Borrelia Line Immunoblot

About Lyme-Borreliosis

Lyme-Borreliosis is a systematic disease caused by an infection with the spirochaeta B. burgdorferi.^1,2  Transmission of the spirochaete to humans is effected by the bite of an infected tick. In Europe the tick Ixodes ricinus has been identified as main vector.³ The following human pathogenic B. burgdorferi species are currently recognised in Europe: B. burgdorferi sensu stricto, B. garinii, B. afzelii, B.spielmanii and B. bavariensis.^4,3,5,5,7,8 They are comprised under the term Borrelia burgdorferi sensu lato (s.l).

Lyme Borreliosis is a multisystem disease, which takes its course in stages, with a predominantly involvement of skin, joints and nervous system. Due to the wide spectrum of occurring clinical manifestations, the diagnosis of the Lyme-Borreliosis is difficult³. Differential-diagnostically meaningful is above others the limitation compared with different dermatological (e.g. B-cell-lymphom of the skin, Lupus erythematodes), neurological (e.g. multiple sclerosis) and internal (e.g. arthritis, carditis) diseases.⁹

The serological diagnostic of the Lyme-Borreliosis is, beside others, complicated by the following factors:

• negative serology does not exclude Lyme-Borreliosis – especially not in in early stages.¹⁰
• development of IgM-antibodies may fail to appear entirely.
• IgM-antibodies may persist for months.^21,36
• IgG-antibodies may remain detectable even years after a clinical remission.^11,12
• Cross-reactions to other micro-organisms have been observed.^13,14 Bacterial caused diseases like Syphilis as well as Herpes-Virus-Infections (especially EBV) are an important factor here.¹⁵ False positive antibody responses may occur also at the presence of autoimmune-antibodies.¹³

The challenge of the Lyme-Borreliosis-serology is based on the supportive clarification of a clinical reasonable suspicion.

Therefore, the Lyme-Borreliosis-serology may give important information about the sero-negativity or confirm the suspicion of presence of an acute- as well as an advanced infection. However, a positive antibody result must absolutely be assessed in connection with the clinical picture.¹⁰

In accordance with MIQ 12/2000 and DIN 58969-44 July 2005, it is recommended to perform Lyme borelliosis serology in two steps.^16,17 In the first step the samples are tested with a sensitive screening assay (the MiQ 12/2000 recommends to-use an ELISA as screening assay). Borderline and positive sera are examined with a confirmatory test (Line Immunoblot/Western Blot) afterwards. The analysis with the Line Immunoblot/Western Blot enables the specific analysis of the antibody response that is aimed against single pathogen antigens.
 

Features & Benefits

• Optimized combination of native, highly purified and recombinant B. burgdorferi s.l. antigens.
• Antigen combination of all important human pathogenic genospecies, including B. spielmanii and B. bavariensis.
• Use of the national Reference Center (NRZ) published B. bavariensis (PBi)-p58 Antigen.
• DbpA antigen combination of several Borrelia genospecies.
• VlsE of two genospecies.
• Exclusion marker for EBV primary infection.
• Additional exclusion marker for a Syphilis infection on the Borrelia Europe + TpN17 LINE.
• Easy reading & interpretation, also with the LabImage LA^® software.
    

References

1. Burgdorfer, W., Barbour, A.G., Hayes S.F. et al. (1982), Lyme disease - a tick -borne pirochetosis? Science 216:1317-19.
2. Steere, A.C. (1989), Lyme Disease, N. Engl. J. Med. 321:586-96.
3. Pfister,H-W., Wilske, B. (1994) Lyme borreliosis: basic science and clinical aspects, The Lancet Vol. 343: 1013-1015.
4. Dressler, F. (1994) Lyme borreliosis in European children and adolescents, Clinical and Experimental Rheumatology 12 (Suppl. 10) :49-54
5. Dressler, F., Ackermann, R. and Steere, A.C. (1994), Antibody responses to the three genomic groups of Borrelia burgdorferi in European Lyme Borreliosis, J. Infect. Dis. 169: 313-318
6. Fingerle, V., Schulte-Spechtel, U.C., Ruzic-Sabljic, E., Leonhard, S., Hofmann, H., Weber, K., Pfister, K., Strle, F., Wilske, B. (2007) Epidemiological aspects and molecular characterization of Borrelia burgdorferi s.l. from southern Germany with special respect to the new species Borrelia spielmanii sp. nov. Int J Med Microbiol
7. Herzberger, P., Siegel, C., Skerka, C., Fingerle, V., Schulte-Spechtel, U., van Dam, A., Wilske, B., Brade, V., Zipfel,P.F., Wallich, R., Kraiczy, P. (2007) Human pathogenic Borrelia spielmanii sp. nov. resist complement-mediated killing by direct binding of immune regulators factor H and FHL-1. Infect Immun
8. Wang, G., van Dam, A.P., Dankert, J. (1999) Phenotypic and genetic characterization of a novel Borrelia burgdorferi sensu lato isolate from a patient with lyme borreliosis. J Clin Microbiol 37: 3025-3028
9. Oschmann und Kraiczy, (1998), Lyme-Borreliose und Frühsommer-Meningoenzephalitis“, UNI-MED-Verlag
10. RKI (1999), Ratgeber Infektionskrankheiten, Lyme-Borreliose, Epidemiologisches Bulletin, überarbeitete Auflage
11. Craft, J.E., Grodzicki, R.L. and Steere, A.C. (1984), Antibody response in Lyme disease: evaluation of diagnostic tests, J. Inf. Dis. 149:789-95
12. Craft, J.E., Fischer, D.K., Shimamoto, G.T. and Steere, A.C. (1986), Antigens of Borrelia burgdorferi recognized during Lyme disease. Appearance of a new immunoglobulin M response and expansion of the immunoglobulin G late in the illness.J. Clin. Invest. 78: 934-39
13. Horst, H. (1997), Einheimische Zeckenborreliose (Lyme-Krankeit) bei Mensch und Tier, 3., überarbeitete Auflage, Spitta Verlag: 128-130
14. Tewald, F. Braun, R. (1998), Durchführung und Interpretation serologischer Tests bei Verdacht auf Borrelien infektion. Clin. Lab. 44: 897-902
15. Goosens, H.A.T., Bogaard, van den A.E., Nohlmans, M.K.E., (1999), Epstein-Barr Virus and Cytomegalovirus Infections cause false.positive results in IgM two-test protocol for early Lyme-Borreliosis, Infection 27 No.3: 231
16. Wilske et al., 12/2000, Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik für Lyme-Borreliose, pp. 38ff., Urban&Fischer Verlag
17. Normenausschuss Medizin (NAMed) im DIN, DIN 58969-44, Medizinische Mikrobiologie-Serologische und molekularbiologische Diagnostik von Infektionskrankheiten -Teil 44: Immunoblot (IB); Spezielle Anforderungen für den Nachweis von Antikörpern gegen Borrelia burgdorferi, Juli 2005, Beuth Verlag GmbH.