Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients

• Published in: Clinical rheumatology Vol. 34; no. 3; pp. 585 - 589
• Main Authors: Rebman, Alison W., Crowder, Lauren A., Kirkpatrick, Allison, Aucott, John N.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.03.2015; Springer Nature B.V
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Borrelia burgdorferi; Borrelia burgdorferi - immunology; Brief Report; Doxycycline - therapeutic use; Female; Humans; Lyme Disease - diagnosis; Lyme Disease - drug therapy; Lyme Disease - immunology; Male; Medicine; Medicine & Public Health; Middle Aged; Prospective Studies; Rheumatology; Seroconversion; Syndrome; Young Adult; Lyme disease; Seroconversion
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-014-2706-z

Two-tier serology is often used to confirm a diagnosis of Lyme disease. One hundred and four patients with physician diagnosed erythema migrans rashes had blood samples taken before and after 3 weeks of doxycycline treatment for early Lyme disease. Acute and convalescent serologies for Borrelia burgdorferi were interpreted according to the 2-tier antibody testing criteria proposed by the Centers for Disease Control and Prevention. Serostatus was compared across several clinical and demographic variables both pre- and post-treatment. Forty-one patients (39.4 %) were seronegative both before and after treatment. The majority of seropositive individuals on both acute and convalescent serology had a positive IgM western blot and a negative IgG western blot. IgG seroconversion on western blot was infrequent. Among the baseline variables included in the analysis, disseminated lesions ( p  < 0.0001), a longer duration of illness ( p  < 0.0001), and a higher number of reported symptoms ( p  = 0.004) were highly significantly associated with positive final serostatus, while male sex ( p  = 0.05) was borderline significant. This variability, and the lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Furthermore, these findings underline the difficulty for rheumatologists in identifying a prior exposure to Lyme disease in caring for patients with medically unexplained symptoms or fibromyalgia-like syndromes.