Comparison of Two Methods for Detecting Intrathecal Synthesis of Borrelia Specific Antibodies

Abstract: In Europe, Lyme disease is caused by the species Borrelia (B.) burgdorferi sensu stricto, B. garinii and B. afzelii. The disease is the most common vector-borne infection in Europe and the United States, and the resulting manifestation can involve the skin, nervous system, heart and joints. The symptoms that arise are associated with the Borrelia species causing the infection. The species most associated with neuroborreliosis is B. garinii whilst B. burgdorferi sensu stricto is associated with arthritis and B. afzelii is associated with dermatological symptoms. Lyme disease normally has three phases in untreated patients. The first phase is characterised by erythema migrans, a reddening of the skin around the area of the tick bite. If the disease develops to the second phase the patient will suffer from neuroborreliosis which is characterised by neurological symptoms such as headache and peripheral facial paralysis. Cerebrospinal fluid (CSF) analysis is used to diagnose neuroborreliosis. The diagnosis is complicated by variations between the different Borrelia species and that many healthy individuals have antibodies directed against Borrelia. Antibodies in CSF can be found in different diseases. The antibodies can be produced in the central nervous system or come across the blood-brain barrier and thus derive originally from the blood. By measuring the concentration of total albumin in serum and in CSF it can be determined if the antibodies present in the CSF have been produced in the central nervous system or if they originate from the blood. The typical manifestation in the last phase of Lyme disease is severe arthritis. The aim of this examination project was to compare two ELISAs for detection of antibodies directed to Borrelia. Indirect ELISAs from DAKO and Euroimmun were compared for the diagnosis of neuroborreliosis in 100 individuals. Borrelia specific antibodies of class IgM or IgG were found in 16 of 100 patients by DAKO’s ELISA and in 20 of the same 100 patients by Euroimmun’s ELISA. The reason that Euroimmun’s method detected more cases of neuroborreliosis is probably that this method detects antibodies directed to all three pathological species of Borrelia while DAKO’s method only detects antibodies directed to B. burgdorferi. In conclusion, this study indicates that Euroimmun’s method to detect antibodies of class IgM and IgG directed to Borrelia is superior to DAKO’s method. The obtained results were confirmed by Western blot analysis which gave results in accordance with those of Euroimmun’s ELISA.