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Posted by AliG (Member # 9734) on :
Clin Vaccine Immunol. 2008 Aug 20. [Epub ahead of print]

Impact of Selected Clinical Variables on Seropositivity in Acute Phase Sera of North American Patients with Culture-Confirmed Early Lyme Disease.

Wormser GP, Nowakowski J, Nadelman RB, Visintainer P, Levin A, Aguero-Rosenfeld ME.

From the Division of Infectious Diseases, Departments of Medicine and Pathology, New York Medical College, Valhalla, NY 10595; the Department of Biostatistics, School of Public Health, New York Medical College, Valhalla, NY 10595; and from Immunetics, Inc., Boston, Mass.

Erythema migrans, the most common manifestation of Lyme disease, has been associated with highly variable rates of seropositivity.

Differences in the sensitivity of serologic assays for detection of antibodies to Borrelia burgdorferi, however, may not be the only or even the primary explanation for this observation.

We investigated the impact on seropositivity of four clinical variables, the duration that erythema migrans was present, the presence of single versus multiple skin lesions, and the gender and age of the patient.

In this analysis, 3 different serologic methods were performed on acute phase sera from 177 untreated patients with culture-confirmed erythema migrans: the C6 single-peptide ELISA; a commercially available ELISA in which a whole cell sonicate of B. burgdorferi is the antigen; and two-tier testing.

Irrespective of the serologic test performed, the results showed that seropositivity rates increased with duration of the erythema migrans skin lesion for patients with single (p less than 0.001) but not multiple skin lesions.

Variability in seropositivity rates was greatest for the two-tier testing strategy, with a greater than six-fold higher rate of seropositivity among patients with a single lesion of 22-30 days duration compared with those whose skin lesion was of 1-7 days duration (85.7% vs. 13.8%, p less than 0.001).

Rates of seropositivity for each of the testing methods were also significantly higher in patients with multiple compared to single skin lesions (p less than 0.001).

In contrast, seropositivity rates were not affected by either the gender or age of the patient.

In patients with erythema migrans certain clinical variables such as duration or multiplicity of the skin lesion had a profound impact on seropositivity rates irrespective of the serologic assay performed.

PMID: 18716009 [PubMed - as supplied by publisher

[ 29. August 2008, 10:52 AM: Message edited by: AliG ]

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