În perioada 17 – 20 octombrie 2012, la Rin Grand Hotel, Bucureşti, a avut loc a VIII-a Ediţie a Zilelor Ştiinţifice ale Institutului Naţional de Boli Infecţioase „Prof. Dr. Matei Balş”.
În cadrul acestei manifestări, Fundația Spandugino i-a invitat pe medicii de la „Borrelioze Centrum Augsburg”, Germania, să prezinte ultimele noutăţi despre neuroborelioză / Boala Lyme, respectiv:
- Actualizare privind diagnosticul în boala Lyme cronică/neuroborelioză – Dr. Armin Schwarzbach, Germania;
- Standarde terapeutice în boala Lyme cronică – Dr. Carsten Nicolaus, Germania.
Pe plan mondial, în ultimul deceniu bolile infecţioase au devenit adevărate pietre de încercare pentru societatea modernă prin infecţiile emergente şi extinderea dramatică a fenomenului de rezistenţă la antibiotice. Această manifestare și-a propus să genereze un bogat şi interesant program ştiinţific, care să antreneze sesiuni interactive, schimburi de experienţă şi să iniţieze colaborări ştiinţifice care să includă Clinicile de Boli Infecţioase Europene.
“Diagnostic novelties of chronic Lyme/Neuroborreliosis “
Armin Schwarzbach MD PhD
Infectolab/Borreliose Centrum Augsburg/Germany
Actually the Robert-Koch-Institut/Germany recommends a two-tier step laboratory diagnosis for Borrelia burgdorferi antibodies by a screening in form of an ELISA technique, followed by an immunoblot technique in positive or borderline ELISA results.
Critically there is no standardized spectrum of specific antigens for test-producers, which must be used in all tests for Borrelia antibodies. On the other hand an early antibiotic treatment of stage I in Lyme disease could suppress the development of specific Borrelia-IgG- and/or IgM-antibodies with the consequence of an isolated production of IgM-antibodies in chronic Lyme disease. Therefore it is known, that negative antibody findings in chronic Lyme disease can not exclude a chronic infection with Borrelia burgdorferi.
We evaluated 50 patients with chronic neurological and musculoskeletal symptoms, who were diagnosed as chronic Lyme disease clinically by an exact anamnesis of all symptoms and the clinical history.
We used commercial available laboratory tests for the antibody detection of Borrelia burgdorferi by IgG/IgM-immmunoblot (Fa. Euroimmun, Germany) and ELISA technique (Fa. Euroimmun, Fa Diasorin, Fa. Aesku.Diagnostics, all Germany) and a multianalyte technique (Fa. Virion Serion, Germany).
The specifity of all tests was over 92 %.
The sensitivity of the Borrelia-IgG/IgM-immunoblot was 60%, for the ELISA techniques
32 % up to 42 %, depending on the indivdidual test producer, and for the multianalyte technique 44 %.
A negative ELISA screening with a positive result in the immunoblot technique was found in 4 % up to 14 % and a negative ELISA screening together with a borderline immunoblot result in 12 % up to 16 %, depending on the individual test-producer.
These results showed a loss of sensitivity by the two-tier test system of 16 % up to 28 %, depending on the individual test-producer.
We found an isolated persistence of IgM-antibodies in 10 % of all chronic infected patients.
This study shows, that there is a high specifity of all test-systems for Borrelia antibodies in a range over 92 %.
But there is no acceptable need for the two-tier step-system because of an exaggerated loss of sensitivity up to 28 %. Therefore the more specific immunoblot technique must be used instead of an ELISA screening until all test-producers will do a good standardization of the ELISA techniques with a much better sensitivity.
So long the immunoblot technique lacks in sensitivity up to 40 % as well, other helpful tests like Elispot Lymphocyte Transformation Test (LTT) and CD57-cells must be used additionally for a higher sensitivity and the control of cellular activity in chronic Lyme disease.
