Re: NEWSGROUP FAQ'S FOR NEWBIES - Political Aspects of Lyme

N Engl J Med. 1994 Jan 27;330(4):229-34.


Comment in:
N Engl J Med. 1994 Jan 27;330(4):282-3.

Detection of Borrelia burgdorferi DNA by polymerase chain reaction in
synovial fluid from patients with Lyme arthritis.

Nocton JJ, Dressler F, Rutledge BJ, Rys PN, Persing DH, Steere AC.

Division of Rheumatology/Immunology, New England Medical Center,
Boston, MA 02111.

BACKGROUND. Borrelia burgdorferi is difficult to detect in synovial
fluid, which limits our understanding of the pathogenesis of Lyme
arthritis, particularly when arthritis persists despite antibiotic
therapy. METHODS. Using the polymerase chain reaction (PCR), we
attempted to detect B. burgdorferi DNA in joint-fluid samples obtained
over a 17-year period. The samples were tested in two separate
laboratories with four sets of primers and probes, three of which
target plasmid DNA that encodes outer-surface protein A (OspA).
RESULTS. B. burgdorferi DNA was detected in 75 of 88 patients with Lyme
arthritis (85 percent) and in none of 64 control patients. Each of the
three OspA primer-probe sets was sensitive, and the results were
moderately concordant in the two laboratories (kappa = 0.54 to 0.73).
Of 73 patients with Lyme arthritis that was untreated or treated with
only short courses of oral antibiotics, 70 (96 percent) had positive
PCR results. In contrast, of 19 patients who received either parenteral
antibiotics or long courses of oral antibiotics (> or = 1 month), only
7 ***(37 percent)*** had positive tests (P < 0.001). None of these
seven patients had received more than two months of oral antibiotic
treatment or more than three weeks of intravenous antibiotic treatment.
Of 10 patients with chronic arthritis (continuous joint inflammation
for one year or more) despite multiple courses of antibiotics, 7 had
consistently negative tests in samples obtained three months to two
years after treatment. CONCLUSIONS. PCR testing can detect B.
burgdorferi DNA in synovial fluid. This test may be able to show
whether Lyme arthritis that persists after antibiotic treatment is due
to persistence of the spirochete.

PMID: 8272083 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

.

Loading