Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay

We used an antibody-capture enzyme immunoassay (EIA) to evaluate the early antibody responses to Borrelia burgdorferi in paired sera from 30 patients with erythema chroni-cum migrans. During acute disease, 20 (670,70) patients had elevated specific IgM responses, and by convalescence(one to four weeks after treatment), 28 (93%) patients had increased IgM or IgG responses. In acute specimens, elevated IgM responses correlated with dis-seminated infection; however, by convalescence, most patients with either localized or disseminated disease had positive tests. Among 133control subjects, IgM cross-reactivity was observed in 4 of 37 patients with either Epstein-Barr virus or rickettsial infections, and false-positive IgG tests were seen in 8 of 28 patients with syphilis. With antibody-capture EIA, the diagnosis of Lyme disease can be confirmed in the majority of acutely ill patients and in almost all patients by convalescence. Borrelia burgdorferi, the etiologic agent of Lyme dis-ease, was first isolated from ticks in 1981 [1] and later from blood, skin, or spinal fluid of patients with acute disease [2, 3]. The infection characteristicall