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Journal of Clinical Microbiology, October 2005, p. 5080-5084, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5080-5084.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease

Peggy Coulter,1 Clara Lema,1 Diane Flayhart,1 Amy S. Linhardt,1 John N. Aucott,2 Paul G. Auwaerter,2 and J. Stephen Dumler1*

Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland,1 Divisions of General Internal Medicine and Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland2

Received 14 April 2005/ Returned for modification 22 April 2005/ Accepted 13 July 2005

Lyme disease is usually diagnosed and treated based on clinical manifestations. However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies. Although cultivation of Borrelia burgdorferi is definitive, prior investigations have shown that no single test is optimal for Lyme disease diagnosis. We applied high-volume blood culture, skin biopsy culture, PCR, and serodiagnosis to a cohort of patients with suspected Lyme disease acquired in Maryland and southern Pennsylvania. The study was performed to confirm the relative utility of culture and to identify laboratory testing algorithms that will supplement clinical diagnosis. Overall, 30 of 86 patients (35%) were culture positive, whereas an additional 15 of 84 (18%) were seropositive only (51% total sero- and culture positive), and PCR on skin biopsy identified 4 additional patients who were neither culture nor seropositive. Among 49 laboratory test-positive patients, the highest sensitivity (100%) for diagnosis was obtained when culture, skin PCR, and serologic tests were used, although serologic testing with skin PCR was almost as sensitive (92%). Plasma PCR was infrequently positive and provided no additional diagnostic value. Although culture is definitive and has a relatively high sensitivity, the results required a mean of 3.5 weeks to recovery. The combination of acute-phase serology and skin PCR was 75% sensitive, offering a practical and relatively rapid alternative for confirming clinical impression. The full battery of tests could be useful for patients with confusing clinical signs or for providing strong laboratory support for clinical studies of Lyme disease.

* Corresponding author. Mailing address: Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 624, Baltimore, MD 21205. Phone: (410) 955-8654. Fax: (443) 287-3665. E-mail: sdumler{at}jhmi.edu.

Journal of Clinical Microbiology, October 2005, p. 5080-5084, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5080-5084.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Rogers, G. B., Carroll, M. P., Bruce, K. D. (2009). Studying bacterial infections through culture-independent approaches. J Med Microbiol 58: 1401-1418 [Abstract] [Full Text]  
  • Morrison, C., Seifter, A., Aucott, J. N. (2009). Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology. J Am Board Fam Med 22: 219-222 [Abstract] [Full Text]  
  • Spinhirne, J., Dumler, J. S. (2006). Evaluation of Tests for Lyme Disease. J. Clin. Microbiol. 44: 1616-1617 [Full Text]  


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