The lymphocyte transformation test for the diagnosis of Lyme borreliosis
Authors: V. von Baehr
Journal: Clinical Microbiology and Infection (2014)

I would like to comment on the letter from Dessau et al.: "Lymphocyte transformation test for diagnosis of Lyme borreliosis is currently not documented to be clinically useful" [[1]Dessau R.B. Fingerle V. Gray J. Hunfeld K.P. Jaulhac B. Kahl O. et al.Lymphocyte transformation test for diagnosis of Lyme borreliosis is currently not documented to be clinically useful.Clin Microbiol Infect. 2014; 20: O786-O787Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar]. I wish to thank Dessau and colleagues for their interest in our study and am very pleased that they confirm that the lymphocyte transformation test (LTT) shows a high specificity in seronegative cases [[1]Dessau R.B. Fingerle V. Gray J. Hunfeld K.P. Jaulhac B. Kahl O. et al.Lymphocyte transformation test for diagnosis of Lyme borreliosis is currently not documented to be clinically useful.Clin Microbiol Infect. 2014; 20: O786-O787Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar]. Especially in such cases, the validity of the LTT is often controversially reported. As expected, the specificity was lower in seropositive samples than in seronegative cases, most likely due to the persistence of few, proliferating memory cells in the blood. Since antibody determinations often do not lead to secure diagnostic results, the specificity of 91.6% of the LTT in seropositive patients may be considered as acceptable. In many cases with positive antibody results, the suspicion of an active borreliosis can be eliminated by a negative LTT, although a false-positive rate of 8.4% must be considered in the assessment. Our publication points to the fact that clinical results are decisive for diagnosis, whereas laboratory diagnostics, including the LTT, may provide additional indications only. The diagnosis of borreliosis in 94 patients was based exclusively on clinical results, taking serology and medical history into account. In our manuscript, the clinical manifestations of 94 patients are described in the fourth paragraph, in the section "Subjects and Patients." It is well known that borreliosis cannot be diagnosed unequivocally. The aim of the present study was to examine the correlation between LTT result and disease activity, thus, the combination of medical history and clinical and serological findings were used for diagnosis of borreliosis. I do not agree with the statement of Dessau and colleagues that our results do not confirm the inhibitory effects of antibiotic treatment on T cell reactivity [[1]Dessau R.B. Fingerle V. Gray J. Hunfeld K.P. Jaulhac B. Kahl O. et al.Lymphocyte transformation test for diagnosis of Lyme borreliosis is currently not documented to be clinically useful.Clin Microbiol Infect. 2014; 20: O786-O787Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar]. Although the study was not specifically designed to address the clinical outcome of the patients following antibiotic therapy, the 92.1% and 53.3% decreases in T cell reactivity in patients with early and late phase manifestations, respectively, show an inhibitory effect of antibiotic treatment on the LTT result. This confirms our findings that T cell reactivity was Borrelia-specific in most cases. In addition, our results are supported by recently published data [2Krause A. Brade V. Schoerner C. Solbach W. Kalden J.R. Burmester G.R. T cell proliferation induced by Borrelia burgdorferi in patients with Lyme borreliosis. Autologous serum required for optimum stimulation.Arthritis Rheum. 1991; 34: 393-402Crossref PubMed Scopus (51) Google Scholar, 3Breier F. Klade H. Stanek G. Poitschek C. Kirnbauer R. Dorda W. et al.Lymphoproliferative responses to Borrelia burgdorferi in circumscribed scleroderma.Br J Dermatol. 1996; 134: 285-291Crossref PubMed Scopus (31) Google Scholar]. In contrast to the opinion of the colleagues who attest a clinical relevance of LTT in the future only, our results indicate that LTT may already provide a useful diagnostic tool for the detection of borreliosis in difficult cases. The prerequisite for its application is an adequate specificity, and the interpretation of LTT results in the context of medical history, clinical findings, and serological procedures. However, we also emphasize the requirement for standardisation among testing laboratories in the near future. The author has no conflict of interested related to the present article. The authors reply to comments on "The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful." Clin Microbiol Infect 2014;20:O786–O787Clinical Microbiology and InfectionVol. 21Issue 3PreviewVon Baehr et al. have provided comments to our letter titled "The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful" [1]. We would like to thank Dr. von Baehr for providing the additional information that the clinical diagnoses were adapted from the patient's health record. However, we still do not know the details of how it was ensured that the 94 patients really suffered from clinical Lyme borreliosis (LB). Full-Text PDF Open Archive