monkeypa at dircon.co.uk (Palund) writes:
> B. burgdorferi isolation via culture from any sample is the most
>definite way to prove that the diagnosis of Lyme borreliosis is correct.
>If patient has neurological symptoms due to LB, analysis of spinal fluid
>should be always attempted. I would suggest not only antibody analysis,
>but culture and PCR of CSF as well. It is best to subject the sample to
>all available testing techniques, since its an invasive procedure and
>antibodies are not 100% reliable.
It is true that a serological test is not definitive, and there have been
several attempts at developing new testing methods that rely on other
fluids/matrices. I worked on development of a rapid urine assay using
high affinity MAbs about 10 years ago, and was able to detect down to
about 3000 organisms/organism parts/ml. The main problem with doing any
other testing for Bb is that the bacteremia involved is exceedingly
transient and on such low concentrations (unlike the bacteremias of
other Borrelia, which can be as high as 10^9/ml that even culture
techniques are not reliable; time to develop a "positive" culture test
may take as long as 2-3 weeks. The virulent organisms tend to grow very slowly as opposed
to the avirulent lab-adapted strains commonly used by researchers. The
bacteremia is usually most noticeable between days 3 and 10
post-infection, whereafter the organisms invade the tissues and mostly
come out only during a "flare" (arthritis, etc).
