Advances in Serodiagnostic Testing for Lyme Disease are at Hand
Microbiology and Immunology
The cause of Lyme disease, Borrelia burgdorferi, was discovered in 1983. A 2-tiered testing protocol was established for serodiagnosis in 1994, involving an enzyme immunoassay (EIA) or indirect fluorescence antibody, followed (if reactive) by immunoglobulin M and immunoglobulin G Western immunoblots. These assays were prepared from whole-cell cultured B. burgdorferi, lacking key in vivo expressed antigens and expressing antigens that can bind non-Borrelia antibodies. Additional drawbacks, particular to the Western immunoblot component, include low sensitivity in early infection, technical complexity, and subjective interpretation when scored by visual examination. Nevertheless, 2-tiered testing with immunoblotting remains the benchmark for evaluation of new methods or approaches. Next-generation serologic assays, prepared with recombinant proteins or synthetic peptides, and alternative testing protocols, can now overcome or circumvent many of these past drawbacks. This article describes next-generation serodiagnostic testing for Lyme disease, focusing on methods that are currently available or near-at-hand.
Branda, J., Body, B., Branson, B., Dattwyler, R., Fikrig, E., Witkowski, J., & Schutzer, S. (2018). Advances in Serodiagnostic Testing for Lyme Disease are at Hand. Clinical Infectious Diseases, 66 (7), 1133-1139. https://doi.org/10.1093/cid/cix943