Evaluation of bacteriological serodiagnostics in patients with undifferentiated arthritis
Part III. Immunoenzymatic method (ELISA) as a screening test in serodiagnosis of joint inflammation of suspected B. burgdorferi aetiology: cross-reactivity of antibodies to B. burgdorferi with S. enteritidis, S. typhimurium, Y. enterocolitica O3 and Ch. trachomatis
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Online publication date: 2009-12-29
Reumatologia 2009;47(5):249-257
Serum antibodies to Borrelia burgdorferi in 1850 cases of patients hospitalized in the Institute of Rheumatology, consulted by physicians in Outpatient Clinics and also ordered by other medical units, were done in the years 2004-2006.
As a screening test, the ELISA method was applied for indication of antibodies IgG and IgM class against B. burgdorferi, and presence of these antibodies may suggest the infectious aetiology of analyzed unclassified joint inflammation.
The majority of the ordered tests (over 60% of all orders) in cases of children and teenagers (hospitalized in the Institute of Rheumatology) originated from the Paediatric Clinic and Paediatric Outpatient Clinic, and there was no correlation (relation) between ordered amount of assays and number of positive results (about 15%) of all ordered (requested) tests. Most frequently (in about 30% of tested samples) these antibodies are confirmed (independently of Ig-s class) in the sera of patients originating from Adult and Children Outpatient Clinics and also in the sera of patients suffering cardiomyopathy, in which (in cardiomyobiopsics) some kinds of spirochetes were discovered (done as part of scientific cooperation with the Department of Pathological Anatomy).
Assessed antibodies were most frequently IgM class (66.2%), only rarely IgG class (around 25%), and only in 9% both classes. These results may be considered as an early stage of infection with joint involvement in the majority of patients seropositive for anti-Borrelia burgdorferi antibodies.
We also observed a high cross-reactivity (around 25%) with antigens of other bacteria such as: Salmonella enteritidis, Salmonella typhimurium, Yersinia enterocolitica O3 and Chlamydia trachomatis and this phenomenon of cross-reactivity indicates very limited value of the screening method, because all positive results should be confirmed by a specific Western blot method. At the same time, co-appearance of antibodies to other bacteria suggests co-infection or possibly former infection, especially in cases with presence of antibodies to two different classes directed at different microbes (bacteria).
The obtained results may be considered as proof that in any case seropositivity should be necessarily interpreted with regard to the clinical studies of particular patients and also differential diagnosis, taking into consideration other diseases giving a similar clinical picture, as in borreliosis.
Schnarr S, Franz JK, Krause A, et al. Lyme borreliosis. Best Pract Res Clin Rheum 2006; 20: 1099-1118.
Klimczak M, Gładysz M, Ząbek J. Diagnostyka różnicowa Lyme- -arthritis z reumatoidalnym zapaleniem stawów. Przegl Epidem 2006; 60: 58-59.
Przytuła L, Gińdzieńska-Sieskiewicz E, Sierakowski S. Diagnostyka i leczenie boreliozowego zapalenia stawów. Przegl Epidem 2006; 60: 125-130.
Massarotti E. Lyme arthritis. Med Clin North Am 2002; 86: 297-309.
Aguero-Rosenfeld ME, Wang G, Schwartz I, et al. Diagnosis of Lyme borreliosis. Clin Microb Rev 2005; 18: 484-509.
Witecka-Knysz E, Klimczak M, Lakwa K i wsp. Borelioza: dlaczego diagnostyka jest tak trudna? Diagnosta Lab 2007; 13: 11-13.
Ząbek J. Diagnostyka boreliozy - wytyczne dla ośrodków reumatologicznych. Reumatologia 1999; 39: 25-32.
Vormiser GP, Bittker S, Cooper D, et al. Yield of large-volume blood cultures in patients with early Lyme disease. J Infect Dis 2001; 184: 1070-1072.
Karlsson M, Ho/vind-Hougen K, Svenungsson B, et al. Cultivation and characterization of spirochetes from cerebro-spinal fluid of patients with Lyme borreliosis. J Clin Microb 1990; 28: 473-479.
Karch H, Huppertz HJ, Bohme M, et al. Demonstration of Borrelia burgdorferi DNA in urine samples from healthy humans whose sera contain B. burgdorferi - specific antibodies. J Clin Microb 1994; 32: 2312-2314.
Nocton JJ, Dressler F, Rutledge BJ, et al. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. New Engl J Med 1994; 330: 229-234.
Wilske B, Fingerle V, Herzer P, et al. Recombinant immunoblot in the serodiagnosis of Lyme borreliosis. Comparison with indirect immunofluorescens and enzyme-linked immuno-sorbent assay. Med Microb Immun 1993; 182: 255-270.
Liang FT, Steere AC, Marques AR, et al. Sensitive and specific serodiagnosis of Lyme disease by enzyme-linked im-munosorbent assay with a peptide based on an im-munodominant conserved region of Borrelia burgdorferi VLsE. J Clin Microb 1999; 37: 3990-3996.
Zajkowska J, Kondrusik M, Grygorczuk S i wsp. Porównanie testów wykrywających przeciwciała przeciw antygenom Borrelia burgdorferi opartych na jednym genogatunku (EIA) i antygenach rekombinowanych (ELISA). Przegl Epidem 2006; 60: 171-176.
Flisiak R, Prokopowicz D. Antibodies against B. garinii in diagnosis of Lyme disease. Przegl Lek 2000; 57: 147-149.
Flisiak R, Chodynicka B. Antibodies against Borrelia afzelii in patients with an early stage of Lyme disease. Wiad Lek 2001; 54: 19-25.
Pancewicz SA, Zajkowska JM, Kondrusik M i wsp. Obecność przeciwciał przeciwko Borrelia burgdorferi wśród pracowników leśnych w północno-wschodniej Polsce. Med Prakt 1998; 49: 253-259.
Zajkowska J, Kondrusik M, Pancewicz S i wsp. Test Western blot z białkiem VLsE oraz antygenami „in vivo” w diagnostyce boreliozy z Lyme. Przegl Epidem 2006; 60: 177-185.
Chmielewska-Badora J, Cisak E, Fatla A. Zastosowanie testu immunoblot w diagnostyce laboratoryjnej boreliozy. Przegl Epidem 2006; 60: 192.
Andrzejewski A, Woźniakowska-Gęsicka T, Wiśniewska-Ligier M. Odrębności przebiegu zakażenia krętkiem Borrelia burgdorferi u dzieci. Przegl Epidem 2006; 60: 16-22.
Noworyta J, Brasse-Rumin M, Ząbek J. Ocena wartości serodiagnostyki bakteriologicznej u chorych na niesklasyfikowane zapalenie stawów. Reumatologia 2008; 46: 115-124.
Noworyta J, Brasse-Rumin M, Ząbek J. Ocena wartości serodiagnostyki bakteriologicznej u chorych na niesklasyfikowane zapalenie stawów. Część II. Analiza badań surowic na obecność przeciwciał dla Salmonella enteritidis i Salmonella typhimurium; reakcje krzyżowe z Yersinia enterocolitica O3, Chlamydia trachomatis i Borrelia burgdorferi. Reumatologia 2008; 46: 198-209.
Zaremba ML, Borowski J. Mikrobiologia lekarska. Wydawnictwo Lekarskie PZWL, Warszawa 1997; 330.
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