Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans

Abstract

We investigated the appearance and evolution of immunoglobulin M (IgM) and IgG antibodies to Borrelia burgdorferi in 46 patients with culture-proven erythema migrans (EM). All patients received antimicrobial treatment and were prospectively evaluated for up to 1 year. A total of 257 serially collected serum samples were tested by commercial IgG-IgM enzyme-linked immunosorbent assay and separate IgM and IgG immunoblots (IBs). At the baseline, 33% of the patients had a positive ELISA result and 43% of the patients had a positive IgM IB result by using the criteria of the Centers for Disease Control and Prevention-Association of State and Territorial Public Health Laboratory Directors for the interpretation of IB results. Positive serology at the baseline and the rate of seroconversion correlated directly with disease duration and/or evidence of dissemination prior to treatment. At days 8 to 14 after the baseline, 91% of patients had a positive ELISA result and/or IgM IB result. Peak IgM antibody levels were seen at this time in patients with localized or disseminated disease. The most frequent IgM bands at the baseline and the peak were of 24 kDa (OspC), 41 kDa, and 37 kDa. Although 89% of the patients developed IgG antibodies as determined at a follow-up examination, only 22% were positive by the IgG IB criteria of the Centers for Disease Control and Prevention-Association of State and Territorial Public Health Laboratory Directors. The persistence of antibodies was directly related to disease duration and/or dissemination prior to treatment. Since IgM antibodies to the 24-and 41-kDa antigens remained detectable for long periods, 38% of IgM IBs were still positive at 1 year postbaseline. IgM to antigens of 39, 58, 60, 66, or 93 kDa, conversely, were most often seen in sera obtained within 1 month postbaseline. Their presence may be of assistance in confirming a recent infection with B. burgdorferi in individuals living in areas where Lyme disease is endemic.

Cell cycle effects and induction of apoptosis caused by infection of HL-60 cells with human granulocytic ehrlichiosis pathogen measured by flow and laser scanning cytometry

“…As mentioned earlier in this paper, propagation of HGE pathogen in HL-60 cells provides a useful cellular model to study various aspects of the cell infection with this agent related to both its mode of reproduction as well as the mechanism by which it induces cytostatic and cytolytic effects on the infected cells (12,16). Immunocytochemical detection of the agent by sera from infected patients (1)(2)(3)(4) made it possible to study the presence of pathogen within the infected cells, measure its quantity, and correlate it with the observed effects on cell cycle and apoptosis. Strong stainability of granulocytic ehrlichia with 7-AAD ( Fig.…”

Development of a foundation for a case definition of post-treatment Lyme disease syndrome

“…8 However, there are currently no such reliable biomarkers or serologic tests to define prior exposure to treated early infection with B. burgdorferi, as prompt antibiotic treatment of seronegative cases of early Lyme disease may prevent seroconversion, and the majority of patients who do seroconvert acutely lose diagnostic seroreactivity over the following year. 9,10 The IDSA PTLDS case definition includes a clinical syndrome of patient-reported symptoms that occurs in the context of documentation of a previously treated, physician-diagnosed case of Lyme disease meeting the Centers for Disease Control and Prevention (CDC) surveillance criteria, 11 and includes symptoms of such severity that they cause significant decline in physical or social functioning. 7 There are additional criteria to exclude patients with untreated tickborne infections or other illnesses with similar clinical features, such as preexisting fibromyalgia, chronic fatigue syndrome, or depression.…”

A joint effort: The interplay between the innate and the adaptive immune system in Lyme arthritis

“…14,15 On the other hand, once formed, immunoglobulin G (IgG) antibodies can be detectable for years, even after the infection has passed. 16,17 Incorrect diagnosis increases the risk of further advancement of Lyme disease in the patient while the infection could be effectively treated with antibiotics such as doxycycline. 18,19 However, in a small percentage of patients, symptoms persist, even after antibiotic treatment, probably due to differences in disease development and recurrent inflammation ( Figure 1).…”