The systematically difficult task of diagnosing Lyme disease can be simplified by sensitive and specific laboratory tests. The currently recommended two-tier test for serology is highly specific but falls short in sensitivity, especially in the early acute phase. We previously examined serially collected serum samples from Borrelia burgdorferi-infected rhesus macaques and defined a combination of antigens that could be utilized for detection of infection at all phases of disease in humans. The five B. burgdorferi antigens, consisting of OspC, OspA, DbpA, OppA2, and the C6 peptide, were combined into a fluorescent cytometric beadbased assay for the detection of B. burgdorferi antigen-specific IgG antibodies. Samples from Lyme disease patients and controls were used to determine the diagnostic value of this assay. Using this sample set, we found that our five-antigen multiplex IgG assay exhibited higher sensitivity (79.5%) than the enzyme immunoassay (EIA) (76.1%), the two-tier test (61.4%), and the C6 peptide enzyme-linked immunosorbent assay (ELISA) (77.2%) while maintaining specificity over 90%. When detection of IgM was added to the bead-based assay, the sensitivity improved to 91%, but at a cost of reduced specificity (78%). These results indicate that the rational combination of antigens in our multiplex assay may offer an improved serodiagnostic test for Lyme disease.
With an estimated 300,000 new cases each year, Lyme disease is the most common vector-borne disease in North America (http://www.cdc.gov/lyme/stats/humanCases.html) (1). The burden of this disease in many parts of Europe is also staggering (1, 2). Treatment with antibiotics is generally effective, even more so when employed soon after infection (3). Therefore, early and reliable laboratory diagnosis is critical for effective cure of Lyme disease patients.Patient serum antibodies specific for Borrelia burgdorferi antigens are detected with currently recommended laboratory tests for Lyme disease. While the detection of antigen may be preferred for early diagnosis, this is encumbered by the absence of detectable spirochetes or spirochetal antigen in the bloodstream once the organism has disseminated. Thus, the use of antigen detection from a blood or skin biopsy specimen has not demonstrated favorable sensitivity (4). The two most commonly used tests for diagnosis of Lyme disease in North America are (i) the two-tier test that includes an enzyme-linked immunosorbent assay (ELISA) and confirmatory Western blotting and (ii) the C6 test, where antibodies to a specific peptide within a conserved region of VlsE, the B. burgdorferi antigen, are detected (5-8). Both the twotier and C6 tests exhibit high specificity and are most sensitive for patients in the disseminated phases of disease (5, 8-10). In addition, the C6 test has been evaluated as an indicator of treatment outcome in the United States (11, 12), with a Ն4-fold decline in antibody titer (up to 6 months after treatment) in a majority of patients. The Western blot procedure is technically dema...