1. Introduction Sang-Hee Park, Kyu-Jam Hwang, Joo-Hyun Kim, A-Ram Ki, Eun-Ju Kim, Kyoung-Ok You, Soo-Kyoung Shim, Young-Sill Choi, and Mi-Yeoun Park* Division of Zoonoses, Center for Immunology & Pathology, National Institute of Health, Seoul, Korea Materials and Methods Results ConclusionsReferences Laboratory detection of Lyme disease with IFA, immunoblot test and these characteristics Lyme disease (LD) is caused by the spirochete Borrelia burgdorferi and is transmitted through the bite of Ixodes spp. ticks. In Korea, B. burgdorferi was isolated from the vector tick and rodents, but few serologic detection of human cases have been reported. In this study, we reported the definite diagnosis results from the patient serum which was requested the serological test from January 2005 to September 2007. Clinical Sample : 28 sera with immunoblot test from January 2005 to September 2007 Serologic Test : Indirect immunofluorescence assay (IFA) with a panel of 3 Borrelia antigens, B. burgdorferi B31 and 297, B. garinii 935T. Immunoblot test: RecomBlot Borrelia (Mikrogen) Test was interpreted following the manufacturer’s score system 1.A band at OspC antigen of B. garinii appeared commonly in 18/21 (80.9 %) patients, followed by p41 of B. burgdorferi in 15/25(71.4%) patients, and p100 of B. burgdorferi in 10/21(47.6%) patients. This study suggests that B. garinii and B. burgdorferi infection is prevalent in the patients. 2.There were reported that OspC and P41 are immunodominant for the IgM responses and detected in sera from the early infection phase of LD. It means that patients of detected in IgM immunoblot might be in early infection phase. Table 1. Symptoms, Request Date of patients No. of patient SymptomRequest DateNo. of patient SymptomRequest Date 1-2005,Nov 10Menigoencephalitis2007, May 2 *Skin lesion2005, Sep 11Neuropathy2007, May 3Body ache, chronic2006, Jun 12Vasculitis2007, May fatigue 13-2007, Jun 4 *-2006, Oct 14-2007, Jul 5Menigoencephalitis2006, Nov 15Unknown fever2007. Jul 6Arm tingling sensation,2007, Apr 16Cutaneous lymphoma2007, Jul Ataxia 17Vasculitis2007, Aug 7Fever, pain2007, Apr 18Fever, Rash2007, Aug 8Knee pain, swelling,2007, Mar 19 *Skin lesion2007, Aug fever 20 *Skin lesion, fever2007, Aug 9Skin lesion2007, May 21-2007, Sep Figure 1. Immunoblot IgG positive results from patients sera No. of patientIFAImmunoblot IgGIgMIgGIgM 11:256< 1:16-+ 21:256< 1:16-+ 31:256< 1:16-+ 41:128< 1:16-+ 51:128< 1:16-+ 6-11:1281:16-+ 6-21:2561:32-+ 7 1:16-+ 81:641:32-+ 9-11:2561:16-+ 9-21:2561:16-+ 9-31:2561:16-+ 10-11:641:16++ 10-21:2561:32++ 111:2561:32-+ 121:321:16N.D*+ 131:5121:16++ 141:641:16N.D+ 151:2561:16-+ 16-11:256< 1:16+N.D 16-21:256< 1:16+- 171:2561:16+- 18-11:321:16N.D+ 18-21:256 1:16-+ 191:256 -+ 20-11:2561:16++ 20-21:10241:64++ 211:1281:16N.D+ Table 2. Indirect fluorescent assay and Immunoblot results of patients sera Table 4. Comparison of the detection rates of diagnostic methods for patients of immunoblot positive serum Diagnostic MethodNo. of detected sampledetection rates Two-tier serologic testing250.0% (2/4) IFA IgG ≥ 1:256 & immunoblot844.4% (8/18) IFA IgM ≥ 1:16 & immunoblot2095.0% (20/21) IgG/IgM immunoblot517.9% (5/28) *N.D., Not determined Figure 2. Immunoblot IgM positive results with serum from patients * Infected from foreign country Control 10-1 10-2 13 16-1 16-2 17 20-1 20-2 Control 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 18 19 20 21 1 2 1 2 3 1 2 1 2 1 2 AntigensIgG detected No.IgM detected No. p10013, 16-1, 16-2, 17, 20-14, 5, 9-1, 9-2, 9-3, 12, 19, 20-1, 20-2 vlsE13, 20-1, 20-23, 6-1, 6-2, 9-1, 9-2, 9-3, 12, 18-1, 18-2, 20-1, 20-2 p41 B. burgdoferii 10-1, 10-2, 13, 16-1, 16-2, 17, 20-1, 20-2 3, 4, 5, 9-1, 9-2, 10-1, 10-2, 11, 13, 14, 15, 18-2, 19, 20-1, 20-2, 21 p3913, 20-1, 20-26-1, 9-1, 15 OspA10-1, 10-2, 20-1, 20-26-1, 6-2, 10-1, 10-2, 12, 15, 19, 20-1, 20-2 OspC B. garinii 10-1, 10-2, 20-1, 20-2 1, 2, 4, 5, 6-1,6-2, 7, 8, 9-1, 11, 12, 13, 14, 15, 18-1, 18-2, 19, 20-1, 20-2, 21 B. sensu strictu/ B. afzelii -1, 2, 11, 12, 13, 20-1, 20-2 p41 B. garinii 10-1, 10-23, 6-1, 6-2, 10-1, 10-2, 13, 19, 20-1, 20-2, 21 B. afzelii10-1, 10-210-1, 10-2, 13, 19 p18-3 Table 3. Immunoblot IgG and IgM positive categories from serum of patients 1. Wilske B, Fingerle V, Schulte-Spechtel U. Microbiological and serological diagnosis of Lyme borreliosis. FEMS Immunol Med Microbiol. 2007 ;49: 13-21. 2. Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of lyme borreliosis.Clin Microbiol Rev. 2005 ;18:484-509. 3. Kee S, Hwang KJ, Oh HB, Park KS. 3. Identification of Borrelia burgdorferi isolated in Korea using outer surface protein A (OspA) serotyping system. Microbiol Immunol. 1994;38:989-993. 4. Park KH, Chang WH, Schwan TG. Identification and characterization of Lyme disease spirochetes, Borrelia burgdorferi sensu lato, isolated in Korea. J Clin Microbiol. 1993 Jul;31(7):1831-1837.