Laboratory diagnosis of Borrelia burgdorferi
- Blood, cerebrospinal fluid, joint fluid, tissue biopsies
- Body fluids should be transported without any preservatives.
- Tissue biopsy specimens should be placed in sterile saline to prevent drying.
Direct detection methods
- The organisms can be seen directly in wet preparations of peripheral blood (mixed with equal parts of sterile, non bacteriostatic saline) under dark- or brightfield illumination, in which the spirochetes move rapidly, often pushing the red blood cells around.
- In case of lyme disease, tissue sections stained with Warthin-Starry silver stain is visualized.
- PCR has detected B. burgdorferi DNA in clinical specimens from patients with early and late clinical manifestations.
- Optimal specimens include urine, synovial tissue, synovial fluid, and skin biopsies from patients with EM.
- Culture is generally not performed because it takes 6–8 weeks to complete and lacks sensitivity.
- The culture of B. burgdorferi from specimens in Barbour–Stonner–Kelly medium permits a definitive diagnosis.
- Positive cultures have been obtained only early in the illness, primarily from biopsy samples of EM lesions.
- Serology has been the mainstay for the diagnosis of Lyme disease, but 3–5% of normal people and persons with other diseases (example; rheumatoid arthritis, many infectious diseases) may be seropositive by initial EIA or indirect fluorescent antibody (IFA) assay.
- An indirect immunofluorescence test is available, but enzyme-linked immunosorbent assay (ELISA) is now widely used.
- Immunoblotting with a panel of carefully selected recombinant antigens is used to confirm serological results.
- Interpretation of the immunoblot is based on the number and molecular size of antibody reactions with the B. burgdorferi
- Blots can be analyzed for IgG or IgM.
- The antigen–antibody band patterns on the immunoblots should be interpreted with knowledge of known results from patients at various stages of Lyme borreliosis.
Treatment of Borrelia burgdorferi
- Doxycycline is the most recommended treatment for the early stages of the disease.
- If arthritic symptoms have already appeared, longer courses of antibiotics (ceftriaxone) are used.
- Amoxicillin should be used in children and pregnant women.
- Doxycycline, amoxicillin, or cefuroxime and parenteral cephalosporins are drugs of choice during the first stage of Lyme disease.
- Broad spectrum cephalosporins, particularly ceftriaxone or cefotaxime, have been used successfully with patients who either fail initial treatment or present in later stages of the disease.
Prevention and control of Borrelia burgdorferi
- A recombinant outer surface protein A vaccine has been licensed for use in humans against Lyme disease caused by infection with organisms belonging to the B. burgdorferi complex.
- Avoiding tick-infested areas; wearing protective clothing; checking clothing, body, and pets for ticks; and removing them promptly will also assist in the prevention of infection.
- Prevention is based on avoidance of exposure to ticks.
- Wearing long sleeves and long pants tucked into socks is recommended.
- Careful examination of the skin for ticks after being outdoors can locate ticks for removal before they transmit B. burgdorferi.
- Environmental control of ticks using application of insecticides has provided modest success in reducing the number of nymphal ticks for a season.
- Prevention of infection also includes use of insect repellents and wearing clothing that sufficiently protects the body from tick bites.