A sonicate
antigen and two concentrations of a purified flagellum
antigen of Borrelia burgdorferi were compared for serological diagnosis of
Lyme borreliosis by an
enzyme immunoassay (EIA). Generally, the higher concentration of flagellum
antigen was found to be superior to the lower concentration, which was diluted eight times compared to the higher concentration. The diagnostic sensitivity for
IgG antibody detection increased from 13% in the sonicate EIA to 31% in the best flagellum EIA assay (p = 0.01) in sera from patients with
erythema migrans (n = 70), and from 34% to 55% (p = 0.01) in sera from patients with neuroborreliosis (n = 77). However, the sensitivity for
IgG in sera from patients with
acrodermatitis chronica atrophicans (n = 20) was high in both assays: 90% in the sonicate EIA compared to 95% in the flagellum EIA. Regarding
IgM, there was no significant difference between the sensitivity of the assays in sera from any of the patient groups. The sensitivity values for
IgM and
IgG in cerebrospinal fluid (CSF) from patients with neuroborreliosis were also without significant differences. Sera and CSF from patients with
meningitis/
encephalitis of non-Borrelia etiology (n = 35),
multiple sclerosis (n = 9) or
syphilis (n = 24), served as controls. The flagellum EIA showed a significantly improved specificity for
IgG in CSF from controls with
syphilis (p less than 0.01). It is concluded that purified Borrelia burgdorferi flagellum
antigen is superior to a sonicate
antigen, especially for serodiagnosis of the early stages of
Lyme borreliosis.