Lyme borreliosis diagnosis: state of the art of improvements and innovations

Abstract

With almost 700 000 estimated cases each year in the United States and Europe, Lyme borreliosis (LB), also called Lyme disease, is the most common tick-borne illness in the world. Transmitted by ticks of the genus Ixodes and caused by bacteria Borrelia burgdorferi sensu lato, LB occurs with various symptoms, such as erythema migrans, which is characteristic, whereas others involve blurred clinical features such as fatigue, headaches, arthralgia, and myalgia. The diagnosis of Lyme borreliosis, based on a standard two-tiered serology, is the subject of many debates and controversies, since it relies on an indirect approach which suffers from a low sensitivity depending on the stage of the disease. Above all, early detection of the disease raises some issues. Inappropriate diagnosis of Lyme borreliosis leads to therapeutic wandering, inducing potential chronic infection with a strong antibody response that fails to clear the infection. Early and proper detection of Lyme disease is essential to propose an adequate treatment to patients and avoid the persistence of the pathogen. This review presents the available tests, with an emphasis on the improvements of the current diagnosis, the innovative methods and ideas which, ultimately, will allow more precise detection of LB.

Keywords: Culture; Diagnostic; Lyme disease; PCR; Serology detection, Direct and indirect methods; Tick.

Fig. 1

Geographic distribution of Borrelia species

Fig. 2

Holistic view of diagnostic approaches performed from patient fluids. Boxes in pink are direct detection methods whereas boxes in blue are indirect ones, potentially applied in the absence of Erythema migrans (represented by concentric circles). Others red spots represent some possible localizations of symptoms

Fig. 3

Indirect detection tests

Fig. 4

iPCR principle

Fig. 5

Phage PCR principle