Much work has been done on the diagnostics side but in terms of patient's follow up after antibiotherapy, many questions remain unsolved. Culture itself is lengthy, expensive and has a low success rate. The situation is probably worse when samples are mailed to the lab but very little is known about specimen stability during transportation. Lead time it takes 3-4 weeks, up to 10 weeks to get a positive culture. As culture is mainly practiced by research labs in order to produce Borrelia for further studies or to produce antigenic material for other testing methods, the issue deserves some comments.
Successive passages have a trend to decrease the antigenic characteristics of Borrelia organisms.
It is therefore essential, when culturing Borrelia in BSK II, to check that each passage does not lead to an impoverishment of the antigenic properties of the strain. This phenomenon has lead researchers or kit manufacturers to opt for recombinant antigens as a source of target proteins for antibody testing instead of lysates from whole Borrelia germs. Unfortunately the results obtained by these methods are often disappointing as the recombinant material appears to differ significantly from the natural antigens. Some commercial assays have recently appeared on the market but they have not gained significant popularity. If the laboratory has not the right expertise in PCR, it is likely that the method applied to Lyme disease will generate many false positives.