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Open AccessArticle

A Community Study of Borrelia burgdorferi Antibodies among Individuals with Prior Lyme Disease in Endemic Areas

Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
Research Foundation for Mental Hygiene, Inc., New York, NY 10032, USA
Institute for Experimental Immunology, Euroimmun, 23560 Lübeck, Germany
Independent Researcher, Basking Ridge, NJ 07920, USA
Author to whom correspondence should be addressed.
Healthcare 2018, 6(2), 69;
Received: 3 May 2018 / Revised: 12 June 2018 / Accepted: 13 June 2018 / Published: 19 June 2018
The objective was to examine the prevalence of Borrelia antibodies among symptomatic individuals with recent and past Lyme disease in endemic communities using standard assays and novel assays employing next-generation antigenic substrates. Single- and two-tiered algorithms included different anti-Borrelia ELISAs and immunoblots. Antibody prevalence was examined in sera from 32 individuals with recent erythema migrans (EM), 335 individuals with persistent symptoms following treatment for Lyme disease (PTLS), and 41 community controls without a history of Lyme disease. Among convalescent EM cases, sensitivity was highest using the C6 ELISA (93.8%) compared to other single assays; specificity was 92.7% for the C6 ELISA vs. 85.4–97.6% for other assays. The two-tiered ELISA-EUROLINE IgG immunoblot combinations enhanced case detection substantially compared to the respective ELISA-IgG Western blot combinations (75.0% vs. 34.4%) despite similar specificity (95.1% vs. 97.6%, respectively). For PTLS cohorts, two-tier ELISA-IgG-blot positivity ranged from 10.1% to 47.4%, depending upon assay combination, time from initial infection, and clinical history. For controls, the two-tier positivity rate was 0–14.6% across assays. A two-tier algorithm of two-ELISA assays yielded a high positivity rate of 87.5% among convalescent EM cases with specificity of 92.7%. For convalescent EM, combinations of the C6 ELISA with a second-tier ELISA or line blot may provide useful alternatives to WB-based testing algorithms. View Full-Text
Keywords: Lyme disease; Borrelia burgdorferi; serology; ELISA; immunoblot Lyme disease; Borrelia burgdorferi; serology; ELISA; immunoblot
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Strobino, B.; Steinhagen, K.; Meyer, W.; Scheper, T.; Saschenbrecker, S.; Schlumberger, W.; Stöcker, W.; Gaito, A.; Fallon, B.A. A Community Study of Borrelia burgdorferi Antibodies among Individuals with Prior Lyme Disease in Endemic Areas. Healthcare 2018, 6, 69.

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