The value of serological testing for Lyme disease in the UK

Although the prevalence of Lyme disease (LD) in the UK is low, patients with clinical presentations compatible with the condition are common. Arthritis often complicates LD in North America, however it is a very rare complication of the condition in the UK. Many patients seen at St George's Hospital, London have visited endemic areas for LD within the UK, Europe and North America. To determine the value of serological testing for LD in the UK, we prospectively studied 120 patients seen at this hospital with clinical manifestations suggestive of LD (12 of whom were recruited to the LD clinic from outside the hospital catchment area), regardless of whether an alternative diagnosis seemed likely. A history of tick bite was obtained and serum antibodies to Borrelia burgdorferi detected initially by enzyme-linked immunosorbent assay (ELISA) and reactive samples immunoblotted to further assess antibody specificity. Tick bites were reported by 22 patients, 16 of whom were bitten in endemic areas for LD. A further 11 patients had exposure to tick habitats in endemic areas, but were unaware of a tick bite. Raised antibody levels were detected by ELISA in 14 individuals (seven of whom had a history of tick bite or tick exposure in an endemic area); however, only four of these had specific antibodies to B. burgdorferi confirmed on immunoblot. All of these four had a history of tick bite in an endemic area, all had arthritis and in three of the four, this was the only manifestation of the condition.(ABSTRACT TRUNCATED AT 250 WORDS)