Borrelia burgdorferi and Lyme Disease (page 5)
(This chapter has 6 pages)
© Kenneth Todar, PhD
Diagnosis of Lyme disease
Lyme disease is often difficult to diagnose because its symptoms and
signs mimic those of so many other diseases. The fever, muscle aches,
fatigue of Lyme disease can easily be mistaken for viral infections,
as influenza or infectious mononucleosis. Joint pain can be mistaken
other types of arthritis, such as rheumatoid arthritis, and neurologic
signs can mimic those caused by other conditions, such as multiple
At the same time, other types of arthritis or neurologic diseases can
misdiagnosed as Lyme disease.
The clinical diagnosis of Lyme disease is usually based on history
possible exposure to ticks, especially in areas where Lyme disease is
to occur and a combination of symptoms and signs of infection.
to detect anti-borrelia antibodies is not useful until in later stages
of illness. Serologic testing may, however, provide valuable supportive
diagnostic information in patients with endemic exposure and/or
findings that suggest late stage or disseminated Lyme disease.
When serologic testing is indicated, CDC recommends testing first
an enzyme-linked immunosorbent assay (ELISA) or an indirect fluorescent
antibody (IFA) test, followed by a more specific Western immunoblot
test to corroborate equivocal or positive results obtained with the
test. None of these tests is useful in the diagnosis of early stages of
Lyme disease since a primary serum immune response is just beginning.
these tests are associated with a high degree of cross-reactivity,
sera from patients with Rocky Mountain spotted fever, relapsing fever,
mononucleosis, syphilis, and rheumatoid arthritis often test positive
Patients with early disseminated or late-stage disease usually have
strong serological reactivity. Antibodies may persist for months or
following successfully treated or untreated infection. Thus,
alone cannot be used as a marker of active disease.
Neither a positive serologic activity nor a history of previous Lyme
disease assures that an individual has protective immunity. Repeated
with B. burgdorferi has been documented.
B. burgdorferi can be cultured from 80% or more of biopsy
taken from early erythema migrans lesions. However, the
value of this procedure is limited because of the need for special
media (BSK medium) and protracted observation of cultures.
The polymerase chain reaction (PCR) has been used to amplify genomic
of B. burgdorferi in skin, blood, cerebrospinal fluid, and
fluid, but PCR has not been standardized for routine diagnosis of Lyme