Reactive Lyme serology in optic neuritis.
BACKGROUND
Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD.


METHODS
Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD.


RESULTS
Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases.


CONCLUSIONS
Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.
Sibony
Patrick
P
Department of Ophthalmology and Neurology, State University of New York at Stony Brook, Stony Brook, NY 11794, USA. psibony@notes.cc.sunysb.edu
Halperin
John
J
Coyle
P K
PK
Patel
Kartik
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood*; D015153:Blotting, Western; D025065:Borrelia burgdorferi / Q000276:immunology*; D002648:Child; D003429:Cross Reactions / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D015818:Eye Infections, Bacterial / Q000209:etiology / Q000276:immunology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D008193:Lyme Disease / Q000150:complications / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009902:Optic Neuritis / Q000209:etiology / Q000276:immunology*; D010211:Papilledema / Q000276:immunology; D012173:Retinitis / Q000276:immunology; D012189:Retrospective Studies; D012698:Serologic Tests; D013587:Syphilis / Q000276:immunology
D000907:Antibodies, Bacterial; D007075:Immunoglobulin M