https://www.ncbi.nlm.nih.gov/pubmed/30344068

Diagn Microbiol Infect Dis. 2018 Oct 3. pii: S0732-8893(18)30435-8. doi: 10.1016/j.diagmicrobio.2018.09.012. [Epub ahead of print]

Evaluation of in vivo expressed Borrelia burgdorferi antigens for improved IgM serodiagnosis of early Lyme disease.

Brandt KS1, Ullmann AJ1, Molins CR1, Horiuchi K1, Biggerstaff BJ1, Gilmore RD2.

Abstract
Improved serologic tests are needed for accurate diagnosis and proper treatment of early stage Lyme disease. We evaluated the 3 antigens currently used for 2-tiered IgM immunoblot testing (FlaB, OspC, and BmpA) in combination with 3 additional antigens (BBA65, BBA70, and BBA73) and measured the sensitivity and specificity against a serum repository of positive and negative controls. Using 3 statistical methods for positivity cutoff determinations and scoring criteria, we found increased sensitivities for early Lyme disease when 2 of 6 antigens were positive as compared with the 2 of 3 antigen IgM criteria currently used for second-tier immunoblot scoring. Specificities for negative controls were comparable or superior to using 2 of 3 antigens. These results indicate that IgM sensitivity and specificity of serological testing for Lyme disease in the early stages of illness can be improved by employing antigens that target the initial host antibody responses.