2000 False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays

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False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays.

J Med Microbiol 2000 Oct;49(10):911-5   (ISSN: 0022-2615)

Kaiser R [Find other articles with this Author]
Neurologische Klinik und Poliklinik der Albert-Ludwigs-Universitat Freiburg, Germany.

The risk of obtaining false-negative results in serological assays in serum and CSF
specimens with only one strain of Borrelia burgdorferi sensu lato as antigen was
investigated in 79 patients with neuroborreliosis with specimens obtained at initial
presentation. Serum antibodies were assessed by immunoblotting; the criteria of Hauser et al. were used to evaluate the test. The intrathecal synthesis of borrelial-specific IgM and IgG antibodies was examined by enzyme immunoassay (EIA). Strains of B. burgdorferi sensu stricto (BbZ160), B. garinii (Bbii50) and B. afzelii (PKO) served as sources of antigen in both assays. All patients produced either a positive IgM or IgG test in serum with at least one strain of B. burgdorferi sensu lato. Reactivity of IgM or IgG antibodies, or both, with antigens of all three strains was demonstrated in 67 (85%) of 79 sera. The correlation of results of immunoblotting with different strains was significantly better for IgG (85%) than for IgM antibodies (54%). The variability of positive IgM reactions in 18 specimens was mainly due to the fact that the antibodies were directed to the relevant variable outer-surface protein C (p23). Intrathecal synthesis of IgG antibodies was demonstrated in 58 patients (81%) of 72 and of IgM antibodies in 25 of 58 patients. No patient had isolated intrathecal synthesis of IgM antibodies. The majority of CSF samples (56 of 58) were assessed as IgG antibody-positive, independent of the borrelial strain used as antigen in EIA, whereas only 10 of 25 IgM antibody-positive CSF specimens reacted with all three strains. All patients in the study had intrathecal antibody synthesis demonstrable at 6-week follow-up. From this study it is concluded that there is a small, but real, risk of false-negative serological findings at the time of initial clinical presentation in patients with typical symptoms of neuroborreliosis. In these patients a negative serological result with one strain should prompt the repetition of the test with other strains of B. burgdorferi sensu lato.

Major Subject Heading(s) Minor Subject Heading(s) CAS Registry / EC Numbers
Antibodies, Bacterial [blood]
Borrelia burgdorferi [immunology]
Lyme Neuroborreliosis [diagnosis]
Find other articles with similar Subjects.
Antibodies, Bacterial [cerebrospinal fluid]
Antibodies, Monoclonal
Antigens, Bacterial [immunology]
Bacterial Outer Membrane Proteins [immunology]
Blotting, Western
Borrelia burgdorferi [classification] [isolation & purification]
Electrophoresis, Polyacrylamide Gel
Enzyme-Linked Immunosorbent Assay
False Negative Reactions
Lyme Neuroborreliosis [immunology]
Predictive Value of Tests
0 (Antibodies, Bacterial)
0 (Antibodies, Monoclonal)
0 (Antigens, Bacterial)
0 (Bacterial Outer Membrane Proteins)
Indexing Check Tags: Human; Support, Non-U.S. Gov't
Language: English
MEDLINE Indexing Date: 200010
Publication Type: Journal Article
PreMedline Identifier: 0011023188
Unique NLM Identifier: 20476039
Journal Code: IM

Original Message: Date: 11/30/2001 6:31:18 PM Eastern Standard Tim
In a message dated 11/6/2001 11:27:54 AM Eastern Standard Time, barb writes:
Barb (she was a dear Lyme friend) offered the following as proof of Borrelia persistence.  These emails were originally posted on Actionlyme and also sent privately.