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November 8, 1995

Diagnosis of Lyme Disease-Reply

Author Affiliations

University of Connecticut Health Center Farmington

JAMA. 1995;274(18):1427-1428. doi:10.1001/jama.1995.03530180021021

In Reply.  —I appreciate Dr Sigal's letter and would like to make a few additional comments. It is true that occasionally a patient with early disseminated Lyme disease (manifest as facial nerve palsy) will lack detectable Borrelia burgdorferi antibodies in the serum using standard testing. Standard testing involves performing an IgM and IgG ELISA determination, then doing a confirmatory Western blot if one or both are positive. Lack of B burgdorferi antibody early in the course of disseminated Lyme disease was demonstrated by a study1 in Suffolk County, New York, where Lyme disease is highly endemic. This study reported that eight of 32 patients with acute facial palsy had Lyme disease. Seven of these eight patients were initially seropositive, while the eighth patient did not become seropositive until a convalescent serum specimen was obtained 5 weeks later. Thus, there is a need for more sensitive antibody tests. Sigal suggests

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