title: The VlsE (IR6) peptide ELISA in the serodiagnosis of lyme facial paralysis.
abstract: OBJECTIVE
  Facial paralysis is a manifestation of early disseminated Lyme neuroborreliosis. In the current study, we compared the immunoglobulin G (IgG) VlsE (sixth invariant region) peptide enzyme-linked immunosorbent assay (ELISA) with the current two-tier approach of sonicate ELISA and Western blot in the serodiagnosis of Lyme facial paralysis.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Serum samples from 47 Lyme patients with facial paralysis and 86 control subjects were analyzed for IgG antibodies to VlsE peptide of Borrelia burgdorferi and for immunoglobulin M (IgM) and IgG antibodies to sonicate antigens of B. burgdorferi using the two-tier approach.
  
  
  METHODS
  Diagnostic.
  
  
  METHODS
  Serum IgG antibody responses to VlsE (IR6) peptide.
  
  
  RESULTS
  All 47 (100%) patients with facial paralysis and 4 (5%) of 86 controls had positive antibody responses to the VlsE peptide. In the two-tier test, 41 (87%) patients had positive IgM, 31 (66%) had positive IgG, and all 47 patients had positive IgM or IgG responses. Of the 86 control subjects, 2 (2%) had positive results with the two-tier test. Thus, the sensitivities of the VlsE and the two-tier tests were 100%; the specificity of the VlsE ELISA was 95% and the specificity of the two-tier test was 98%.
  
  
  CONCLUSIONS
  The VlsE peptide ELISA showed a high sensitivity and specificity in the serological diagnosis of Lyme facial paralysis, similar to the two-tier test. The principal advantage of the VlsE peptide ELISA is that it requires only one test rather than four tests. However, the specificity of the VlsE test may not be as high as that of the two-tier test.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. miikka.peltomaa@iki.fi
authors.forename: Miikka
authors.initials: M
authors.lastname: Peltomaa
authors.forename: Gail
authors.initials: G
authors.lastname: McHugh
authors.forename: Allen C
authors.initials: AC
authors.lastname: Steere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood*; D000942:Antigens, Bacterial / Q000276:immunology*; D001426:Bacterial Proteins / Q000276:immunology*; D015153:Blotting, Western; D025065:Borrelia burgdorferi / Q000276:immunology* / Q000472:pathogenicity; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005158:Facial Paralysis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008074:Lipoproteins / Q000276:immunology*; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D007074:Immunoglobulin G; D008074:Lipoproteins; C105546:VlsE protein, Borrelia burgdorferi