meijer B, Verduyn Lunel F, Nabuurs-Franssen M, Stelma FF, Ang CW, Van Dam AP, Bijlmer HA
Interlaboratoriumvariatie van de serologie voor de ziekte van Lyme in Nederland.
Ned Tijdschr Med Microbiol 2012;20:nr3, 105-110 Ang CW, Brandenburg AH, Van Burgel ND, Bijlmer NA,Herremans T, Stelma FF, Verduyn Lunel F, Van Dam AP.
Nationale vergelijking van serologische assays voor het aantonen van Borrelia-antistoffen.
Ned Tijdschr Med Microbiol 2012;20:nr3, 111-119 Ang CW, Van Burgel ND.
Borrelia-serologie in de Nederlandse situatie: interpretatie van testuitslagen en ontwikkelingen.
Ned Tijdschr Med Microbiol 2012;20:nr3, 120-125 Ang CW.
Diagnostische (on)mogelijkheden bij Borrelia-infecties.
Ned Tijdschr Med Microbiol 2012;20:nr3, 126-129 Van Nunen FJHB, Sprong H, Hofhuis A, Bijlmer HA Herremans T.
Detectie van Borrelia burgdorferi s.l.-specifieke immuuncomplexen in patiënten met erythema migrans en neuroborreliose.
Ned Tijdschr Med Microbiol 2012;20:nr3, 130-133 Steere AC, Taylor E, McHugh GL, Logigian EL.
The overdiagnosis of Lyme disease.
JAMA. 1993 Apr 14;269():1812-6. Ang CW, Notermans DW, Hommes M, Simoons-Smit AM, Herremans T
Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots.
Eur J Clin Microbiol Infect Dis. 2011 August; 30(8): 1027–1032
"There are numerous examples—from this and other studies—in which patients with early Lyme disease were initially ELISA-positive and blot-negative. In such cases,immunoblot seroconversion can only be documented in a follow-up sample, and, sometimes, even this option is blocked because antibiotic treatment may interfere with the development of the anti-Borrelia antibody response"
" Surprisingly, we found anti-Borrelia immunoblot reactivity in samples that were negative in all eight ELISAs. These are samples that normally would not have been tested in immunoblots. Again, this was not dependent on the nature of the antigen used for the immunoblot. For the Euroimmun immunoblot, 4/11 (36%) of the ELISA-negative samples were blot-positive. "
Wormser GP, Schriefer M, Aguero-Rosenfeld ME,Levin A, Steere AC, Nadelman RB, Nowakowski J,Marques A, Johnson BJ, Dumler JS.
Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease.
Diagn Microbiol Infect Dis. 2013 Jan;75(1):9-15.
“In this study, the diagnostic accuracy of a single-tiercommercial C6 ELISA kit was compared with 2-tiertesting. The results showed that the C6 ELISA wassignificantly more sensitive than 2-tier testing withsensitivities of 66.5% (95% confidence interval [CI] 61.7-71.1) and 35.2% (95% CI 30.6-40.1), respectively (P <0.001) in 403 sera from patients with erythema migrans. ”
Stichting de Ombudsman & NVLP. De ziekte van Lyme, een onderschat probleem.Onderzoek naar de gevolgen voor patiënten enmaatschappij, september 2011. 146 p.In tabel 4.2 zien we dat 17% van de lymepatiëntenminstens twee negatieve tests en minimaal één positievetest hadden en 9% minstens drie negatieve tests enminimaal één positieve test. 12% van de patiënten hadeen negatieve EIA test én een positieve Immunoblot - door de Nederlandse labs zouden deze patiënten als'negatief' bestempeld zijn, want na een negatieve EIAwordt - conform advies van de microbiologen - geenImmunoblot uitgevoerd.
Donta ST.Late and chronic Lyme disease.Med Clin North Am. 2002 Mar;86(2):341-9, vii. Aguero-Rosenfeld ME, Wang G, Schwartz I, WormserGP.
Diagnosis of lyme borreliosis.Clin Microbiol Rev. 2005 Jul;18(3):484-509.
“PCR positivity in seronegative patients suspected ofhaving late manifestations of LB most likely represents afalse-positive result. ”
Jolanta Chmielewska-Badora1, Ewa Cisak1, AngelinaWójcik-Fatla1, Jacek Zwoliński1,Alicja Buczek2, Jacek Dutkiewicz1.
Correlation of tests for detection of Borrelia burgdorferisensu lato infection in patients with diagnosed borreliosis.
Ann Agric Environ Med 2006, 13, 307–311
“No correlation was found to exist between the PCRresults and the results of any of the serologic tests fordetection of anti B. burgdorferi s.l. antibodies of IgM class.PCR results correlated significantly at a relatively low level(0.01 < p < 0.05) with the results of IgG-ELISA, but notwith the results of IgG-immunoblot with regard to totalreactions (0.2 < p < 0.1). ”
Coulter P, Lema C, Flayhart D, Linhardt AS, AucottJN, Auwaerter PG, Dumler JS.
Two-year evaluation of Borrelia burgdorferi culture andsupplemental tests for definitive diagnosis of Lymedisease. J Clin Microbiol. 2005 Oct;43:5080-4.
“Overall, 30 of 86 patients (35%) were culture positive,whereas an additional 15 of 84 (18%) were seropositiveonly (51% total sero- and culture positive), and PCR onskin biopsy identified 4 additional patients who wereneither culture nor seropositive ,,
Tylewska-Wierzbanowska S, Chmielewski T Limitation of serological testing for Lyme borreliosis:evaluation of ELISA and western blot in comparison withPCR and culture methods. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):601-5. “No correlation was found between levels of specific B.burgdorferi antibodies detected with a recombinantantigen ELISA and the number of protein fractionsdeveloped with these antibodies by immunoblot.Moreover, Lyme borreliosis patients who have livespirochetes in body fluids have low or negative levels ofborrelial antibodies in their sera. This indicates that anefficient diagnosis of Lyme borreliosis has to be based ona combination of various techniques such as serology,PCR and culture, not solely on serology. ” Grignolo MC, Buffrini L, Monteforte P, Rovetta G Reliability of a polymerase chain reaction (PCR) techniquein the diagnosis of Lyme borreliosis.Minerva Med. 2001 Feb;92(1):29-33. “50% of the PCR positive results, obtained with serum andcerebrospinal fluid samples corresponded to patients whowere true positives at clinical examination but negatives atserologic tests. ” Honegr K, Hulínská D, Dostál V, Gebouský P,Hanková E, Horácek J, Vyslouzil L, Havlasová J. Persistence of Borrelia burgdorferi sensu lato in patientswith Lyme borreliosis. Epidemiol Mikrobiol Imunol. 2001 Feb;50(1):10-6. “In 18 patients with Lyme borreliosis the authors provedthe persistence of Borrelia burgdorferi sensu lato bydetection of the causal agent by immune electronmicroscopy or of its DNA by PCR in plasma orcerebrospinal fluid after an interval of 4-68 months.Clinical manifestations common in Lyme borreliosis werepresent in only half the patients, in the remainder non-specific symptoms were found. In nine subjects withconfirmed Borrelia burgdorferi sensu lato in thecerebrospinal fluid the cytological and biochemical findingwas normal. Examination of antibodies by the ELISAmethod was negative in 7 of 18 patients during the firstexamination and in 12 of 18 during the secondexamination ” Girard YA, Fedorova N, Lane RS Genetic Diversity of Borrelia burgdorferi and Detection of B. bissettii-Like DNA in Serum of North-Coastal California Residents.J Clin Microbiol. 2011 March; 49(3): 945–954. "Clinical and serological data previously gathered fromCHR residents and analyzed (17, 18) were reevaluated inthe light of our new, PCR-based evidence of B. burgdorferiinfection among the study subjects. Three out of 16(18.8%) and 7/12 (58.3%) (P = 0.039) of the B. burgdorferiPCR-positive sera collected in 1988 and 1989,respectively, were test positive for LB antibodies using themost stringent criteria. Greater concordance betweenPCR and serology was found when borderline sampleswere considered . Most B. burgdorferi PCR-positiveindividuals reported one or more LB clinical manifestationsor had physician-diagnosed LB. Of the 24 subjects whowere B. burgdorferi PCR positive in at least 1 year, 79.1%reported a history of one or more tick bites. In the same24 individuals, joint pain was the most common symptom followed by EM and flu-like illness, neurologicalmanifestations, and cardiac abnormalities." Jiang Y, Hou XX, Geng Z, Hao Q, Wan KL. Interpretation criteria for standardized Western blot for thepredominant species of Borrelia burgdorferi sensu lato in China. Biomed Environ Sci. 2010 Oct;23(5):341-9. Liu ZY, Hao Q, Hou XX, Jiang Y, Geng Z, Wu YM,Wan KL.A Study of the Technique of Western Blot for Diagnosis ofLyme Disease caused by Borrelia afzelii in China. Biomed Environ Sci. 2013 Mar;26(3):190-200. Brandenburg AH, Van Dam AP, Schellekens J. Problems in comparing test strategies for detection of anti-Borrelia antibodies. Eur J Clin Microbiol Infect Dis. 2011 Aug;30(8):1033-4;author reply 1035-7.(21) Laane MM, Mysterud I.
A simple method for the detection of live Borreliaspirochaetes in human blood using classical microscopytechniques. Biological and Biomedical Reports 2013, 3(1), 15-28 “We also present a simple hypothesis for explaining theconfusion generated through the interpretation of possiblestages of Borrelia seen in human blood. We hypothesizethat these various stages in the blood stream are derivedfrom secondarily infected tissues and biofilms in the bodywith low oxygen concentrations. Motile stages transformrapidly into cysts or sometimes penetrate other blood cellsincluding red blood cells (RBCs). The latter are idealhiding places for less motile stages that take advantage ofthe host’s RBCs blebbing-system. Less motile, morphologically different stages may be passively ejectedin the blood plasma from the blebbing RBCs, more or lesscoated with the host’s membrane proteins which preventdetection by immunological methods.” Brunner M.Report refuting value of immune complexes to diagnoselyme disease is invalid.Letters to the editor. Clin Vaccine Immunol. 2006;13:304-6(23) Goossens HA, van den Bogaard AE, Nohlmans MK. Evaluation of fifteen commercially available serologicaltests for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 1999 Aug;18(8):551-60. "The performance of 11 commercially available enzymeimmunoassays (EIA) and four Western blot (WB) tests forthe detection of IgM and IgG antibodies against Borreliaburgdorferi were compared. ... In specimens from patientswith early Lyme borreliosis, the sensitivity of the individualtests ranged from 35 to 81% for detection of IgM. In lateLyme borreliosis, sensitivity of the tests ranged from 46 to92%. In healthy controls the specificity of the tests rangedfrom 89 to 100% and from 82 to 97% for IgM and IgGtests, respectively. In the patient control group, specificityof the tests ranged from 75 to 90% for IgM and from 84 to100% for IgG tests. ... The maximum sensitivity ofWestern blotting for detecting IgM in patients with earlyLyme borreliosis and IgG in patients with late Lymeborreliosis was 50 and 46%, respectively. The use of anEIA-WB two-test protocol improved the specificity andpositive predictive values of the EIA results but caused asignificant loss in sensitivity Hunfeld KP, Stanek G, Straube E,Hagedorn HJ,Schörner C, Mühlschlegel F, Brade V. Quality of Lymedisease serology.Lessons from the German Proficiency Testing Program1999- 2001. A preliminary report. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):591-600." ,,Test results were found to be in part highly variable andclearly correlated with the manufacturers and the appliedtest methodology. ... Quantification of test results andreporting of specific immunoblot bands also showed highvariability. Moreover, for some assays a high number offalse positive and false negative test results were reportedby the participants.,, ,,...In view of our results further standardisation of Lymedisease serology is not just desirable but is urgentlyneeded. Moreover, stronger criteria for the validation ofavailable test kits must be applied."
Smismans A, Goossens VJ, Nulens E, BruggemanCA.
Comparison of five different immunoassays for thedetection of Borrelia burgdorferi IgM and IgG antibodies. Clin Microbiol Infect. 2006 Jul;12(7):648-55.
"The performances of five commercially available enzymeimmunoassays were compared for the detection ofBorrelia burgdorferi IgM and IgG antibodies. Sensitivitywas assessed with European serum samples collectedfrom 45 patients with clinically defined Lyme disease inconjunction with a positive immunoblot (n = 44) or otherserological test (n = 1). Sensitivities for the detection ofIgM and IgG with each test were: Dako IgM 64%; DakoIgG 53%; Serion IgM 89%; and Serion IgG 88%. TheImmunetics assay makes no distinction between IgM andIgG antibodies and had a sensitivity of 91%. Specificitywas calculated by testing a control group comprising 40patients with acute Epstein-Barr virus infection, cytomegalovirus infection, syphilis or rheumatoid factorpositivity. The specificities achieved for each test were:Dako IgM 78%; Dako IgG 100%; Serion IgM 52%; SerionIgG 92%; and Immunetics 92%."
Müller I, Freitag MH, Poggensee G, Scharnetzky E,Straube E, Schoerner Ch, Hlobil H, Hagedorn HJ, StanekG, Schubert-Unkmeir A, Norris DE, Gensichen J, HunfeldKP
Evaluating frequency, diagnostic quality, and cost of Lymeborreliosis testing in Germany: a retrospective modelanalysis. Clin Dev Immunol. 2012;2012:595427.
"Currently, a large variety of serological tests for thedetection of LB are available in the European market,supplied by an increasing number of manufacturers. ...the quantity of detected antibody measured in titers orquantitative EIA results and, similarly, the number andcategory of specific immunoblot bands can vary greatly forthe same sample. In addition, changes in qualitative andquantitative serologic test results may be misleading andcan emerge simply by using different assay systems indifferent laboratories. "
Baranton G, Seinost G, Theodore G, Postic D,Dykhuizen D.
Distinct levels of genetic diversity of Borrelia burgdorferiare associated with different aspects of pathogenicity. Res Microbiol. 2001 Mar;152(2):149-56.
"Only two groups in B. afzelii and four groups in B. gariniicause invasive disease. Thus, only ten out of the 58defined ospC groups cause invasive and presumablychronic Lyme disease."
Wormser GP, Brisson D, Liveris D, Hanincová K,Sandigursky S, Nowakowski J, Nadelman RB, Ludin S,Schwartz I.
Borrelia burgdorferi genotype predicts the capacity forhematogenous dissemination during early Lyme disease. J Infect Dis. 2008 Nov 1;198(9):1358-64.
" ... a distinct subset of just 4 of the 16 ospC genotypesidentified were responsible for >80% of cases of earlydisseminated Lyme disease."
Crowder CD, Matthews HE, Schutzer S, Rounds MA,Luft BJ, Nolte O, Campbell SR, Phillipson CA, Li F,Sampath R, Ecker DJ, Eshoo MW.
Genotypic variation and mixtures of Lyme Borrelia inIxodes ticks from North America and Europe. PLoS One. 2010 May 14;5(5):e10650.
"Human risk for the disease may be dependent on acomplex interaction between environment and vector withtransmission of the resultant bacterial genotypes anessential determinant of disease.""Previous studies have shown that certain strains of B.burgdorferi are more likely to cause an erythema migransand/or disseminate through the body. The ability to quicklyidentify the Borrelia species and associate particulargenotypes with certain symptoms can have importantpatient-management implications."These findings indicate genotype mixtures in ticks arecommon in both Europe and North America. ... Exposureto multiple Borrelia genotypes from a single tick bite mayfurther increase the risk of disseminated Lyme disease."
Tijsse-Klasen E, Pandak N, Hengeveld P, Takumi K,Koopmans MP, Sprong H.
Ability to cause erythema migrans differs between Borreliaburgdorferi sensu lato isolates.Parasit Vectors. 2013 Jan 22;6(1):23.
"We identified a strong correlation of certain IGS andospC types with formation of erythema migrans. Thisindicates that only a small subset of B. burgdorferi slcarried by ticks in the wild actually cause EM. Othergenotypes either may be apathogenic for humans or maycause Lyme borreliosis without the typical first sign ofinfection. However, as we restricted our investigation toan early form of Lyme borreliosis, it cannot be excludedthat other B. burgdorferi sl genospecies and genotypes,not associated with EM, might omit this early sign of Lymeborreliosis and still lead to disseminated infections."
Tylewska-Wierzbanowska S, Chmielewski T Limitation of serological testing for Lyme borreliosis:evaluation of ELISA and western blot in comparison withPCR and culture methods. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):601-5. “No correlation was found between levels of specific B.burgdorferi antibodies detected with a recombinantantigen ELISA and the number of protein fractionsdeveloped with these antibodies by immunoblot.Moreover, Lyme borreliosis patients who have livespirochetes in body fluids have low or negative levels ofborrelial antibodies in their sera. This indicates that anefficient diagnosis of Lyme borreliosis has to be based ona combination of various techniques such as serology,PCR and culture, not solely on serology. ” Grignolo MC, Buffrini L, Monteforte P, Rovetta G Reliability of a polymerase chain reaction (PCR) techniquein the diagnosis of Lyme borreliosis.Minerva Med. 2001 Feb;92(1):29-33. “50% of the PCR positive results, obtained with serum andcerebrospinal fluid samples corresponded to patients whowere true positives at clinical examination but negatives atserologic tests. ” Honegr K, Hulínská D, Dostál V, Gebouský P,Hanková E, Horácek J, Vyslouzil L, Havlasová J. Persistence of Borrelia burgdorferi sensu lato in patientswith Lyme borreliosis. Epidemiol Mikrobiol Imunol. 2001 Feb;50(1):10-6. “In 18 patients with Lyme borreliosis the authors provedthe persistence of Borrelia burgdorferi sensu lato bydetection of the causal agent by immune electronmicroscopy or of its DNA by PCR in plasma orcerebrospinal fluid after an interval of 4-68 months.Clinical manifestations common in Lyme borreliosis werepresent in only half the patients, in the remainder non-specific symptoms were found. In nine subjects withconfirmed Borrelia burgdorferi sensu lato in thecerebrospinal fluid the cytological and biochemical findingwas normal. Examination of antibodies by the ELISAmethod was negative in 7 of 18 patients during the firstexamination and in 12 of 18 during the secondexamination ” Girard YA, Fedorova N, Lane RS Genetic Diversity of Borrelia burgdorferi and Detection of B. bissettii-Like DNA in Serum of North-Coastal California Residents.J Clin Microbiol. 2011 March; 49(3): 945–954. "Clinical and serological data previously gathered fromCHR residents and analyzed (17, 18) were reevaluated inthe light of our new, PCR-based evidence of B. burgdorferiinfection among the study subjects. Three out of 16(18.8%) and 7/12 (58.3%) (P = 0.039) of the B. burgdorferiPCR-positive sera collected in 1988 and 1989,respectively, were test positive for LB antibodies using themost stringent criteria. Greater concordance betweenPCR and serology was found when borderline sampleswere considered . Most B. burgdorferi PCR-positiveindividuals reported one or more LB clinical manifestationsor had physician-diagnosed LB. Of the 24 subjects whowere B. burgdorferi PCR positive in at least 1 year, 79.1%reported a history of one or more tick bites. In the same24 individuals, joint pain was the most common symptom followed by EM and flu-like illness, neurologicalmanifestations, and cardiac abnormalities." Jiang Y, Hou XX, Geng Z, Hao Q, Wan KL. Interpretation criteria for standardized Western blot for thepredominant species of Borrelia burgdorferi sensu lato in China. Biomed Environ Sci. 2010 Oct;23(5):341-9. Liu ZY, Hao Q, Hou XX, Jiang Y, Geng Z, Wu YM,Wan KL.A Study of the Technique of Western Blot for Diagnosis ofLyme Disease caused by Borrelia afzelii in China. Biomed Environ Sci. 2013 Mar;26(3):190-200. Brandenburg AH, Van Dam AP, Schellekens J. Problems in comparing test strategies for detection of anti-Borrelia antibodies. Eur J Clin Microbiol Infect Dis. 2011 Aug;30(8):1033-4;author reply 1035-7.(21) Laane MM, Mysterud I.
A simple method for the detection of live Borreliaspirochaetes in human blood using classical microscopytechniques. Biological and Biomedical Reports 2013, 3(1), 15-28 “We also present a simple hypothesis for explaining theconfusion generated through the interpretation of possiblestages of Borrelia seen in human blood. We hypothesizethat these various stages in the blood stream are derivedfrom secondarily infected tissues and biofilms in the bodywith low oxygen concentrations. Motile stages transformrapidly into cysts or sometimes penetrate other blood cellsincluding red blood cells (RBCs). The latter are idealhiding places for less motile stages that take advantage ofthe host’s RBCs blebbing-system. Less motile, morphologically different stages may be passively ejectedin the blood plasma from the blebbing RBCs, more or lesscoated with the host’s membrane proteins which preventdetection by immunological methods.” Brunner M.Report refuting value of immune complexes to diagnoselyme disease is invalid.Letters to the editor. Clin Vaccine Immunol. 2006;13:304-6(23) Goossens HA, van den Bogaard AE, Nohlmans MK. Evaluation of fifteen commercially available serologicaltests for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 1999 Aug;18(8):551-60. "The performance of 11 commercially available enzymeimmunoassays (EIA) and four Western blot (WB) tests forthe detection of IgM and IgG antibodies against Borreliaburgdorferi were compared. ... In specimens from patientswith early Lyme borreliosis, the sensitivity of the individualtests ranged from 35 to 81% for detection of IgM. In lateLyme borreliosis, sensitivity of the tests ranged from 46 to92%. In healthy controls the specificity of the tests rangedfrom 89 to 100% and from 82 to 97% for IgM and IgGtests, respectively. In the patient control group, specificityof the tests ranged from 75 to 90% for IgM and from 84 to100% for IgG tests. ... The maximum sensitivity ofWestern blotting for detecting IgM in patients with earlyLyme borreliosis and IgG in patients with late Lymeborreliosis was 50 and 46%, respectively. The use of anEIA-WB two-test protocol improved the specificity andpositive predictive values of the EIA results but caused asignificant loss in sensitivity Hunfeld KP, Stanek G, Straube E,Hagedorn HJ,Schörner C, Mühlschlegel F, Brade V. Quality of Lymedisease serology.Lessons from the German Proficiency Testing Program1999- 2001. A preliminary report. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):591-600." ,,Test results were found to be in part highly variable andclearly correlated with the manufacturers and the appliedtest methodology. ... Quantification of test results andreporting of specific immunoblot bands also showed highvariability. Moreover, for some assays a high number offalse positive and false negative test results were reportedby the participants.,, ,,...In view of our results further standardisation of Lymedisease serology is not just desirable but is urgentlyneeded. Moreover, stronger criteria for the validation ofavailable test kits must be applied."
Smismans A, Goossens VJ, Nulens E, BruggemanCA.
Comparison of five different immunoassays for thedetection of Borrelia burgdorferi IgM and IgG antibodies. Clin Microbiol Infect. 2006 Jul;12(7):648-55.
"The performances of five commercially available enzymeimmunoassays were compared for the detection ofBorrelia burgdorferi IgM and IgG antibodies. Sensitivitywas assessed with European serum samples collectedfrom 45 patients with clinically defined Lyme disease inconjunction with a positive immunoblot (n = 44) or otherserological test (n = 1). Sensitivities for the detection ofIgM and IgG with each test were: Dako IgM 64%; DakoIgG 53%; Serion IgM 89%; and Serion IgG 88%. TheImmunetics assay makes no distinction between IgM andIgG antibodies and had a sensitivity of 91%. Specificitywas calculated by testing a control group comprising 40patients with acute Epstein-Barr virus infection, cytomegalovirus infection, syphilis or rheumatoid factorpositivity. The specificities achieved for each test were:Dako IgM 78%; Dako IgG 100%; Serion IgM 52%; SerionIgG 92%; and Immunetics 92%."
Müller I, Freitag MH, Poggensee G, Scharnetzky E,Straube E, Schoerner Ch, Hlobil H, Hagedorn HJ, StanekG, Schubert-Unkmeir A, Norris DE, Gensichen J, HunfeldKP
Evaluating frequency, diagnostic quality, and cost of Lymeborreliosis testing in Germany: a retrospective modelanalysis. Clin Dev Immunol. 2012;2012:595427.
"Currently, a large variety of serological tests for thedetection of LB are available in the European market,supplied by an increasing number of manufacturers. ...the quantity of detected antibody measured in titers orquantitative EIA results and, similarly, the number andcategory of specific immunoblot bands can vary greatly forthe same sample. In addition, changes in qualitative andquantitative serologic test results may be misleading andcan emerge simply by using different assay systems indifferent laboratories. "
Baranton G, Seinost G, Theodore G, Postic D,Dykhuizen D.
Distinct levels of genetic diversity of Borrelia burgdorferiare associated with different aspects of pathogenicity. Res Microbiol. 2001 Mar;152(2):149-56.
"Only two groups in B. afzelii and four groups in B. gariniicause invasive disease. Thus, only ten out of the 58defined ospC groups cause invasive and presumablychronic Lyme disease."
Wormser GP, Brisson D, Liveris D, Hanincová K,Sandigursky S, Nowakowski J, Nadelman RB, Ludin S,Schwartz I.
Borrelia burgdorferi genotype predicts the capacity forhematogenous dissemination during early Lyme disease. J Infect Dis. 2008 Nov 1;198(9):1358-64.
" ... a distinct subset of just 4 of the 16 ospC genotypesidentified were responsible for >80% of cases of earlydisseminated Lyme disease."
Crowder CD, Matthews HE, Schutzer S, Rounds MA,Luft BJ, Nolte O, Campbell SR, Phillipson CA, Li F,Sampath R, Ecker DJ, Eshoo MW.
Genotypic variation and mixtures of Lyme Borrelia inIxodes ticks from North America and Europe. PLoS One. 2010 May 14;5(5):e10650.
"Human risk for the disease may be dependent on acomplex interaction between environment and vector withtransmission of the resultant bacterial genotypes anessential determinant of disease.""Previous studies have shown that certain strains of B.burgdorferi are more likely to cause an erythema migransand/or disseminate through the body. The ability to quicklyidentify the Borrelia species and associate particulargenotypes with certain symptoms can have importantpatient-management implications."These findings indicate genotype mixtures in ticks arecommon in both Europe and North America. ... Exposureto multiple Borrelia genotypes from a single tick bite mayfurther increase the risk of disseminated Lyme disease."
Tijsse-Klasen E, Pandak N, Hengeveld P, Takumi K,Koopmans MP, Sprong H.
Ability to cause erythema migrans differs between Borreliaburgdorferi sensu lato isolates.Parasit Vectors. 2013 Jan 22;6(1):23.
"We identified a strong correlation of certain IGS andospC types with formation of erythema migrans. Thisindicates that only a small subset of B. burgdorferi slcarried by ticks in the wild actually cause EM. Othergenotypes either may be apathogenic for humans or maycause Lyme borreliosis without the typical first sign ofinfection. However, as we restricted our investigation toan early form of Lyme borreliosis, it cannot be excludedthat other B. burgdorferi sl genospecies and genotypes,not associated with EM, might omit this early sign of Lymeborreliosis and still lead to disseminated infections."
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