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The T-Cell Proliferative Assay in the Diagnosis of Lyme Disease

Frank Dressier, MD; Natalino H. Yoshinari, MD; and Allen C. Steere, MD
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Grant Support: In part by grants AR-20358 and AR-40576 from the U.S. Public Health Service. Dr. Dressier received a research scholarship from the Deutsche Forschungsgemeinschaft, and Dr. Yoshinari received a scholarship from the University of São Paulo and the Fundacao de Amparo de São Paulo, Brazil.

Requests for Reprints: Allen C. Steere, MD, Division of Rheumatology, New England Medical Center, NEMC 406, 750 Washington Street, Boston, MA 02111.

Current Author Addresses: Drs. Dressier and Steere: New England Medical Center, NEMC #406, 750 Washington Street, Boston, MA 02111.

Dr. Yoshinari: Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 3 andar, CEP 01246, São Paulo, Brazil.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(7):533-539. doi:10.7326/0003-4819-115-7-533
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Objective: To determine the sensitivity and specificity of the T-cell proliferative assay as a diagnostic test in Lyme disease.

Design: Cross-sectional study of patients with Lyme arthritis or chronic neuroborreliosis who had a history of erythema migrans, positive antibody responses to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), or both; patients with other diseases; and healthy subjects.

Setting: Diagnostic Lyme disease clinic in a university hospital.

Patients: Forty-two of the 67 patients with active Lyme arthritis or chronic neuroborreliosis who were seen during the study period; 16 patients with inactive late Lyme disease; 77 patients with other rheumatologic or neurologic diseases; 9 workers from the Borrelia laboratory; and 9 healthy subjects.

Measurements and Main Results: Nineteen of 42 patients with Lyme arthritis or chronic neuroborreliosis and 4 of 77 patients with other diseases had positive T-cell proliferative responses to B. burgdorferi antigens. The sensitivity of the proliferative assay was 45% (95% Cl, 30% to 60%) and the specificity was 95% (95% Cl, 87% to 99%). Twelve of 27 patients with active Lyme arthritis, 7 of 15 patients with chronic neuroborreliosis, 4 of 16 patients with inactive Lyme disease, 4 of 9 healthy Borrelia laboratory workers, and 0 of 9 healthy subjects had positive responses. Three of five patients with Lyme disease who had negative or indeterminant antibody responses by ELISA had positive T-cell proliferative responses.

Conclusion: The T-cell proliferative assay may be a helpful diagnostic test in the small subset of patients with late Lyme disease who have negative or indeterminant antibody responses by ELISA.





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