Serologic Tests for Antibody to Borrelia burgdorferi Another Pandora's Box for Medicine?

Abstract

Much has been written about serologic tests for antibody to Borrelia burgdorferi and their use in the diagnosis of Lyme disease since it first became available in 1983.¹Borrelia burgdorferi antibody serologic tests have offered much promise for improving the diagnosis of Lyme disease and for increasing our knowledge of its epidemiology. However, like "Pandora's box," they have presented us with many unforeseen difficulties. Numerous researchers, reviewers, and editorial writers have wrestled with the merits of alternative test methods, ^2-5 low test See also p 761. sensitivity during the early stages of Lyme disease, ⁶ cross-reactivity with other spirochetal organisms, ⁷ interlaboratory variability with tests that are not standardized, ⁸ and the lack of clinical significance of "positive" serologic test results in patients who do not have Lyme disease.^9,10 As the clinical use of B burgdorferi antibody serologic tests has (apparently) moved forward, Luger and Krause¹¹ entered