Introduction. Lyme borreliosis is a multi-systemic disease caused by
spirochete Borrelia burgdorferi sensu lato. The specific response is
influenced by phenotypic characteristics of Borrelia, different antigen
structure, their different geographic distribution, and the patient?s
capability to react to the infection. The immune response to Borrelia
burgdorferi sensu lato develops relatively late, whereas in some patients it
never develops. The immune response in the early phase of Lyme borreliosis is
very similar to the one of healthy population. Diagnosis of borrelia.
Clinical manifestation, detailed anamnesis and epidemiological data are
crucial for making the diagnosis. The majority of patients in the late phase
of Lyme borreliosis have IgG antibody response, which could be followed by
IgM also throughout this period of time. The number of serologically positive
findings increases with the duration of the infection. Specific borrelial
antigens can be detected by a Western blot test. In patients with
neuroborreliosis, antibodies could be synthesized only intrathecally. IgG and
IgM antibody response can persist for many years after the treatment. There
is no positive serological test, which could be the indicator of the disease
activity on its own; even if it demonstrates high antibody titre. If there
are no clinical signs of Lyme borreliosis, the diagnosis of Lyme borreliosis
should be primarily based on clinical findings, and serological results
should be used only to confirm but not to make the diagnosis of Lyme
borreliosis. Specific antibodies from the IgM class can be proved in about
50% of patients, 2 to 4 weeks after the onset of primary infection, but an
early administration of the antibiotics can postpone or inhibit that
response. Interpretation of serological results. When interpreting the
serological test results with high level of sensitivity and specificity used
for making diagnosis of lyme borreliosis, it is necessary to take into
consideration the seroprevalence in a certain region. In the population with
a low prevalence of the disease, the tests will have a low positive
predicative value, i.e. the probability of indicating the real disease will
be lower. According to the recommendations given by the Centre for Disease
Control in North America, all extreme and positive results of EA and IFA are
to be confirmed by a Western blot test. Diagnostic problems. The main problem
in making diagnosis of lyme borreliosis is underestimation and overrating of
the diagnosis. Not a single positive serologic test is the indicator of the
disease activity on its own, regardless of the antibodies titre level, when
clear clinical signs are scarce. <br><br><font color="red"><b> This article has been retracted. Link to the retraction <u><a href="http://dx.doi.org/10.2298/MPNS1212531U">10.2298/MPNS1212531U</a><u></b></font>
Lyme borreliosis: Diagnostic difficulties in interpreting serological results
