New Lyme Disease Tests Offer More Accurate Detection

Lyme disease frequently, but not always, presents with a bull's-eye rash and when the rash is absent, a laboratory test is needed. New diagnostic methods offer a better chance for more accurate detection of the infection from the Lyme bacteria, the most common tick-borne infection in North America and Europe.

Scientists at Rutgers University (New Brunswick, NJ, USA) and their colleagues examined the diagnostic methods employed to detect Lyme disease. A two-tiered testing protocol was established for serodiagnosis in 1994, involving an enzyme immunoassay (EIA) or indirect fluorescence antibody, followed (if reactive) by immunoglobulin M (IgM) and IgG Western immunoblots. These assays were prepared from whole-cell cultured Borrelia 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, two-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. The authors describe next-generation serodiagnostic testing for Lyme disease, focusing on methods that are currently available or near-at-hand.

Steven Schutzer, MD, a physician-scientist and senior author of the study, said, “New tests are at hand that offer more accurate, less ambiguous test results that can yield actionable results in a timely fashion. Improved tests will allow for earlier diagnosis, which should improve patient outcomes. New tests are more exact and are not as susceptible to the same false-positive or false-negative results associated with current tests.” The study was published on December 7, 2017, in the journal Clinical Infectious Diseases.

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