Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots.

Abstract

We investigated the influence of assay choice on the results in a two-tier testing algorithm for the detection of anti-Borrelia antibodies. Eighty-nine serum samples from clinically well-defined patients were tested in eight different enzyme-linked immunosorbent assay (ELISA) systems based on whole-cell antigens, whole-cell antigens supplemented with VlsE and assays using exclusively recombinant proteins. A subset of samples was tested in five immunoblots: one whole-cell blot, one whole-cell blot supplemented with VlsE and three recombinant blots. The number of IgM- and/or IgG-positive ELISA results in the group of patients suspected of Borrelia infection ranged from 34 to 59%. The percentage of positives in cross-reactivity controls ranged from 0 to 38%. Comparison of immunoblots yielded large differences in inter-test agreement and showed, at best, a moderate agreement between tests. Remarkably, some immunoblots gave positive results in samples that had been tested negative by all eight ELISAs. The percentage of positive blots following a positive ELISA result depended heavily on the choice of ELISA-immunoblot combination. We conclude that the assays used to detect anti-Borrelia antibodies have widely divergent sensitivity and specificity. The choice of ELISA-immunoblot combination severely influences the number of positive results, making the exchange of test results between laboratories with different methodologies hazardous.

• Authors: C W Ang, D W Notermans, M Hommes, A M Simoons-Smit, T Herremans
• Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 30 Issue 8 Pg. 1027-32 (Aug 2011) ISSN: 1435-4373 [Electronic] Germany
• PMID: 21271270 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Antibodies, Bacterial
• Antigens, Bacterial
• Immunoglobulin G
• Immunoglobulin M
• Recombinant Proteins

Topics

• Antibodies, Bacterial (blood)
• Antigens, Bacterial (immunology)
• Borrelia (immunology)
• Clinical Laboratory Techniques (methods)
• Enzyme-Linked Immunosorbent Assay (methods)
• Humans
• Immunoblotting (methods)
• Immunoglobulin G (blood)
• Immunoglobulin M (blood)
• Lyme Disease (diagnosis)
• Recombinant Proteins (immunology)
• Sensitivity and Specificity