The Bascom Palmer Eye Institute Lyme/syphilis survey

Abstract

Serologic screening of patients for Lyme borreliosis began at the Bascom Palmer Eye Institute (BPEI) in September 1987. This report reviews the data on 641 sera from that date up to January 1, 1990. Initially only immunofluorescent (IFA) IgG and IgM titers were obtained. Because of increasing numbers of borderline and positive IFA tests, a Lyme enzyme linked immunosorbent assay (ELISA) was added in April 1988. Also, because of significant serologic cross reactivity in patients exposed to Treponema pallidum, rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) tests were added to the serologic screening panel. Of all sera tested, 10% showed reactive RPR tests and 22% showed reactive FTA-ABS tests. Lyme IFA IgG titers were greater than or equal to 1:64 in 17% of the sera, and Lyme ELISA tests were greater than 1.25 in 15% of the sera. Our experience agrees with reports that serum RPR or VDRL tests are nonreactive in Lyme borreliosis, and that false positive FTA-ABS tests can occur in Lyme borreliosis. The importance of getting all four tests--RPR, FTA-ABS, Lyme IFA IgG and IgM, and Lyme ELISA--in all patients suspected of spirochetal disease is emphasized.