Cutaneous manifestations of Lyme disease : Pitfalls in the serological diagnostic workup

Serology, the detection of B. burgdorferi-specific IgM and IgG serum antibodies, is the most common laboratory test to diagnose cutaneous manifestations of Lyme disease. In a two-tiered approach, an ELISA is used as a screening test. A positive or equivocal ELISA result needs confirmation by a speci...

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Bibliographic Details
Published in:Hautarzt 2017-04, Vol.68 (4), p.329-339
Main Authors: Glatz, M, Müllegger, R R
Format: Article
Language:ger
Subjects:
Diagnosis, Differential
Diagnostic Errors - prevention & control
Humans
Lyme Disease - blood
Lyme Disease - diagnosis
Lyme Disease - immunology
Reproducibility of Results
Sensitivity and Specificity
Serologic Tests - methods
Skin Diseases, Bacterial - blood
Skin Diseases, Bacterial - diagnosis
Skin Diseases, Bacterial - immunology
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Summary:Serology, the detection of B. burgdorferi-specific IgM and IgG serum antibodies, is the most common laboratory test to diagnose cutaneous manifestations of Lyme disease. In a two-tiered approach, an ELISA is used as a screening test. A positive or equivocal ELISA result needs confirmation by a specific immunoblot. The sensitivity of this approach reaches 80-95%. The diagnosis of erythema migrans is based on its typical clinical appearance. Serology is only indicated in atypical cases. In contrast, serology is mandatory in the diagnostic workup of borrelial lymphocytoma and acrodermatitis chronica atrophicans. A positive serology can persist for many years, even after adequate antibiotic treatment. A positive serology is no indication for antibiotic treatment if typical symptoms of Lyme disease are absent.
ISSN:1432-1173
DOI:10.1007/s00105-017-3952-1