title: Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients.
abstract: Two-tier serology is often used to confirm a diagnosis of Lyme disease. One hundred and four patients with physician diagnosed erythema migrans rashes had blood samples taken before and after 3 weeks of doxycycline treatment for early Lyme disease. Acute and convalescent serologies for Borrelia burgdorferi were interpreted according to the 2-tier antibody testing criteria proposed by the Centers for Disease Control and Prevention. Serostatus was compared across several clinical and demographic variables both pre- and post-treatment. Forty-one patients (39.4%) were seronegative both before and after treatment. The majority of seropositive individuals on both acute and convalescent serology had a positive IgM western blot and a negative IgG western blot. IgG seroconversion on western blot was infrequent. Among the baseline variables included in the analysis, disseminated lesions (p < 0.0001), a longer duration of illness (p < 0.0001), and a higher number of reported symptoms (p = 0.004) were highly significantly associated with positive final serostatus, while male sex (p = 0.05) was borderline significant. This variability, and the lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Furthermore, these findings underline the difficulty for rheumatologists in identifying a prior exposure to Lyme disease in caring for patients with medically unexplained symptoms or fibromyalgia-like syndromes.
authors.affiliation: Lyme Disease Research Foundation, 10755 Falls Rd., Suite 200, Lutherville, MD, 21093, USA, alison.rebman@gmail.com.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Rebman
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Crowder
authors.forename: Allison
authors.initials: A
authors.lastname: Kirkpatrick
authors.forename: John N
authors.initials: JN
authors.lastname: Aucott
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi / Q000276:immunology; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069078:Seroconversion; D013577:Syndrome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline