Excerpt:

We investigated the influence of assay choice on the results in a two-tier
testing algorithm for the detection of anti-Borrelia antibodies.

Eighty-nine serum samples from clinically well-defined patients were tested
in eight different enzyme-linked immunosorbent assay (ELISA) systems based
on whole-cell antigens, whole-cell antigens supplemented with VlsE and
assays using exclusively recombinant proteins.

A subset of samples was tested in five immunoblots: one whole-cell blot, one
whole-cell blot supplemented with VlsE and three recombinant blots.

The number of IgM- and/or IgG-positive ELISA results in the group of
patients suspected of Borrelia infection ranged from 34 to 59%.

The percentage of positives in cross-reactivity controls ranged from 0 to
38%.

Comparison of immunoblots yielded large differences in inter-test agreement
and showed, at best, a moderate agreement between tests.

***Remarkably, some immunoblots gave positive results in samples that had
been tested negative by all eight ELISAs.***

The percentage of positive blots following a positive ELISA result depended
heavily on the choice of ELISA-immunoblot combination.

We conclude that the assays used to detect anti-Borrelia antibodies have
widely divergent sensitivity and specificity.

The choice of ELISA-immunoblot combination severely influences the number of
positive results, making the exchange of test results between laboratories
with different methodologies hazardous.

Excerpt:

Lyme disease is a tick-borne spirochetal infection that may
affect the heart.
Cardiac manifestations include conduction disturbances and other
pathologies of the heart. We report on a 37-year old male, who
was admitted to the emergency department because of Cardiac manifestations Physical examination and the initial
laboratory values revealed no abnormalities. The patient’s
electrocardiogram on admission revealed newly diagnosed
bradycardia due to atrioventricular heart block. The ventricular
heart rate was 35/min. The patient was admitted to the ICU. Lyme
serology and Western blot were positive for Borrelia antibodies.
After institution of antibiotic therapy with ceftriaxone,
atrioventricular heart block resolved rapidly. We therefore have
to assume that in this patient Lyme carditis was the cause of
third-degree AV block.