SNOWMASS, COLO. — Lyme disease patients without erythema migrans were thought to be rare—until they showed up frequently in a large trial of the Lyme disease vaccine, Linda K. Bockenstedt, M.D., said at a symposium sponsored by the American College of Rheumatology.
In that trial, 269 cases of Lyme disease were detected by serum assay, of which 42, or about 16%, involved patients without erythema migrans. However, those patients did have flulike symptoms, such as malaise, fever, myalgia, migratory arthralgias, occipital headache, and neck stiffness. They did not have any upper respiratory symptoms, such as cough.
Additionally, Dr. Bockenstedt, of the rheumatology section at Yale University, New Haven, Conn., noted that there may soon be a way to monitor Lyme disease treatment.
A new enzyme-linked immunoabsorbent assay for Lyme disease, the C6 ELISA (Immunetics Inc.), tests for a single small peptide expressed by the Borrelia burgdorferi spirochete during active infection, instead of the whole organism.
Research has shown that antibody titers to this antigen drop fourfold when an infected individual has been successfully treated. Dr. Bockenstedt added that forthcoming study results will confirm the ability of the assay to adequately detect a drop in the antigen level.