Serologic Diagnosis of Lyme Borreliosis by Using Enzyme-Linked Immunosorbent Assays with Recombinant Antigens

Class-specific enzyme-linked immunosorbent assays (ELISAs) with purified recombinant antigens of Borrelia burgdorferi sensu stricto and Western blot analyses with whole cells of this spirochete were used to test human sera to determine which antigens were diagnostically important. In analyses for immunoglobulin M (IgM) antibodies, 14 (82%) of 17 serum samples from persons who had erythema migrans reacted positively by an ELISA with one or more recombinant antigens. There was frequent antibody reactivity to protein 41-G (p41-G), outer surface protein C (OspC), and OspF antigens. In an ELISA for IgG antibodies, 13 (87%) of 15 serum samples had antibodies to recombinant antigens; reactivity to p22, p39, p41-G, OspC, and OspF antigens was frequent. By both ELISAs, serum specimens positive for OspB, OspE, and p37 were uncommon. Analyses of sera obtained from persons who were suspected of having human granulocytic ehrlichiosis (HGE) but who lacked antibodies to ehrlichiae revealed IgM antibodies to all recombinant antigens of B. burgdorferi except OspB and IgG antibodies to all antigens except OspE. Immunoblotting of sera from the study group of individuals suspected of having HGE reaffirmed antibody reactivity to multiple antigens of B. burgdorferi. There was minor cross-reactivity when sera from healthy subjects or persons who had syphilis, oral infections, or rheumatoid arthritis were tested by ELISAs with p37, p41-G, OspB, OspC, OspE, and OspF antigens. Although the results of class-specific ELISAs with recombinant antigens were comparable to those recorded for assays with whole-cell antigen and for individuals with confirmed clinical diagnoses of Lyme borreliosis, immunoblotting is still advised as an adjunct procedure, particularly when there are low antibody titers by an ELISA.

Download Full-text

Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19

Russian Clinical Laboratory Diagnostics ◽

10.51620/0869-2084-2021-66-11-689-694 ◽

2021 ◽

Vol 66 (11) ◽

pp. 689-694

Author(s):

A. L. Shutikova ◽

G. N. Leonova ◽

A. F. Popov ◽

M. Yu. Shchelkanov

Keyword(s):

Lyme Disease ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Underlying Disease ◽

Laboratory Diagnostics ◽

Igg Antibodies ◽

Serum Samples ◽

Igm Antibodies ◽

Chronic Encephalitis ◽

Tbev Strain

The coexistence of various pathogens inside the patient’s body is one of the poorly studied and current issues. The aim of the study is to identify the relationship between the indicators of complex laboratory diagnostics and the clinical manifestations of a mixed disease during subsequent infection with the SARS-CoV-2 virus using the example of a case of chronic encephalitis-borreliosis infection. Seven blood serum samples were collected from the patient over the course of a year. For the etiological verification of the causative agents of TBE, Lyme disease and COVID-19, the methods of ELISA and PCR diagnostics were used. The patient was diagnosed with Lyme disease on the basis of the detection of IgG antibodies to Borrelia 5 months after the onset of the disease, since she denied the tick bite. In the clinical picture, there was an articular syndrome and erythema migrans. Later, IgG antibodies to the TBEV were found in the blood. Throughout the study, IgM antibodies to Borrelia were not detected. The exacerbation of Lyme disease could be judged by the clinical manifestations of this disease and by the growth of specific IgG antibodies. A feature of this case was that during an exacerbation of the Lyme disease, an infection with the SARS-CoV-2 virus occurred. Treatment (umifenovir, hydroxychloroquine, azithromycin, ceftriaxone) was prescribed, which improved the condition of the underlying disease, decreased joint pain, decreased IgG levels to borrelia. However, during this period, serological markers of TBEV appear: antigen, IgM antibodies, and the titer of IgG antibodies increases. Most likely, this was facilitated by the switching of the immune system to the SARS-CoV-2 virus, with the simultaneous suppression of borrelia with antibiotics and the appointment of hydroxychloroquine, which has an immunosuppressive effect. Despite the activation of the virus, clinical manifestations of TBE were not observed in the patient, which is most likely associated with infection with a weakly virulent TBEV strain. The further course of tick-borne infections revealed the dominant influence of B. burgdorferi in relation to TBEV. Laboratory studies have shown that suppression of the activity of the borreliosis process by etiotropic treatment subsequently led to the activation of the persistent TBEV.

Download Full-text

Peptide-Based OspC Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Lyme Borreliosis

Journal of Clinical Microbiology ◽

10.1128/jcm.36.12.3474-3479.1998 ◽

1998 ◽

Vol 36 (12) ◽

pp. 3474-3479 ◽

Cited By ~ 43

Author(s):

Marianne J. Mathiesen ◽

Michael Christiansen ◽

Klaus Hansen ◽

Arne Holm ◽

Eva Åsbrink ◽

...

Keyword(s):

Lyme Borreliosis ◽

Immunosorbent Assay ◽

Erythema Migrans ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Amino Acid Residues ◽

Serum Samples ◽

Igg Antibody ◽

Acrodermatitis Chronica Atrophicans ◽

Increased Sensitivity

Sera from 210 patients with Lyme borreliosis (LB) were studied by an enzyme-linked immunosorbent assay (ELISA) based on a synthetic peptide (pepC10) comprising the C-terminal 10-amino-acid residues of OspC of Borrelia burgdorferi. We found that 36.3 and 45.0% of the serum samples from patients with erythema migrans (EM) and neuroborreliosis (NB), respectively, displayed immunoglobulin M (IgM) anti-pepC10 reactivities, while these samples rarely (≤8%) displayed IgG antibody reactivities. Sera from patients with acrodermatitis chronica atrophicans did not contain anti-pepC10 antibodies. The diagnostic performance of this newly developed peptide ELISA was compared with those of an ELISA based on the full-length recombinant OspC protein (rOspC) and a commercially available ELISA based on theB. burgdorferi flagellum (Fla). The sensitivity of the IgM pepC10 ELISA was slightly lower (P < 0.04) than that of the rOspC ELISA for EM patients (36.3 versus 43.8%), while there was no difference for NB patients (45.0 versus 48.0%). However, the optical density values obtained by the pepC10 ELISA were generally higher than those obtained by the rOspC ELISA, leading to a significantly better quantitative discrimination between seropositive patients with NB and controls (P < 0.008). The specificity of the pepC10 ELISA was similar to those of the rOspC ELISA and the Fla ELISA for relevant controls including patients with syphilis and mononucleosis. Although the overall diagnostic sensitivity of the Fla ELISA was superior, 8.8 and 12.0% of the EM and NB patients, respectively, were antibody positive only by the pepC10 ELISA. Thus, use of a diagnostic test for LB based on the detection of IgM antibodies to pepC10 and Fla has increased sensitivity for the diagnosis of early LB.

Download Full-text

Cross-Reactivity of Epstein-Barr Virus-Specific Immunoglobulin M Antibodies with Cytomegalovirus Antigens Containing Glycine Homopolymers

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.8.4.747-756.2001 ◽

2001 ◽

Vol 8 (4) ◽

pp. 747-756 ◽

Cited By ~ 21

Author(s):

Dieter Lang ◽

Rolf Vornhagen ◽

Markus Rothe ◽

Walter Hinderer ◽

Hans-H. Sonneborn ◽

...

Keyword(s):

Epstein Barr Virus ◽

Hcmv Infection ◽

Cross Reactivity ◽

Immunoglobulin M ◽

Serum Samples ◽

Screening Programs ◽

Barr Virus ◽

Ebv Infection ◽

Igm Antibodies ◽

Epstein Barr

ABSTRACT Timely and reliable detection of acute primary human cytomegalovirus (HCMV) infection is important in prenatal screening programs and for differential diagnosis of infectious mononucleosis-like disease. Enzyme-linked immunosorbent assays (ELISAs) based on HCMV proteins enable the sensitive detection of immunoglobulin M (IgM) antibodies during primary infection. However, concerns have been raised about possible cross-reactivities of the HCMV antigens used for the design of such ELISAs with IgM antibodies induced by Epstein-Barr Virus (EBV). In this study we investigated whether IgM antibodies generated during acute EBV infection reacted with recombinant HCMV antigens. Serum samples from patients with primary EBV infection frequently scored positive when tested in different HCMV IgM ELISAs, irrespective of whether conventional or recombinant antigens were used for the design of the HCMV IgM assays. Such cross-reactive IgM antibodies were found to be directed against short glycine-rich motifs contained within the nonstructural HCMV proteins pUL44 and pUL57. Further analyses revealed that these glycine-rich motifs were major antigenic domains for IgM antibodies induced during HCMV infection. Their deletion from recombinant proteins abrogated reactivity with IgM synthesized during HCMV infection. EBV-induced IgM antibodies that reacted with HCMV antigens showed similar kinetics of reactivity in HCMV- or EBV-specific assays in the course of primary EBV infection, indicating that the two populations of antibodies were highly overlapping. The results demonstrate that primary EBV infection leads to the induction of IgM antibodies that specifically bind to widely used diagnostic antigens of HCMV. This has to be considered in the interpretation of HCMV-specific IgM assays.

Download Full-text

Diagnosis of west Nile neuroinvasive disease in humans

Archives of Veterinary Medicine ◽

10.46784/e-avm.v11i1.19 ◽

2018 ◽

Vol 11 (1) ◽

pp. 79-90

Author(s):

Ivana Hrnjaković Cvjetković ◽

Vesna Milošević ◽

Tamaš Petrović ◽

Dušan Petrić ◽

Gordana Kovačević ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Real Time ◽

Cross Reactivity ◽

Igg Antibodies ◽

Rt Pcr ◽

Serum Samples ◽

West Nile ◽

Igm Antibodies ◽

Neuroinvasive Disease ◽

Viremia Level

West Nile virus (WNV) is arbovirus distributed all around the world. In humans, 80% of infection cases are asymptomatic. In 20% of infected people, a febrile self-limiting illness is reported. WNV has the potential for fatal neuroinvasive disease. In 1% of cases, the infection may result in neuroinvasive disease with permanent neurological consequences or death outcome. Neurological forms may vary presenting with encephalitis, meningitis, meningoencephalitis or acute flaccid paralysis. Outbreaks with neurological forms of WNV infection were recorded in different areas of Greece, Italy, Romania, Hungary and Serbia. During the period from 2013 to 2016, 114 samples of cerebrospinal fluid and 107 serum samples were taken from 114 patients suspected of WNV neuroinvasive disease (WNND). The presence of specific anti-WNV IgM and IgG antibodies in cerebrospinal fluid (CSF) and sera samples were tested by WNV IgM and IgG ELISA (Euroimmun, Germany). In addition, 48 samples of CSF or/and serum of people with suspected WNV infection were examined by commercial molecular tests - real time RT-PCR (WNV Real-TM, Sacace biotechnologies, Italy). The IgM antibodies against WNV were present in 25.4% (29/114) of CSF samples, and in 31.8% (34/107) of serum samples tested from 114 patients suspected of WNND. The IgG antibodies against WNV were detected in 3.5% (4/114) of CSF samples, and in 11.2% (12/107) of serum samples. The WNV RNA was detected by real time RT-PCR test in 7 out of 48 (14.6%) CSF or/and serum samples. In this study, detection of IgM antibodies in CSF is more frequent than detection of WNV RNA in CSF or serum samples. WNV RNA detection in CSF is confirmatory diagnostic test but has limited utility in the diagnosis of WNV neuroinvasive disease due to low viremia level at the time of clinical presentation of the disease. The limitations in the use of ELISA IgM test are linked to cross - reactivity among flaviviruses and long persistence of IgM antibodies in the serum and CSF.

Download Full-text

Diagnosis of Eastern Equine Encephalomyelitis Virus Infection in Horses by Immunoglobulin M and G Capture Enzyme-Linked Immunosorbent Assay

Journal of Veterinary Diagnostic Investigation ◽

10.1177/104063879400600107 ◽

1994 ◽

Vol 6 (1) ◽

pp. 34-38 ◽

Cited By ~ 28

Author(s):

Sudhir P. Sahu ◽

Arnold D. Alstad ◽

Douglas D. Pedersen ◽

James E. Pearson

Keyword(s):

Virus Isolation ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Igg Antibodies ◽

Serum Samples ◽

Capture Elisa ◽

Igm Antibodies ◽

Viral Antigens ◽

Encephalomyelitis Virus ◽

Eastern Equine Encephalomyelitis

Immunoglobulin M (IgM) and G (IgG) capture enzyme-linked immunosorbent assays (ELISAs) were used as possible adjuncts to hemagglutination inhibition (HI) and virus neutralization (VN) tests to differentiate between reaction to recent exposure to eastern equine encephalomyelitis (EEE) virus and those due to prior vaccination. Serum samples were evaluated by the IgM-capture ELISA, and the results were compared with those of HI and VN tests. Of 381 serum samples, 51% (195 samples) were positive by HI test (≥1:40) and 54% (205 samples) were positive by VN test (≥ 1:10), but only 35% (132 samples) were positive by IgM-capture ELISA (≥ 1:100). With only a few exceptions, the sera with IgG ELISA titers had a VN titer of ≥1: 100. When EEE virus isolation and serology were compared, the EEE cases were divided into three categories: 1) peracute cases- the serum was negative for EEE IgM and IgG by the ELISA, negative for VN antibody, but HI antibody positive; 2) acute cases-IgM and HI antibody positive but negative for IgG and VN antibody; and 3) transitional cases–positive for IgM and IgG antibodies, HI titers of 1:40–1:160, and VN titers of ≥ 1: 100. IgM antibodies of EEE virus were monospecific and did not cross-react with western or Venezuelan equine encephalomyelitis viral antigens by the ELISA. Isolation of EEE virus from tissue or detection of IgM antibodies to EEE virus in a single serum sample is evidence of recent EEE infection and differentiated serum from previously vaccinated horses. However, the presence of IgM in the absence of virus isolation could also be due to a recent viral vaccination.

Download Full-text

EVALUATION OF ELEVEN IMMUNOCHROMATOGRAPHIC ASSAYS FOR SARS-CoV-2 DETECTION: INVESTIGATING DENGUE CROSS-REACTION

10.1101/2020.10.09.20210039 ◽

2020 ◽

Author(s):

Beatriz Araujo Oliveira ◽

Lea Campos de Oliveira ◽

Franciane Mendes de Oliveira ◽

Geovana Maria Pereira ◽

Regina Maia de Souza ◽

...

Keyword(s):

Sensitivity And Specificity ◽

High Sensitivity ◽

Diagnostic Techniques ◽

Cross Reactivity ◽

Cross Reaction ◽

List Type ◽

Rt Pcr ◽

Serum Samples ◽

Igm Antibodies ◽

Good Agreement

AbstractBackgroundCOVID-19 disease (Coronavirus disease 2019) caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) is widespread worldwide, affecting more than 11 million people globally (July 6th, 2020). Diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and low cost alternative for monitoring the spread of COVID-19 in the population.MethodsHere we evaluate the sensitivity and specificity of eleven different immunochromatographic tests in 98 serum samples from confirmed cases of COVID-19 through RT-PCR and 100 negative serum samples from blood donors collected in February 2019. Considering the endemic situation of Dengue in Brazil, we also evaluated the cross-reactivity with Dengue using 20 serum samples from patients with confirmed diagnosis for Dengue collected in early 2019 through four different tests.ResultsOur results demonstrated agreement between immunochromatographic assays and RT-PCR, especially after 10 days since the onset of symptoms. The evaluation of IgG and IgM antibodies combined demonstrated a strong level of agreement (0.85) of IC assays and RT-PCR. It was observed cross-reactivity between Dengue and COVID-19 using four different IC assays for COVID-19 diagnosis. The specificity of IC assays to detected COVID-19 IgM antibodies using Dengue serum samples varied from 80% to 85%; the specificity of IgG detection was 100% and total antibody was 95%.ConclusionsWe found high sensitivity, specificity and good agreement of IC assays, especially after 10 days onset of symptoms. However, we detected cross-reactivity between Dengue and COVID-19 mainly with IgM antibodies demonstrating the need for better studies about diagnostic techniques for these diseases.HighlightsImmunochromatographic assays demonstrated high sensitivity and specificity and good agreement with the gold-standard RT-PCR;Increase in sensitivity and specificity of assays using samples collected after the 10th day of symptoms;Cross-reaction with Dengue serology in evaluation of IgM.

Download Full-text

Detection of antibodies to decorin-binding protein A (DbpA) and DbpB after infection of dogs with Borrelia burgdorferi by tick challenge

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638720912394 ◽

2020 ◽

Vol 32 (3) ◽

pp. 481-485

Author(s):

Darby G. Oldenburg ◽

Dean A. Jobe ◽

Steven D. Lovrich ◽

Rhonda L. LaFleur ◽

Douglas W. White ◽

...

Keyword(s):

Lyme Disease ◽

Borrelia Burgdorferi ◽

Ixodes Scapularis ◽

Binding Protein ◽

Protein A ◽

Immune Serum ◽

Immunoglobulin M ◽

Antibody Responses ◽

Igg Antibodies ◽

Serum Samples

We characterized the antibody response to decorin-binding protein A (DbpA) or DbpB from immune serum samples collected from 27 dogs infected with Borrelia burgdorferi by Ixodes scapularis ticks. Immunoglobulin M (IgM) antibodies to DbpA or DbpB were rarely detected, but high levels of IgG antibodies to DbpA were detected in 16 of 27 of the immune sera collected 1 mo after infection, 20 of 25 of the sera collected after 2 mo, and each of the 23, 17, or 11 serum samples evaluated after 3, 4, or 5 mo, respectively. In addition, IgG antibodies to DbpB were detected in 22 of 27 ( p = 0.005) tested dogs after 1 mo, and the frequency of detecting the antibodies thereafter closely mimicked the antibody responses to DbpA. Moreover, antibodies to DbpA or DbpB were not produced by dogs vaccinated with a whole-cell B. burgdorferi bacterin; removing the antibodies to DbpA by adsorption to recombinant DbpA (rDbpA) did not affect the reactivity detected by a rDbpB ELISA. Therefore, the findings from our preliminary study showed that antigenically distinct antibodies to DbpA or DbpB are produced reliably during canine infection with B. burgdorferi, and the response is not confounded by vaccination with a Lyme disease bacterin. Larger studies are warranted to more critically evaluate whether detecting the antibody responses can improve serodiagnostic confirmation of canine Lyme disease.

Download Full-text

Heterologous Expression, Purification, and Immunological Reactivity of a Recombinant HSP60 from Paracoccidioides brasiliensis

Clinical and Vaccine Immunology ◽

10.1128/cdli.9.2.374-377.2002 ◽

2002 ◽

Vol 9 (2) ◽

pp. 374-377 ◽

Cited By ~ 6

Author(s):

Daniela A. Cunha ◽

Roseli M. Zancopé-Oliveira ◽

M. Sueli ◽

S. Felipe ◽

Silvia M. Salem-Izacc ◽

...

Keyword(s):

Escherichia Coli ◽

Recombinant Protein ◽

Paracoccidioides Brasiliensis ◽

High Sensitivity ◽

Cross Reactivity ◽

Antibody Responses ◽

Healthy Individuals ◽

Immunological Reactivity ◽

Serum Samples ◽

Recombinant Antigens

ABSTRACT The complete coding cDNA of HSP60 from Paracoccidioides brasiliensis was overexpressed in an Escherichia coli host to produce high levels of recombinant protein. The protein was purified by affinity chromatography. A total of 169 human serum samples were tested for reactivity by Western blot analysis with the purified HSP60 recombinant protein. Immunoblots indicated that the recombinant P. brasiliensis HSP60 was recognized by antibodies in 72 of 75 sera from paracoccidioidomycosis patients. No cross-reactivity was detected with individual sera from patients with aspergillosis, sporotrichosis, cryptococcosis, and tuberculosis. Reactivity to HSP60 was observed in sera from 9.52% of control healthy individuals and 11.5% of patients with histoplasmosis. The high sensitivity and specificity (97.3 and 92.5%, respectively) for HSP60 suggested that the recombinant protein can be used singly or in association with other recombinant antigens to detect antibody responses in P. brasiliensis-infected patients.

Download Full-text

Evaluation of an Immunoglobulin M Capture Enzyme-Linked Immunosorbent Assay for Diagnosis of Orientia tsutsugamushi Infection

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.10.3.394-398.2003 ◽

2003 ◽

Vol 10 (3) ◽

pp. 394-398 ◽

Cited By ~ 19

Author(s):

Won-Jong Jang ◽

Myung-Suk Huh ◽

Kyung-Hee Park ◽

Myung-Sik Choi ◽

Ik-Sang Kim

Keyword(s):

Immunosorbent Assay ◽

Scrub Typhus ◽

Microtiter Plate ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Orientia Tsutsugamushi ◽

Serum Samples ◽

Capture Elisa ◽

Igm Antibodies ◽

Immunodominant Antigen

ABSTRACT To differentiate scrub typhus from other acute febrile diseases, a rapid and reliable serological diagnosis is important. We developed an immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) for diagnosis of recent Orientia tsutsugamushi infections in humans. The 56-kDa major outer membrane protein of O. tsutsugamushi is well known as the most immunodominant antigen in scrub typhus. The test is based on the use of the biotinylated recombinant 56-kDa protein of O. tsutsugamushi Boryong, Bor56, which was expressed as a fusion protein with a maltose-binding protein in Escherichia coli. In the test, the serum IgM antibodies were captured by anti-human IgM antibodies coated onto a microtiter plate. The captured IgM antibodies were revealed through sequential addition of biotinylated Bor56 antigen and peroxidase-conjugated streptavidin to the plate. The IgM capture ELISA was compared with the immunofluorescence antibody assay (IFA) by testing 176 serum samples from patients with diagnosed cases of rickettsial disease and patients with other acute febrile diseases. Of the 81 IgG IFA-positive samples, 78 tested positive (sensitivity, 96.3%) and all 31 IgM IFA-positive samples tested positive (sensitivity, 100%) by the IgM capture ELISA. The specificity of the IgM capture ELISA was 99%, and 1 of the 95 IFA-negative samples was positive in the assay. These results strongly suggest that IgM capture ELISA using the recombinant Bor56 antigen is a reliable and detailed method for the detection of early O. tsutsugamushi infection.

Download Full-text

Study of a Cohort of 1,886 Persons To Determine Changes in Antibody Reactivity to Borrelia burgdorferi 3 Months after a Tick Bite

Clinical and Vaccine Immunology ◽

10.1128/cvi.00026-15 ◽

2015 ◽

Vol 22 (7) ◽

pp. 823-827 ◽

Cited By ~ 3

Author(s):

Ram B. Dessau ◽

Linda Fryland ◽

Peter Wilhelmsson ◽

Christina Ekerfelt ◽

Dag Nyman ◽

...

Keyword(s):

Borrelia Burgdorferi ◽

Lyme Borreliosis ◽

Erythema Migrans ◽

Significant Rise ◽

Tick Bite ◽

Content Type ◽

Paired Samples ◽

Antibody Reactivity ◽

Flagellar Antigen ◽

Relative Change

ABSTRACTLyme borreliosis is a tick-borne disease caused by the bacteriumBorrelia burgdorferi. The most frequent clinical manifestation is a rash called erythema migrans. Changes in antibody reactivity toB. burgdorferi3 months after a tick bite are measured using enzyme-linked immunosorbent assays (ELISAs). One assay is based on native purified flagellum antigen (IgG), and the other assay is based on a recombinant antigen called C6 (IgG or IgM). Paired samples were taken at the time of a tick bite and 3 months later from 1,886 persons in Sweden and the Åland Islands, Finland. The seroconversion or relative change is defined by dividing the measurement units from the second sample by those from the first sample. The threshold for the minimum level of significant change was defined at the 2.5% level to represent the random error level. The thresholds were a 2.7-fold rise for the flagellar IgG assay and a 1.8-fold rise for the C6 assay. Of 1,886 persons, 102/101 (5.4%) had a significant rise in antibody reactivity in the flagellar assay or the C6 assay. Among 40 cases with a diagnosis of Lyme borreliosis, the sensitivities corresponding to a rise in antibodies were 33% and 50% for the flagellar antigen and the C6 antigen, respectively. Graphical methods to display the antibody response and to choose thresholds for a rise in relative antibody reactivity are shown and discussed. In conclusion, 5.4% of people with tick bites showed a rise inBorrelia-specific antibodies above the 2.5% threshold in either ELISA but only 40 (2.1%) developed clinical Lyme borreliosis.

Download Full-text