There is wide divergence of opinion between physicians regarding the use of serological measures for the diagnosis and treatment of
erythema migrans, the hallmark of
Lyme borreliosis. We studied the outcome of an
enzyme immunoassay and immunoblot (Western blot) used on the sera of patients who had suffered
tick bite and
erythema migrans, and had been subsequently treated with various
antibiotics. Ninety-nine consecutive patients presenting with
erythema migrans after
tick bite were prospectively recruited at the outpatient department of two Vienna City hospitals and at the consultation office for
Lyme borreliosis of the Institute of Hygiene. University Vienna. Blood samples were taken before
antibiotic treatment and 3 and 6 months thereafter. Blood samples from 100 blood donors served as controls.
Antibodies against Borrelia burgdorferi sensu lato were determined by
enzyme immunoassay (
IgG and
IgM EIA) and by
IgG immunoblot. The latter was performed with isolates of B. alzelii (H2) B. burgdorferi sensu stricto (Le) and B. garinii (W) from Austrian patients. The 4 interpretation criteria for immunoblot results were: A (3 bands out of 8),
B (2 bands out of 9), C and D (1 band out of 6). In all patients, the
erythema resolved within the treatment period. No complications secondary to the
borrelia infection were registered.
After treatment there was no significant change in titre, nor was there a difference in the immunoblot pattern between the first, second and third serum samples. Serum
antibodies to B. burgdorferi were positive by EIA in 22.9% (
IgG) and 2.5% (
IgM). Immunoblot results offered by borrelia species and by the interpretation criteria, ranging between 8.3% (criterion A, strain Le) and 44.2% (criterion D, strain H2). By EIA, control samples were
IgG and
IgM positive in 5% and 1%, respectively. Positive immunoblot results with strain H2 were found in 9%, 13%, 18%, and 20% by the criteria A through D respectively. After
antibiotic treatment of
erythema migrans the immunological response appears to be abrogated. Thus, serological results are not supportive for the diagnosis of
erythema migrans, not will they retrospectively prove successful
antibiotic treatment of
borrelia infection.