The use of serology in Lyme borreliosis is very much debated. The two-tier investigation method, ELISA and Western-blot admittedly fails by low sensitivity in several cases, especially in:
- the early stage of the disease (see reference)
- low-endemic areas (see reference)
- so-called sero-negative Lyme disease when immune reaction is absent or late
- false positive cases, when the patient has been immunised, from cross-reaction by spirochetes or viral infections
- Lupus (SLE) or other autoimmune diseases
Hence, serology can be an excellent tool to increase specificity for a patient with a known infection, but not a screening tool for the early stage.
Serology has a high sensitivity in the disseminated or late phase of the disease. However, by this time the spirochetes have already invaded the body, neurologic or cardiac manifestations, arthritis or chronic neurologic abnormalities may be present.