[Lyme Disease - Laboratory Diagnostics]

Lyme Disease - Laboratory Diagnostics Abstract. Lyme borreliosis is caused by Borrelia burgdorferi. Laboratory testing for Borrelia-specific antibodies is crucial for the diagnosis of Lyme borreliosis in addition to clinical definitions. The diagnostic approach consists of a two-tier testing: firstly, a highly sensitive screening test such as an enzyme immunoassay and secondly, a highly specific confirmatory assay such as a line immunoblot. The screening test detects Borrelia-specific IgM and IgG antibodies but also unspecific antibodies or cross-reactive antibodies against Treponema (causative agent of syphilis). Thus, a reactive screening test always needs confirmation by a specific test such as the immunoblot thereby resolving specific antibodies against different Borrelia antigens. Moreover, the characteristic spectrum of bands in the immunoblot provides evidence to divide the immune response into an early or a late stage of the disease. For the diagnosis of Lyme neuroborreliosis, intrathecal antibody production to B. burgdorferi should be determined by analyzing paired serum and cerebrospinal fluid samples obtained on the same timepoint. Diagnostics of Lyme borreliosis requires a comprehensive report of Borrelia-specific antibody responses and clinical manifestations.