In the absence of erythema migrans at least one other clinical manifestation must be noted and confirmed using serological diagnosis of Borrelia in blood or CSF. According to the most recent German Society for Hygiene and Microbiology (Deutsche Gesellschaft für Hygiene und Mikrobiologie, DGHM) guidelines [43], serological diagnosis for patients in Europe should follow a two-step procedure: (i) ELISA and if reactive, followed by (ii) an immunoblot, if possible using recombinant antigens (p100, p58, p41i, VlsE, OspC, DbpA), including those expressed primarily in vivo (VlsE and DbpA), instead of whole-cell lysate antigen blots. OspC and VlsE are the most sensitive antigens for IgM antibody detection [54]. European standardisation of these diagnostic tests and new markers for detecting active infections are urgently required [55].
AT least they are now saying the disease is incurable in half the cases.
