Duration of Lyme Enzyme Immunoassay Positivity After Treatment
Persistence of Serologic Markers
- Antibodies against B. burgdorferi typically persist for months to years after successfully treated or untreated infection, making seroreactivity alone unsuitable as a marker of active disease 1
- The Centers for Disease Control and Prevention recommends that antibodies to B. burgdorferi should not be used as a marker of active infection, as they often persist for months to years after successful treatment of Lyme disease 1
Factors Affecting Antibody Persistence
- Disease stage at time of treatment affects antibody persistence, with early vs. late disease stage influencing the duration of antibody detection 2
Clinical Implications
- Neither positive serologic test results nor a history of previous Lyme disease ensures that a person has protective immunity; repeated infection with B. burgdorferi has been reported 1
- The presence of persistent antibodies should not be confused with persistent infection, according to the Centers for Disease Control and Prevention 1 and other guidelines 3
- Clinical response should be the primary determinant of treatment success, not serologic findings, as stated by the Infectious Diseases Society of America 5, 2
Distinguishing Persistent Antibodies from Active Infection
- Objective clinical manifestations are uncommon after appropriate treatment of Lyme disease, as reported by the Infectious Diseases Society of America 5
- Subjective symptoms may persist for weeks to months after treatment due to slow resolution of the inflammatory process, not persistent infection, affecting approximately 35% of patients at day 20, 24% at 3 months, and 17% at 12 months 5, 2
- PCR positivity after treatment should not be interpreted as evidence of ongoing infection without corresponding clinical symptoms and other supporting evidence, as recommended by the Centers for Disease Control and Prevention 3