title: Improvement in the laboratory recognition of lyme borreliosis with the combination of culture and PCR methods.
abstract: BACKGROUND
  Lyme disease is a multisystem, multistage infection caused by three genospecies of the Borrelia burgdorferi sensu lato species. The diagnosis of Lyme disease is based on a history of tick-bite, physical examination, and serological tests. In the seronegative patients with Lyme borreliosis symptoms, additional testing should be introduced.
  
  
  METHODS
  The study group was composed of 240 hospitalized patients presented with various clinical symptoms suggesting Lyme borreliosis: 221 of the patients with neurological abnormalities and 19 with oligoarticular arthritis. Citrated blood and serum samples were collected from the patients for culture and serological examination, respectively. Moreover, 173 cerebrospinal and 6 synovial fluid samples were tested. New oligonucleotide primers based on B. burgdorferi sensu lato 16SrRNA gene sequences were designed for the detection of the bacteria in blood, cerebrospinal, and synovial fluid specimens with PCR. Levels of specific antibodies were measured in serum, cerebrospinal fluid and synovial fluid samples using ELISA and Western blot. B. burgdorferi spirochetes from blood, cerebrospinal fluid, and synovial fluid samples were cultured in cell line. Extracted and purified B. burgdorferi DNA was identified by PCR with new oligonucleotide primers. Then three genospecies were identified by PCR amplification with other primer sets specific for 16S rDNA and/or by the restriction fragment length polymorphism of 23S(rrl)-5S(rrf).
  
  
  RESULTS
  Bacterial DNA were found in samples from 32 patients, including 28 patients with neuroborreliosis and 4 with Lyme arthritis. B. burgdorferi-specific IgM and/or IgG serum antibodies were detected in 14 of these patients. Fourteen strains of Borrelia garini, 4 strains of Borrelia afzelii and 1 strain of B. burgdorferi sensu stricto were identified by PCR. Genospecies were not recognized in 13 specimens.
  
  
  CONCLUSIONS
  The procedure can be a rapid and sensitive diagnostic method for the detection of etiological agents in clinical materials derived from patients with the clinical symptoms of Lyme borreliosis. It can be utilized for both basic research as well as routine laboratory diagnosis.
authors.affiliation: Department of Bacteriology, National Institute of Hygiene, Warsaw, Poland. tchmielewski@pzh.gov.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Chmielewski
authors.forename: Janusz
authors.initials: J
authors.lastname: Fiett
authors.forename: Marek
authors.initials: M
authors.lastname: Gniadkowski
authors.forename: Stanislawa
authors.initials: S
authors.lastname: Tylewska-Wierzbanowska
mesh_terms: D001483:Base Sequence; D025065:Borrelia burgdorferi / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification; D017931:DNA Primers; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007753:Laboratories / Q000592:standards*; D008193:Lyme Disease / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000379:methods*; D015203:Reproducibility of Results
chemical_list: D017931:DNA Primers