Discrepancies in widely used serological methods to detect Borrelia infections may cause missed Lyme diagnoses
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The accurate diagnosis of Lyme disease, caused by Borrelia burgdorferi , is critical for effective treatment and prevention of disabling long-term effects. This study investigates discrepancies in serological testing methods for Borrelia infections, focusing on the performance of different assays in annual Lyme screening for high-risk populations. We compared the results of two-tier protocols, including first-tier assays from EUROIMMUN, ZEUS, SERION (all ELISA) and Diasorin (CLIA). Our findings reveal significant variability in test sensitivity: EUROIMMUN combined with ZEUS ELISA detected more positive cases compared to the Diasorin and SERION tests. Notably, 19% of recent Borrelia infections were missed due to test selection, highlighting the clinical implications of these discrepancies. Case studies illustrate the potential for misdiagnosis and delayed treatment, emphasizing the need for standardized and optimized testing protocols. We recommend the adoption of more sensitive and comprehensive methods, and the practice of comparing current results with previous samples from the same individual to improve diagnostic accuracy and patient outcomes.
