Borrelia burgdorferi infection: clinical diagnostic techniques

Borrelia burgdorferi is a tick-borne spirochete and the etiologic agent of Lyme disease. This pathogen now accounts for 91% of vector-borne infections in the United States, and from a public health viewpoint is one of our major emerging infectious disorders. Specific properties of B. burgdorferi have resulted in diagnostic problems, including the lack of a readily available laboratory assay to detect active infection. Most laboratory testing for Lyme disease relies on serologic documentation of prior exposure to the agent. However, such testing detects asymptomatic infections, and does not detect seronegative infections. In addition, antibody tests for Lyme disease are not standardized. Cases of Lyme disease are both underdiagnosed and overdiagnosed. This review will discuss the spirochetal properties which contribute to diagnostic difficulties, will discuss current laboratory diagnostic tests, including serology and detection of B. burgdorferi DNA, and will discuss diagnostic tests in development, including recombinant-based serologic assays and detection of B. burgdorferi antigens.