The Polymerase Chain Reaction Assay for Borrelia burgdorferi in the Diagnosis of Lyme Disease (1994)

Editorials15 March 1994The Polymerase Chain Reaction Assay for Borrelia burgdorferi in the Diagnosis of Lyme DiseaseLeonard H. Sigal, MDLeonard H. Sigal, MDUniversity of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-6-199403150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail An increasing worship of the instrument for its own sake sometimes leads to enslavement by it [1].Lyme arthritis was first described in 1975 [2], and as the recognition of the clinical spectrum of infection with Borrelia burgdorferi increased, so did the diagnostic tests for what is now called Lyme disease [3]. The desire for a widely available, quick, inexpensive, sensitive, and reliable test has not yet been realized. Even so, the diagnosis of Lyme disease is becoming more test-oriented, and a positive test result, even in the absence of clinical findings suggesting Lyme disease, is mistakenly thought to be ...References1. Seegal D. Seen but unperceived. J Med Educ. 1964; 39:321-4. Google Scholar2. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum. 1977; 20:7-17. Google Scholar3. Steere AC. Lyme disease. N Engl J Med. 1989; 321:586-96. Google Scholar4. Sigal LH. Persisting complaints of Lyme disease: a conceptual review. Am J Med. (In press). Google Scholar5. Dressler F, Whalen JA, Reinhardt BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis. 1993; 167:392-400. Google Scholar6. Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med. 1990; 88:577-81. Google Scholar7. Steere AC, Taylor E, McHugh GL, Logigian EL. The overdiagnosis of Lyme disease. JAMA. 1993; 269:1812-6. Google Scholar8. Hsu VM, Patella SJ, Sigal LH. “Chronic Lyme disease” as the incorrect diagnosis in patients with fibromyalgia. Arthritis Rheum. 1993; 36:1493-500. Google Scholar9. Weiss NL, Sadock VA, Sigal LH, Philips M, Merryman PF, Abramson SB. False positive seroreactivity to Borrelia burgdorferi in rheumatic disease: The value of immunoblot analysis. Autoimmunity. (In press). Google Scholar10. Kaell AT, Redecha PR, Elkon KB, Golightly MG, Schulman PE, Dattwyler RJ, et al. Occurrence of antibodies to Borrelia burgdorferi in patients with nonspirochetal subacute bacterial endocarditis. Ann Intern Med. 1993; 119:1079-83. Google Scholar11. Zoller L, Haude M, Hassler D, Burkard S, Sonntag HG. Spontaneous and post-treatment antibody kinetics in late Lyme disease. Serodiagnosis and Immunotherapy in Infectious Disease. 1989; 3: 345-53. Google Scholar12. Liebling MR, Nishio MJ, Rodriguez A, Sigal LH, Louie JS. The polymerase chain reaction for the detection of Borrelia burgdorferi in human body fluids. Arthritis Rheum. 1993; 36:665-75. Google Scholar13. Garon CF, Dorward DW, Corwin MD. Structural features of Borrelia burgdorferi—the Lyme disease spirochete: silver staining for nucleic acids. Scanning Microsc Suppl. 1989; 3:109-15. Google Scholar14. Persing DH, Barthold SW, Malawista SE. Molecular detection of Borrelia burgdorferi. In: Schutzer SE, ed. Lyme Disease: Molecular and Immunologic Approaches. Plainview, New York: Cold Spring Harbor Laboratory Press; 1992:299-315. Google Scholar15. Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Intern Med. 1994; 120:487-489. Google Scholar16. Sigal LH. Immunopathogenisis of Lyme borreliosis. Clin Dermatol. 1993; 11:415-22. Google Scholar17. Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology. 1992; 42:32-42. Google Scholar18. Schwartz I, Wormser GP, Schwartz JJ, Cooper D, Weissensee P, Gazumyan A, et al. Diagnosis of early Lyme disease by polymerase chain reaction amplification and culture of skin biopsies from erythema migrans lesions. J Clin Microbiol. 1992; 30:3082-8. Google Scholar19. Pachner AR, Delaney E. The polymerase chain reaction in the diagnosis of Lyme neuroborreliosis. Ann Neurol. 1993; 34:544-50. Google Scholar20. Sigal LH, Steere AC, Freeman DH, Dwyer JM. Proliferative responses of mononuclear cells in Lyme disease. Reactivity to Borrelia burgdorferi antigens is greater in joint fluid than in blood. Arthritis Rheum. 1986; 29:761-9. Google Scholar21. Sigal LH. B. burgdorferi (BB)-specific immune reactivity (IR) at the site of Lyme disease (LD) inflammation. IV International Conference on Lyme Borreliosis; Stockholm, Sweden. Google Scholar22. Pachner AR, Ricalton N, Delaney E. Comparison of polymerase chain reaction with culture and serology for diagnosis of murine experimental Lyme borreliosis. J Clin Microbiol. 1993; 31:208-14. Google Scholar Author, Article, and Disclosure InformationAuthors: Leonard H. Sigal, MDAffiliations: University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019.Corresponding Author: Leonard H. Sigal, MD, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 484, New Brunswick, NJ 08903-0019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis John F. Bradley , Russell C. Johnson , and Jesse L. Goodman Metrics Cited byManagement of Lyme Disease in European Children: a Review for Practical PurposeCutaneous and systemic Lyme diseaseLyme Arthritis: Pathogenesis, Clinical Presentation, and ManagementLes traitements non antibiotiques de la borréliose de LymeHuman granulocytic anaplasmosis affecting the myocardiumHuman Granulocytic Anaplasmosis Affecting the MyocardiumLaboratory EvaluationCurrent and future treatment of Lyme diseaseCanine Systemic Bacterial InfectionsLyme DiseasePitfalls in the diagnosis and management of Lyme diseaseLyme diseaseLYME DISEASE:A Review of Aspects of Its Immunology and ImmunopathogenesisPCR in laboratory diagnosis of human Borrelia burgdorferi infectionsRole of Borrelia burgdorferi in the pathogenesis of morphea/scleroderma and lichen sclerosus et atrophicus: a PCR study of thirty-five casesLyme diseaseEarly disseminated Lyme disease: Cardiac manifestationsAnxiety and persistence of Lyme diseaseMANAGEMENT OF LYME DISEASE REFRACTORY TO ANTIBIOTIC THERAPY 15 March 1994Volume 120, Issue 6 Page: 520-521 Keywords Antibiotics Antibodies Cerebrospinal fluid DNA Endocarditis Enzyme linked immunosorbent assay Lyme disease Polymerase chain reaction Specificity Synovial fluid ePublished: 15 August 2000 Issue Published: 15 March 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. 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