Advances in Serodiagnostic Testing for Lyme Disease Are at Hand CLINICAL INFECTIOUS DISEASES Branda, J. A., Body, B. A., Boyle, J., Branson, B. M., Dattwyler, R. J., Fikrig, E., Gerald, N. J., Gomes-Solecki, M., Kintrup, M., Ledizet, M., Levin, A. E., Lewinski, M., Liotta, L. A., Marques, A., Mead, P. S., Mongodin, E. F., Pillai, S., Rao, P., Robinson, W. H., Roth, K. M., Schriefer, M. E., Slezak, T., Snyder, J., Steere, A. C., Witkowski, J., Wong, S. J., Schutzer, S. E. 2018; 66 (7): 1133–39


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.

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