Diseases, Disorders information

Although visual recognition of erythema migrans is the best indicator of early localized Lyme disease, supportive laboratory data can be helpful in confirming the diagnosis. Isolation of the spirochete through culture of skin biopsy specimens obtained from the lesion is definitive evidence of B burgdorferi infection. Successful isolation of B burgdorferi in Barbour-Stoenner-Kelly medium is possible in 60% to 90% of patients with erythema migrans in highly endemic areas of the United States. However, culture is not performed routinely in clinical laboratories because of the rigorous growth requirements of the organism. Buy human growth hormone
Polymerase chain reaction (PCR) has been used to amplify both genomic and nongenomic gene sequences of B burgdorferi in tissue biopsy samples in an effort to develop a surrogate for culture. Although PCR can detect DNA sequences specific to B burgdorferi, the yield is variable and techniques are not standardized, resulting in difficulties with both false-positive and false-negative results. Routine use of PCR is not currently recommended for diagnosis of Lyme disease. Direct demonstration of spirochetes in specially stained histologic specimens from erythema migrans lesions is possible, but expert pathologic interpretation is required and the technique has not been standardized.
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Serologic testing is the only routinely available laboratory diagnostic aid for Lyme disease.
A two-step approach involving enzyme-linked immunosorbent assay (ELISA) with subsequent testing of equivocal or positive samples by Western immunoblot technique for specific B burgdorferi antigenic bands can reveal IgM or IgG directed at B burgdorferi with a sensitivity of 64% and a specificity of 100% in early localized disease. According to recommendations of a CDC national consensus panel, serologic testing should be considered positive only if both ELISA and Western blot are positive).
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Although serologic testing is less sensitive in early Lyme disease than in later manifestations it can help clinch the diagnosis in cases in which clinical recognition of erythema migrans is un certain. Laboratory confirmation of B burgdorferi infection may be especially crucial in geographic areas not known to be endemic for Lyme disease, where erythema migrans or similar lesions occur but have not yet been conclusively linked to a specific spirochete or other cause (discussed further in “Issues in Disease Management”). Canadian pharmacy