Circulating Borrelia burgdotferi in Patients with Acute Lyme Disease: Results of Blood Cultures and Serum DNA Analysis

To determine the usefulness of blood culture and polymerase chain reaction (peR) analysis in detecting circulating Borreliaburgdorfeti or its DNA, blood and serum from untreated patients with acute Lyme disease were examined. None of the cultures of blood or serum from the 7 patients tested demonstrated spirochetes. Similarly, all patient serum samples, assayed in two laboratories, were negative for B. burgdorferi DNA using PCR amplification. These results sug-gest that in patients with acute Lyme disease, spirochetes, spirochete DNA, or both circulate early, only intermittently, or at low levels and that neither culture nor PCR testing of blood or serum, as currently done, appears likely to prove generally useful in the diagnosis of Lyme disease. In the absence of erythema migrans (EM), a skin lesion thought to be characteristic of infection with Borrelia burg-dorferi [1], it is difficult to make a secure diagnosis of Lyme disease for at least two reasons. First, the clinical manifesta-tions ofboth acute and chronic Lyme disease are highly vari-able and not specific [1, 2]. Second, serologic and immuno