Lyme Disease
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About Lyme Disease

The diagnosis of Lyme disease is based primarily on clinical findings, and it is often appropriate to treat patients with early disease solely on the basis of objective signs and a known exposure. Serologic testing may, however, provide valuable supportive diagnostic information in patients with endemic exposure and objective clinical findings that suggest later stage disseminated Lyme disease. When serologic testing is indicated, CDC recommends testing initially with a sensitive first test, either an enzyme-linked immunosorbent assay (ELISA) or an indirect fluorescent antibody (IFA) test, followed by testing with the more specific Western immunoblot (WB) test to corroborate equivocal or positive results obtained with the first test. Although antibiotic treatment in early localized disease may blunt or abrogate the antibody response, patients with early disseminated or late-stage disease usually have strong serological reactivity and demonstrate expanded WB immunoglobulin G (IgG) banding patterns to diagnostic B. burgdorferi antigens. Antibodies often persist for months or years following successfully treated or untreated infection. Thus, seroreactivity alone cannot be used as a marker of active disease. Neither positive serologic test results nor a history of previous Lyme disease assures that an individual has protective immunity. Repeated infection with B. burgdorferi has been documented. B. burgdorferi can be cultured from 80% or more of biopsy specimens taken from early erythema migrans lesions. However, the diagnostic usefulness of this procedure is limited because of the need for a special bacteriologic medium (modified Barbour-Stoenner-Kelly medium) and protracted observation of cultures. Polymerase chain reaction (PCR) has been used to amplify genomic DNA of B. burgdorferi in skin, blood, cerobro-spinal fluid, and synovial fluid, but PCR has not been standardized for routine diagnosis of Lyme disease.


Berger BW, Johnson RC, Kodner C, Coleman L. Cultivation of Borrelia burgdorferi from erythema migrans lesions and perilesional skin. J Clin Microbiol 1992;30:359-361.

Brettschneider S, Bruckbauser H, Klugbauer K, Hofmann H. Diagnostic value of PCR for detection of Borrelia burgdorferi in skin biopsy and urine samples from patients with skin borreliosis. J Clin Microbiol 1998;36:2658-2665.

Centers for Disease Control and Prevention. Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Aug 11, 1995;44:590-591. (Also available in PDF format [214 KB, 16 pages].)

Dressler F, Whelan JA, Reinhart BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 1993;167:392-400.

Johnson, BJ, Robbins KE, Bailey RE, et al. Serodiagnosis of Lyme disease: accuracy of a two-step approach using a flagella-based ELISA and immunoblotting. J Infect Dis 1996;174:346-353.

Nocton JJ, Dressler F, Rutledge BJ, et al. Detection of Borrelia burgdorferi by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. N Engl J Med 1994;44:1203-1207.

Nowakowski J, Schwartz I, Nadelman RB, et al. Culture-confirmed infection and reinfection with Borrelia burgdorferi. Ann Intern Med 1997;127:130-132.

Tugwell P, Dennis DT, Weinstein A, et al. Clinical guideline 2: laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med 1997; 127:1109-1123.

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About Lyme Disease
Causes and Transmission

Clinical Symptoms
Treatment Strategies
Conventional Treatment
The Dilemma
Why Chinese Medicine

Spirochete Diseases in China and Modern Chinese Medicine
The Design of Comprehensive LD Treatment Strategy
Herxheimer's Reaction