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Diagnosis of Lyme-associated uveitis: value of serological testing in a tertiary centre
  1. Alexia Bernard1,
  2. Laurent Kodjikian1,
  3. Amro Abukhashabh1,
  4. Chantal Roure-Sobas2,
  5. Andre Boibieux3,
  6. Philippe Denis1,
  7. Christiane Broussolle4,
  8. Pascal Seve4
  1. 1Department of Ophthalmology, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
  2. 2Laboratory of Bacteriology, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
  3. 3Department of Infectious Diseases, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
  4. 4Internal Medicine Department, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
  1. Correspondence to Professor Pascal Seve, Département de Médecine Interne, 103 Grande Rue de la Croix-Rousse, F-69317 Lyon Cedex 04, France; pascal.seve{at}chu-lyon.fr

Abstract

Aims To determine the frequency and clinical presentation of Lyme disease in patients with uveitis and to assess the value of Borrelia burgdorferi serological testing.

Methods Retrospective study on all patients with uveitis who were referred to our tertiary hospital were serologically tested for Lyme in our laboratory between 2003 and 2016. Screening consisted of determining B. burgdorferi serum IgG and IgM by ELISA method. The patient's serology was considered as positive if the ELISA-positive result in IgM and/or IgG was confirmed by an immunoblot positive in IgM and/or IgG. Lyme-associated uveitis was diagnosed based on serological results as well as response to antibiotics and exclusion of other diagnosis.

Results Of the 430 patients with uveitis (60% women, mean age 49 years) fulfilling inclusion criteria, 63 (14.7%) had an ELISA-positive serology, confirmed by immunoblot for 34 patients (7.9%). The diagnosis of Lyme-associated uveitis was finally retained in seven patients (1.6%). These patients reported either a previous exposure including tick bite or forest walks (n=5), symptoms suggestive of Lyme disease (n=5) and resistance to local and/or systemic steroids (n=7). Among the remaining 27 positive patients, 22 had other established aetiologies and 5 other were unclassified.

Conclusion The seroprevalence of B. burgdorferi among our patients with uveitis was 7.9% compared with 68.5% in the general French population which leads to a low predictive value of serological testing. Its use should be reserved for patients with unexplained uveitis, an exposure history, systemic findings suggestive of Lyme disease and steroids resistance.

  • Uveitis
  • Lyme disease
  • Borrelia burgdoferi serology
  • Diagnosis
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Footnotes

  • Contributors PS and LK were the principal investigators who conceived and designed the study. CR was the biologist retrieving data of the serological analyses. This manuscript was drafted by AB, revised by PS, LK, AA and AnB and read and approved by all living authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice The article has been corrected since it was published Online First. Some typos have been removed from the Abstract of the paper.

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