Western blot analysis for diagnosis of Lyme disease in acute facial palsy.
BACKGROUND
Lyme borreliosis has been implicated in the pathogenesis of acute peripheral facial palsy (APFP). Few studies, however, have used Western blot analyses to confirm the serological diagnosis.


OBJECTIVE
To analyze the prevalence of anti-Borrelia antibodies in patients with APFP compared with healthy control subjects living in Hokkaido Island, Japan.


METHODS
In total, 113 patients with APFP were analyzed. They included 32 patients with varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome and zoster sine herpete) and 81 patients with Bell's palsy. Fifty-eight healthy control subjects were also included. IgM and IgG antibodies to Borrelia garinii and afzelii were tested by Western blot, and diagnoses were made according to the Centers for Disease Control and Prevention criteria.


RESULTS
Five of 81 (6.2%) patients with Bell's palsy, 1 of 32 (3.1%) patients with VZV reactivation, and 1 of 58 control subjects (1.7%) were judged to have both IgM and IgG antibodies to Borrelia. This difference was not significant (P >.05, chi2 test). Patients with Bell's palsy who had herpes simplex virus type 1 (HSV-1) reactivation at the onset of palsy had a higher IgM-immunoreactivity to Borrelia afzelii.


CONCLUSIONS
Although it is one of the endemic areas of Lyme disease in Japan, the prevalence of APFP caused by Lyme borreliosis is low in Hokkaido Island. In addition, cross-reactivity to B. afzelii in IgM blots is often observed in patients with HSV-1 reactivation, suggesting that careful interpretation of Borrelia IgM immunoblot data are needed for accurate serological diagnosis.
Furuta
Y
Y
Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp
Kawabata
H
H
Ohtani
F
F
Watanabe
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis; D020330:Bell Palsy / Q000453:epidemiology / Q000209:etiology; D015153:Blotting, Western; D001898:Borrelia / Q000276:immunology / Q000302:isolation & purification; D016022:Case-Control Studies; D005158:Facial Paralysis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies
D000907:Antibodies, Bacterial