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Lyme disease: antibodies to borrelia in the blood
Last reviewed: 05.07.2025
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Antibodies to Borrelia are normally absent in the blood serum.
Lyme disease, or systemic tick-borne borreliosis, is a recurrent transmissible natural focal infection caused by the spirochete Borrelia burgdorferi (motile, spiral-shaped, gram-negative bacteria).
The disease is characterized by a staged clinical picture:
- stage 1 develops 3-33 days after an insect bite (tick) and is manifested by fever, erythematous migratory rash (in 85% of patients);
- stage 2 occurs 4 weeks after the bite; 10% of patients develop cardiac pathology, 15% develop neurological symptoms (symptoms of aseptic meningitis, Bell's palsy, peripheral neuropathy);
- Stage 3 develops 6 weeks (up to several years) after the bite in 60% of untreated patients, manifested by arthritis (often regarded as juvenile rheumatoid); reinfection may occur.
To confirm the diagnosis, the ELISA method is used to detect specific IgM and IgG antibodies to Borrelia.
In Lyme disease, specific IgM antibodies usually appear in the blood 2-4 weeks after the onset of erythema migrans, with the peak of antibodies occurring at 6-8 weeks of the disease. In stage 1, IgM antibodies are detected in 40-60% of patients. In some patients, IgM levels remain elevated for many months or reappear at the end of the disease, indicating ongoing infection and the ineffectiveness of antibiotic therapy. The IgG antibody titer increases more slowly (4-6 weeks after erythema), with the peak occurring at 4-6 months, and the titer may remain high for several months or years, even with successful treatment. Almost all patients with stage 2 and 3 complications have high IgG antibody levels. A single determination of the IgG antibody titer has no diagnostic value, as it may indicate a previous infection. A study of paired sera (acute and convalescent) taken 4-6 weeks apart, showing a decrease or increase in IgG levels, indicates recovery or the presence of Lyme disease.
False positive results of IgM antibody determination are possible in the presence of rheumatoid factor in the patient's blood, and a high titer of IgG antibodies may be due to antibodies in diseases caused by spirochetes (for example, syphilis); a low titer of IgG antibodies is possible in infectious mononucleosis, viral hepatitis B, rheumatic diseases (SLE), periodontal diseases, in 5-15% of healthy individuals from the epidemic zone.
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