ANALYSIS OF BLOOD SERA OF PATIENTS WITH LYME ARTHRITIS FOR THE PRESENCE OF ANTIBODIES TO OTHER INFECTIOUS AGENTS
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i2.14721Keywords:
Lyme arthritis, Lyme borreliosis, specific antibodies of classes M and G, ELISA, immunoblot, multiplex indirect immunofluorescence, BIOCHIP technology, other infectionsAbstract
SUMMARY. The aim – to determine the frequency of detection of specific antibodies to pathogens of various infectious diseases in the blood sera of patients with Lyme arthritis (LA).
Material and Methods. The study included 43 patients with LA who were treated on an outpatient and inpatient basis at the Ternopil Regional Clinical Hospital of the Ternopil Regional Council and the Ternopil District Primary Health Care Center of the Velyka Berezovytsia Rural Council. Overall, 14 men (32.6 %) and 29 women (67.4 %), aged 19 to 68 years, were included in the study. Residents of the city comprised 62.7 % (27 individuals) of the patients, while 37.3 % (16 individuals) were from the rural areas.
To assess joint damage, a modified Disease Activity Score (DAS) was used, specifically the one with modification termed DAS 28. Serological confirmation of Lyme Borreliosis (LB) utilized a two-step diagnostic approach. In the first stage, specific antibodies to antigens of the B. burgdorferi s.l. complex in patients' sera were determined using enzyme-linked immunosorbent assay (ELISA). Subsequently, positive and equivocal ELISA results were confirmed using immunoblotting.
Antibodies of classes M and G to pathogens of other infectious diseases, which could also be causes of arthritis, were detected in patients' sera using the multiplex indirect immunofluorescence assay method. The "Mosaic for Infectious Serology, Infections arthritis profile 1(IgM/IgG)" test systems from Euroimmun AG (Germany), utilizing the BIOCHIP technology, were employed. These test systems contained fluorescently labeled antigens of infectious disease pathogens.
The results of determination of specific class M and G antibodies to pathogens of infectious diseases, which could also induce arthritis, were evaluated under a fluorescence microscope (Olympus IX70, ok ×10, ob ×20; 40) based on the bright green fluorescence of the antigen-antibody immune complex labeled with fluorescein.
Results. Specific serum anti-IgG to B. burgdorferi s.l., using a two-step scheme, were detected in all (100.0 %) patients with clinical signs of Lyme arthritis. Serum IgM against pathogens of various infections, which could be the cause of arthritis, were found: against Influenza virus type B – in 9.3 % of patients, against Influenza virus type A (H1N1) – in 4.7 %, against Y. enterocolitica O:3 – also in 4.7 % of individuals. Specific class G antibodies to Influenza virus type A (H3N2) were detected in the sera of 37.2 % of patients, against Influenza virus type B – in 32.7 %, against Influenza virus type A (H3N2) – in 30.2 %, against Varicella-zoster virus – in 32.7 %, against Y. enterocolitica O:3 – in 20.9 % of individuals.
Conclusions. The multiplex indirect immunofluorescence assay method, utilizing the BIOCHIP technology, is highly informative in patients with arthritis, as it allows the detection of specific IgM and/or IgG antibodies to 12 infectious disease pathogens simultaneously. The obtained results dictate the necessity of proper differential diagnosis of arthritis and arthralgia in patients with LB. In case of polyinfection in patients, correction of etiotropic therapy is advisable.
References
Millins, C., Leo, W., MacInnes, I., Ferguson, J., Charlesworth, G., Nayar, D., Davison, R., Yardley, J., Kilbride, E., Huntley, S., Gilbert, L., Viana, M., Johnson, P., & Biek, R. (2021). Emergence of lyme disease on Treeless Islands, Scotland, United Kingdom. Emerging Infectious Diseases, 27(2), 538–546. https://doi.org/10.3201/eid2702. 203862
Bord, S., Dernat, S., Ouillon, L., René-Martellet, M., Vourc'h, G., Lesens, O., Forestier, C., & Lebert, I. (2022). Tick ecology and Lyme borreliosis prevention: a regional survey of pharmacists’ knowledge in Auvergne-Rhône-Alpes, France. Ticks and Tick-borne Diseases, 13(3), 101932. https://doi.org/10.1016/j.ttbdis.2022.101932
Böhmer, M. M., Ens, K., Böhm, S., Heinzinger, S., & Fingerle, V. (2021). Epidemiological surveillance of Lyme Borreliosis in Bavaria, Germany, 2013–2020. Microorganisms, 9(9), 1872. https://doi.org/10.3390/microorganisms 9091872
Teodorowicz, P., & Weiner, M. (2022). Importance of ticks in the transmission of selected bacterial pathogens of human diseases. Health Problems of Civilization, 16(1), 5–14. https://doi.org/10.5114/hpc.2022.113599
Andreychyn, M. A., Korda, M. M., Shkilna, M. I., Ivakhiv, O. L., Andreychyn, S. M., Bilkevych, N. A., ... & Yuskevych, V. V. (2021). Lyme Borreliosis. 376 p.
Rochlin, I., & Toledo, A. (2020). Emerging tick-borne pathogens of public health importance: a mini-review. Journal of Medical Microbiology, 69(6), 781–791. https://doi.org/10.1099/jmm.0.001206
McWilliams, D. F., Kiely, P. D. W., Young, A., Joharatnam, N., Wilson, D., & Walsh, D. A. (2018). Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis. BMC Rheumatology, 2(1). https://doi.org/ 10.1186/s41927-018-0016-9
DAS 28 - Disease activity score calculator for rheumatoid arthritis. (n.d.). HomepageDAWN Clinical Software. https://www.4s-dawn.com/DAS28/
Milevska-Vovchuk, L. S. (2016). Selection of the optimal method for assessing pain in patients with chronic lumbar pain syndrome. Ukrainian Neurological Journal, 2, 96-100.
Berghoff, W. (2012). Chronic lyme disease and co-infections: Differential diagnosis. The Open Neurology Journal, 6(1), 158–178. https://doi.org/10.2174/1874205x01206010158
Garg, K., Jokiranta, T. S., Filén, S., & Gilbert, L. (2021). Assessing the need for multiplex and multifunctional tick-borne disease test in routine clinical laboratory samples from lyme disease and febrile patients with a history of a tick bite. Tropical Medicine and Infectious Disease, 6(1), 38. https://doi.org/10.3390/tropicalmed 6010038
Lochhead, R. B., Arvikar, S. L., Aversa, J. M., Sadreyev, R. I., Strle, K., & Steere, A. C. (2018). Robust interferon signature and suppressed tissue repair gene expression in synovial tissue from patients with postinfectious, Borrelia burgdorferi-induced Lyme arthritis. Cellular Microbiology, 21(2). https://doi.org/10.1111/cmi.12954
Arvikar, S. L., & Steere, A. C. (2022). Lyme arthritis. Infectious Disease Clinics of North America, 36(3), 563–577. https://doi.org/10.1016/j.idc.2022.03.006
Protsenko, G. A, & Pasternak, M. L. (2021). Experience of using nabumetone in patients with reactive arthritis. Rheumatology. 4 (86), 74–79 https://doi.org/10.32471/rheumatology.2707-6970.86.16631
