Western blotting in the serodiagnosis of Lyme disease.
There are currently no accepted criteria for positive Western blots in Lyme disease. In a retrospective analysis of 225 case and control subjects, the best discriminatory ability of test criteria was obtained by requiring at least 2 of the 8 most common IgM bands in early disease (18, 21, 28, 37, 41, 45, 58, and 93 kDa) and by requiring at least 5 of the 10 most frequent IgG bands after the first weeks of infection (18, 21, 28, 30, 39, 41, 45, 58, 66, and 93 kDa). When these definitions were tested in a prospective study of all 237 patients seen in a diagnostic Lyme disease clinic during a 1-year period and in 74 patients with erythema migrans or summer flu-like illnesses, the IgM blot in early disease had a sensitivity of 32% and a specificity of 100%; the IgG blot after the first weeks of infection had a sensitivity of 83% and a specificity of 95%. Among patients with indeterminate IgG responses by ELISA, 6 of 9 patients with active Lyme disease had positive blots compared with 2 of 34 patients with other illnesses (P < .001). Thus, Western blotting can be used to increase the specificity of serologic testing in Lyme disease.
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111.
F
F
Dressler
J A
JA
Whalen
B N
BN
Reinhardt
A C
AC
Steere
D000907:Antibodies, Bacterial / Q000097:blood*; D001170:Arthritis, Infectious / Q000175:diagnosis; D015153:Blotting, Western; D015748:Borrelia burgdorferi Group / Q000276:immunology*; D001927:Brain Diseases / Q000175:diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D015787:Erythema Chronicum Migrans / Q000175:diagnosis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008193:Lyme Disease / Q000175:diagnosis*; D016920:Meningitis, Bacterial / Q000175:diagnosis; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M