Challenges and new methods in the diagnosis of Lyme disease in children

Despite the constant development of biotechnology, laboratory diagnostics of Lyme disease in children still poses a significant challenge. The aim of this article is to present the current methods of Lyme disease diagnosis and its future perspectives. A serological test is often the first step in supporting clinical diagnosis of Lyme disease in children. Recently, a new generation of enzyme-linked immunosorbent assays has been created. These assays use recombinant proteins or synthetic peptides in their antigenic spectrum. It is postulated that these tests may replace the classic immunoblot as the second step in the Lyme disease diagnostic protocol. Direct detection methods based on bacterial culture techniques or using the polymerase chain reaction (PCR) have inadequate sensitivity, which prevents their widespread use in clinical practice. Recently, a number of other tools have been developed that are of supportive importance. Among them, measuring of the CXCL13 chemokine concentration in the cerebrospinal fluid has the potential to become a routine procedure in the diagnosis of Lyme disease in children. Future diagnostic strategies of Lyme disease might include: innovative immunological tests using new antigens, combining serology with direct methods in order to increase sensitivity, standardization of selected unconventional tests, identification of host response biochemical metabolic markers or linking clinical symptoms reported by patients with appropriate test panels. In the absence a vaccine which protects against the disease, the preventive recommendations given to parents to prevent tick bites in children remain valid.