A Dutch nationwide evaluation of serological assays for detection of Borrelia antibodies in clinically well-defined patients

• In early Lyme borreliosis, the sensitivity of antibody assays varies considerably.
• In late Lyme borreliosis, the sensitivity of antibody testing is high.
• In late Lyme borreliosis, the sensitivity of antibody assays differs only marginally.
• In cross-reactivity controls, there is large variation in the reactivity rate.
• The majority of false positives in Borrelia burgdorferi antibody assays are of the IgM isotype.

Numerous tests for the detection of antibodies against Borrelia burgdorferi are commercially available. Manufacturer-derived data invariably report a high sensitivity and specificity, but comparative studies demonstrate large differences in clinical practice, especially with regard to specificity. We retrospectively collected data from validation studies for B. burgdorferi antibody assays from 8 laboratories in the Netherlands. The total number of samples was 809. Samples were selected based on clinical and laboratory parameters. We included samples from patients with erythema migrans, acrodermatitis chronicum atrophicans, and neuroborreliosis; cross-reactivity controls; and healthy controls. Data are presented from 10 enzyme-linked immunosorbent assays and 5 immunoblots. For manifestations of B. burgdorferi infection with short disease duration, the positivity rate of the assays varied significantly. In patients with long disease duration, the positivity rate differed only marginally. In cross-reactivity controls, there was significant variation in the reactivity rate. The majority of false-positive reactions are of the IgM isotype.