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The antibody response in Lyme disease.

ABSTRACT We determined the antibody response against the Ixodes dammini spirochete in Lyme disease patients by indirect immunofluorescence and an enzyme-linked immunosorbent assay (ELISA). The specific IgM response became maximal three to six weeks after disease onset, and then declined, although titers sometimes remained elevated during later disease. Specific IgM levels correlated directly with total serum IgM. The specific IgG response, often delayed initially, was nearly always present during neuritis and arthritis, and frequently remained elevated after months of remission. Although results obtained by indirect immunofluorescence and the ELISA were similar, the ELISA was more sensitive and specific. Cross-reactive antibodies from patients with other spirochetal infections were blocked by absorption of sera with Borrelia hermsii, but titers of Lyme disease sera were also decreased. To further characterize the specificity of the humoral immune response against the I. dammini spirochete, 35S-methionine-labeled spirochetal antigens were identified by immunoprecipitation with sera from Lyme arthritis patients. These polypeptides had molecular weights of 62, 60, 47, 37, 22, 18, and 15 kDa, and were not recognized by control sera. We conclude that the ELISA, without absorption, is the best method to assay the humoral immune response in Lyme disease, and we have identified methionine-containing spirochetal polypeptides that may be important in Lyme arthritis.

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    ABSTRACT: Lyme disease was originally identified in Lyme, Connecticut, based upon an unusual cluster of what appeared to be patients with juvenile rheumatoid arthritis. It was subsequently identified as a new clinical entity originally called Lyme arthritis based on the observation that arthritis was a major clinical feature. However, Lyme arthritis is now called Lyme disease based upon the understanding that the clinical features include not only arthritis, but also potential cardiac, dermatologic and neurologic findings. Lyme disease typically begins with an erythematous rash called erythema migrans (EM). Approximately 4–8% of patients develop cardiac, 11% develop neurologic and 45–60% of patients manifest arthritis. The disease is transmitted following exposure to a tick bite containing a spirochete in a genetically susceptible host. There is considerable data on spirochetes, including Borrelia burgdorferi (Bb), the original bacteria identified in this disease. Lyme disease, if an organism had not been identified, would be considered as a classic autoimmune disease and indeed the effector mechanisms are similar to many human diseases manifest as loss of tolerance. The clinical diagnosis is highly likely based upon appropriate serology and clinical manifestations. However, the serologic features are often misinterpreted and may have false positives if confirmatory laboratory testing is not performed. Antibiotics are routinely and typically used to treat patients with Lyme disease, but there is no evidence that prolonged or recurrent treatment with antibiotics change the natural history of Lyme disease. Although there are animal models of Lyme disease, there is no system that faithfully recapitulates the human disease. Further research on the effector mechanisms that lead to pathology in some individuals should be further explored to develop more specific therapy.
    Journal of Autoimmunity 10/2014; 57. DOI:10.1016/j.jaut.2014.09.004 · 7.02 Impact Factor
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    ABSTRACT: The spirochetes are a unique group of bacteria that can be distinguished morphologically from most other bacteria based on their large size and helical or corkscrew-shaped appearance. They also possess flagella that are internal rather than extracellular like most other motile organisms. Spirochetes usually cause diseases that are nonacute upon initial exposure of the host to the infectious agent, but they can have devastating consequences on the human body later on, in the absence of curative antibiotic therapy. The sexually transmitted treponemal disease, syphilis, has been with us for many centuries, perhaps as far back as Biblical times, whereas the tick-borne borrelial-caused illness, Lyme disease, has only been recently described as a serious clinical entity. Both of these pathogens can cause a variety of multi-system disorders that can be easily confused with other infectious or noninfectious illnesses. Early diagnosis of syphilis and Lyme disease is essential for successful antibiotic treatment and prevention of chronic debilitating sequelae. Other spirochetal infections caused by Borrelia, Leptospira, and treponemes are uncommon in developed countries but still can cause significant morbidity in various other parts of the world. All spirochetal infections rely heavily on serologic techniques for verifying or establishing the diagnosis. Nonmedical preventive measures include avoiding contact with (a) the appropriate insect vector; (b) an infected sex partner or body fluid: and (c) contaminated eating utensils or skin lesions. Vaccines for human use are unavailable except for experi- mental ones now being tested for the immunoprophylaxis axis of Lyme disease.
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