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The usefulness of Western blot in the serological diagnosis of
Lyme borreliosis was evaluated compared with an ELISA using a whole cell sonicate antigen. Fifty-three of 68 (78%) patients with neuroborreliosis had positive IgM and/or IgG immunoblots and 40 of 68 (59%) had positive IgM and/or IgG ELISA titers in serum. Eight of 44 (18%) controls with meningitis/encephalitis of non-borrelia etiology had positive IgM and/or IgG immunoblots and 4 of 44 (9%) had positive IgM and/or IgG ELISA titers in serum. Western blot was more sensitive than ELISA, the difference being most pronounced in sera from patients with neurological
disease for four weeks or less. Both patients and controls lived in an area endemic for
Lyme borreliosis and some ELISA negative but Western blot positive controls were thought to have been previously exposed to Borrelia burgdorferi. However, the specificity for current
disease was not improved by Western blot. In conclusion, Western blot does not seem to be the method of choice for screening purposes in a routine laboratory but can be used as a complement to ELISA for serodiagnosis in patients with
disease of short duration.