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Steven E. Schutzer, MD; P. K. Coyle, MD; Patrick Reid, MS; Bart Holland, PhD

JAMA. 1999;282:1942-1946.

Context  Diagnosis of infection with Borrelia burgdorferi, the cause of Lyme disease (LD), has been impeded by the lack of effective assays to detect active infection.

Objective  To determine whether B burgdorferi–specific immune complexes are detectable during active infection in LD.

Design, Setting, and Patients  Cross-sectional analysis of serum samples from 168 patients fulfilling Centers for Disease Control and Prevention surveillance criteria for LD and 145 healthy and other disease controls conducted over 8 years. Tests were performed blinded.

Main Outcome Measure  Detection of B burgdorferi immune complexes by enzyme-linked immunosorbent assay and Western blot.

Results  The B burgdorferi immune complexes were found in 25 of 26 patients with early seronegative erythema migrans (EM) LD; 105 of 107 patients with seropositive EM LD; 6 of 10 patients who were seronegative with culture-positive EM; 0 of 12 patients who were treated and recovered from LD; and 13 of 13 patients with neurologic LD without EM. Among 147 controls, B burgdorferi immune complex was found in 0 of 50 healthy individuals; 0 of 40 patients with persistent fatigue; 0 of 7 individuals with frequent tick exposure; and 2 of 50 patients with other diseases.

Conclusion  These data suggest that B burgdorferi immune complex formation is a common process in active LD. Analysis of the B burgdorferi immune complexes by a simple technique has the potential to support or exclude a diagnosis of early as well as active LD infection.

Author Affiliations: Department of Medicine, Division of Allergy and Immunology (Dr Schutzer and Mr Reid) and Department of Preventive Medicine (Dr Holland), University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Schutzer and Mr Reid); and the Department of Neurology, State University of New York, Stony Brook (Dr Coyle).

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