See last paragraph of each one.  Slight difference & notice how the
Reuter's article has the following last paragraph in quotation marks-
Would be good to see the full article from Archives of Dermatology July
issue.
"These symptoms," the researchers say, "are not caused by persistence
of B burgdorferi and cannot be affected by repeated courses of
antimicrobial drug therapy."


Erythema Migrans Features Affect Persistence of Anti-B. burgdorferi
Antibodies




NEW YORK (Reuters Health) Jul 19 - Erythema migrans of long duration or
large size prior to treatment predicts the persistence of anti-Borrelia
burgdorferi IgG antibodies after antibiotic therapy, according to a
report in the Archives of Dermatology for July.

By contrast, the duration of therapy or the clinical course following
treatment has no bearing on serologic profiles, the report indicates.
This suggests that antibody testing is not useful in gauging the
therapeutic response.

Erythema migrans is the hallmark of early Lyme disease, seen in 70% to
80% of all cases, lead author Dr. Martin Glatz and colleagues, from the
Medical university of Graz in Austria, note. Antibiotic therapy is the
recognized treatment for erythema migrans, but the role of laboratory
tests in guiding such therapy is unclear.

In the present study, the researchers correlated serial anti-B.
burgdorferi antibody levels with clinical variables in 113 patients
with erythema migrans. In addition to a pretreatment serum sample, a
median of four consecutive posttreatment serum samples were obtained.
Antibody levels were measured for at least 1 year after standard
antibiotic therapy.

The authors identified three antibody patterns: persistent positivity
during follow-up, persistent negativity, and pretreatment
positivity/posttreatment negativity. The most common pattern for IgG
antibodies, noted in 56% of patients, was persistent negativity. For
IgM antibodies, the most common was pretreatment
positivity/posttreatment negativity, seen in 43% of patients.

As noted, the serologic profiles did not correlate with treatment
duration or the clinical course following therapy. The only association
seen was persistence of anti-B. burgdorferi IgG antibodies with
pretreatment erythema migrans of long duration or large size.

The results indicate that "antibody testing during follow-up of
patients with erythema migrans is unsuitable and unnecessary for the
assessment of treatment response," the authors conclude.

In the introduction to their paper, they note that up to 50% of
patients will have persistent post-Lyme symptoms such as fatigue,
musculoskeletal pain, or cognitive dysfunction after treatment of
erythema migrans. "These symptoms," the researchers say, "are not
caused by persistence of B burgdorferi and cannot be affected by
repeated courses of antimicrobial drug therapy."
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Arch Dermatol 2006;142:862-868.

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to
Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans
Long-term Follow-up Study of 113 Patients Martin Glatz, MD; Marjaneh
Golestani, MD; Helmut Kerl, MD; Robert R. M=FCllegger, MD
Arch Dermatol. 2006;142:862-868. Objectives  To investigate the
kinetics of anti-Borrelia burgdorferi antibodies for a minimum of 1
year after antibiotic therapy in patients with erythema migrans (EM)
and to correlate antibody titer kinetics with clinical variables.
Design  Retrospective study of serial anti-B burgdorferi antibodies
in correlation to clinical variables. Setting  University-based
hospital. Patients  One hundred thirteen patients with EM.
Interventions  Pretreatment and a median of 4 consecutive posttreatment
serum samples from median follow-up of more than 400 days were
simultaneously investigated for anti-B burgdorferi IgG and IgM
antibodies. Semiquantitative titers were plotted to identify different
groups of antibody kinetics. Individual patients were then stratified
to those groups according to their antibody development. A statistical
comparison of clinical and therapy-related characteristics among the
serologic groups was performed. Results  Anti-B burgdorferi IgG and
IgM antibody titers developed in 3 distinct courses: persistent
positivity across follow-up (IgG: 12 patients, 11%; IgM: 14, 12%),
persistent negativity (IgG: 63, 56%; IgM: 47, 42%), and decrease of a
positive pretreatment titer to a negative titer approximately 5 months
after therapy (IgG: 34, 30%; IgM: 49, 43%). Statistics revealed
significant correlations only between persistent positive IgG titers
and long disease duration or large EM lesions before therapy.
Conclusions : Long duration or large size of EM before therapy
correlates with persistence of a positive anti- B burgdorferi IgG
antibody titer after therapy. Serologic profiles do not depend on the
type or duration of therapy or the clinical course thereafter. Thus,
antibody testing in the follow-up of patients with EM is inappropriate
for the assessment of therapeutic response.
Author Affiliations: Department of Dermatology, Medical university of
Graz, Graz, Austria.
RELATED ARTICLE
This Month in Archives of Dermatology
Arch Dermatol. 2006;142:823.

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