title: Direct molecular detection and genotyping of Borrelia burgdorferi from whole blood of patients with early Lyme disease.
abstract: Direct molecular tests in blood for early Lyme disease can be insensitive due to low amount of circulating Borrelia burgdorferi DNA. To address this challenge, we have developed a sensitive strategy to both detect and genotype B. burgdorferi directly from whole blood collected during the initial patient visit. This strategy improved sensitivity by employing 1.25 mL of whole blood, a novel pre-enrichment of the entire specimen extract for Borrelia DNA prior to a multi-locus PCR and electrospray ionization mass spectrometry detection assay. We evaluated the assay on blood collected at the initial presentation from 21 endemic area patients who had both physician-diagnosed erythema migrans (EM) and positive two-tiered serology either at the initial visit or at a follow-up visit after three weeks of antibiotic therapy. Results of this DNA analysis showed detection of B. burgdorferi in 13 of 21 patients (62%). In most cases the new assay also provided the B. burgdorferi genotype. The combined results of our direct detection assay with initial physician visit serology resulted in the detection of early Lyme disease in 19 of 21 (90%) of patients at the initial visit. In 5 of 21 cases we demonstrate the ability to detect B. burgdorferi in early Lyme disease directly from whole blood specimens prior to seroconversion.
authors.affiliation: Ibis Biosciences Inc, an Abbott Company, Carlsbad, California, United States of America. mark.eshoo@abbott.com
authors.forename: Mark W
authors.initials: MW
authors.lastname: Eshoo
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Crowder
authors.forename: Alison W
authors.initials: AW
authors.lastname: Rebman
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rounds
authors.forename: Heather E
authors.initials: HE
authors.lastname: Matthews
authors.forename: John M
authors.initials: JM
authors.lastname: Picuri
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Soloski
authors.forename: David J
authors.initials: DJ
authors.lastname: Ecker
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schutzer
authors.forename: John N
authors.initials: JN
authors.lastname: Aucott
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D025065:Borrelia burgdorferi / Q000235:genetics* / Q000276:immunology; D004269:DNA, Bacterial / Q000097:blood* / Q000235:genetics* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D005929:Glossitis, Benign Migratory / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000276:immunology / Q000382:microbiology; D006801:Humans; D008193:Lyme Disease / Q000097:blood* / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology / Q000382:microbiology; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial