Borrelia Burgdorferi IgM Antibody

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1) What is Lyme disease?

Lyme disease or Lyme borreliosis is a bacterial infection caused by Borrelia burgdorferi. Borrelia is a large, motile, elongated, flexible and spirally twisted bacteria belonging to the Spirochete group of family. Several species of Borrelia exist but diseases of medical importance are Lyme disease by B.burgdorferi, B.mayonii, B.garinii, or B.afzelii and those causing relapsing fever-like B.vincenti, B.duttonii, B.hermsii and B.parkeri.

2) What is the mode of transmission?

Lyme infection is a vector-borne infection transmitted by the bites of Ixodid ticks. Borrelia grows in the midgut of these ticks and infection occurs by regurgitation of the midgut contents upon a person being bitten. These ticks live in woody and forest areas.

3) What are the symptoms of this infection?

Lyme infection symptoms can differ from person to person with varying degrees of severity. After an incubation period of 3-30 days, initially, there is localized infected skin at the site of tick bite in the form of Erythema migrans. It is the first stage of infection and is a telltale rash that occurs in about 70% to 80% of the cases. It starts as a small red spot that expands for days or weeks, forming a circular, triangular, or oval-shaped rash and central clearing. A few weeks later, the second stage begins which is ‘disseminated infection’ – spread via blood. Here the patient has flu-like symptoms such as fever, headache, muscle aches, joint pain, fatigue, stiff neck and swollen lymph nodes (lymphadenopathy).

4) What are the complications of this infection?

During the second stage, few patients may show involvement of the heart or nervous system (involving meninges - the outer covering of the brain and spinal cord). The third stage sets in months or years later after the initial infection and is recognized as ‘persistent infection’. This is a more advanced disease wherein the patient suffers from nerve problems (polyneuropathy), meningitis and encephalopathy (brain involvement), acrodermatitis and long-standing arthritis (especially knees). Untreated Lyme infection can lead to Lyme arthritis, hepatitis, eye rash, neurologic symptoms like facial paralysis and neuropathy, cognitive defects such as impaired memory and irregular heartbeats.

5) Is this a preferred test for the diagnosis of Lyme disease?

Yes. Borrelia burgdorferi takes two weeks or more to grow outside the body in an artificial culture media. This organism is difficult to culture or to be directly seen in tissue, so these antibody tests (known as serological tests) are the preferred method for diagnosis as indicators of exposure.

6) Is there any other test that I need to add?

Yes. For reliable interpretation of results, both IgG and IgM antibodies must be done. IgG antibodies appear four to six weeks after the onset of initial symptoms and peak at 4 to 6 months. A positive IgG test with a negative IgM result indicates that a person has a late-stage infection or has been infected in some time in the past.

7) Is it possible that the results are positive but the patient is not having any infection?

Yes. In medical language, we label such cases as false positives. A person with detectable IgM antibodies may have a very recent infection or a false-positive test result. False positives are generally weakly reactive results due to cross-reactivity with related bacterial diseases like syphilis, relapsing fever, or other spirochetal diseases and viral infections like Cytomegalovirus, Epstein Barr virus or Rocky Mountain spotted fever or nonspecific immune response due to autoimmune disease, rheumatoid arthritis or SLE (systemic lupus erythematosus).  Detailed history and clinical examination along with supportive laboratory tests can help in distinguishing all these conditions from Lyme infection. Also, Lyme vaccines recipients will have positive test results.

8) How can we distinguish Lyme disease from syphilis?

Cross-reactivity has been shown in serum from patients having Lyme disease with syphilis. In such a scenario, clinical signs and symptoms, epidemiological information, RPR, VDRL, TPHA, or specific syphilis ELISA test results and other laboratory data must be taken into account in addition to IgG and IgM assay results. This will help in the distinction between these two diseases.

9) Is it possible that the results are negative but the patient is having Lyme disease?

Yes. In medical language, we label such cases as a false negative. The approach to the diagnosis of Lyme disease varies, depending on the probability of disease (based on endemicity and clinical findings) and the existing stage of the disease. The false negatives are primarily due to the difficulty in detecting early disease by serologic tests because in the initial stages of infection, the body may not form detectable levels of antibody or early antibiotics therapy may prevent antibody production from reaching diagnostic levels.

10) Is this infection treatable?

Yes. Lyme infection can be easily treated by an antibiotics course prescribed by the treating physician. However, after completion of the antibiotics course, if symptoms like joint and muscle pain persist, supportive treatment is needed.

11) Can this test be used to see whether the treatment has been effective or not?

No. IgM antibodies may persist for months even after giving antimicrobial treatment. Continued presence or absence of antibodies in the patient’s serum cannot be used to determine the success or failure of therapy.

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