Pitfalls and Benefits of Serological Diagnosis of Lyme Borreliosis From a Laboratory Perspective
; Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Oktavija Đaković Rode orcid.org/0000-0001-8023-4314 ; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Croatia
Lyme borreliosis (LB) in Europe is most commonly caused by different borrelia of Borrelia burgdorferi sensu lato complex , while in North America the only pathogen is B.burgdorferi sensu stricto. Clinical manifestations of LB are polymorphic. Diagnosis is based on the clinical presentation and epidemiological data on the likelihood of contact with ticks and with the application of microbiological diagnostics. The most common routine diagnosis is serology to determine and monitor the dynamics of specific IgM and IgG antibodies. After primary testing, the results need to be confirmed by an additional high-specificity test. In regions with a high prevalence, the specificity of the results of a highly sensitive and specific test does not need to be further confirmed. Both positive and negative findings must be interpreted clinically. Serological diagnosis is beneficial for the recognition and treatment of patients only if the results are interpreted on the basis of knowledge of the pathogenesis, clinical presentation and immune response as well as the characteristics of the test used. The characteristics of borrelia itself and the presentation of the antigen, the avoidance of the immune response, the availability of various tests as well as the Internet are pitfalls, especially if unverified information is followed.
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