Lyme Disease: Celebrating the 40th Anniversary of the First Diagnostic Test of Lyme Disease

Dear Colleagues,

Since the discovery of Borrelia burgdorferi in 1982, we have had the ability to support the serological diagnosis of Lyme borreliosis. This procedure has helped countless people recover. However, it soon became clear that the test was neither sufficiently sensitive nor specific. The inexpensive ELISA test, which is suitable for mass screening, is considered a screening test in most guidelines. It is intentionally oversensitive and requires confirmation with an immuno (Western) blot. This is the "two-step" protocol. The Western blot can differentiate between specific and nonspecific (cross-reacting) antibodies, making it much more reliable than ELISA.

Over the years, however, it became evident that increasing sensitivity comes at the cost of specificity. And no matter what innovations we introduced, serology alone, unfortunately, cannot be relied upon. Clinical knowledge is essential. However, since clinicians prefer to learn from their own experience rather than from the (far from perfect) scientific literature, a vast number of false serological results have led to the recording of misleading information regarding possible clinical symptoms. Adding to this issue, numerous Lyme foundations spread pseudoscientific information, creating the impression that everyone in the world either has or could have Lyme disease.

Some publications claim that the specificity of their Lyme serology tests is 99%. This is only conceivable if their sensitivity is very poor. Even with such a test, the positive predictive value is very weak—less than 10%. Paradoxically, serology is least reliable precisely in the population at the highest risk for Borrelia infection. Since most infections occur asymptomatically, without causing clinical symptoms, and in most cases, our immune system successfully eliminates the pathogens, an immune response develops—even in the absence of disease. This means that the serological result will be positive, but Lyme disease is not actually present. The older a forester, hunter, or orienteer is, the more tick bites they accumulate, making it more likely that their test will be positive. Unfortunately, the likelihood also increases that they will have rheumatological, neurological, cardiological, or other conditions. Since they are foresters, hunters, or orienteers, Lyme serology will be performed at some point, and a positive result will lead to a series of antibiotic treatments. Meanwhile, convinced of the certainty of their diagnosis, clinicians may fail to investigate the true underlying cause of the symptoms.

However, some fundamental principles can help differentiate between long-standing (“chronic”) borreliosis and an infection that occurred asymptomatically years ago. There is also a straightforward method to reliably diagnose neuroborreliosis. Furthermore, there are procedures that can diagnose Lyme arthritis with high certainty, as well as acrodermatitis chronica atrophicans and multiple erythema migrans. These topics will also be discussed in the upcoming Special Issue.

Dr. András Lakos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• lyme borreliosis
• borrelia antibody testing
• predictive value
• testing serological progression and regression
• how to prove cure of Lyme disease