Clinical Rheumatology

, Volume 34, Issue 3, pp 585–589

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

  • Alison W. Rebman
  • Lauren A. Crowder
  • Allison Kirkpatrick
  • John N. Aucott
Brief Report

DOI: 10.1007/s10067-014-2706-z

Cite this article as:
Rebman, A.W., Crowder, L.A., Kirkpatrick, A. et al. Clin Rheumatol (2015) 34: 585. doi:10.1007/s10067-014-2706-z

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.

Keywords

Borrelia burgdorferi Lyme disease Seroconversion 

Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • Alison W. Rebman
    • 1
  • Lauren A. Crowder
    • 1
  • Allison Kirkpatrick
    • 1
  • John N. Aucott
    • 2
  1. 1.Lyme Disease Research FoundationLuthervilleUSA
  2. 2.Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineLuthervilleUSA