Evaluation of immuno-reactive epitopes in the sera and cerebrospinal fluid of patients with post-treatment Lyme disease syndrome

While most patients fully recover after treatment for Lyme disease with
recommended antibiotic regimens, some report non-specific symptoms after
treatment. When these symptoms are unexplained by other conditions and
persist for >6 months, this condition is called post-treatment Lyme
disease symptoms or syndrome (PTLDS). The pathogenesis of PTLDS is
unknown, and no specific diagnostic biomarkers have been identified. In
this study, we used a high-density peptide array to examine antibody
responses to >60 primary antigens of B. burgdorferi from a cohort
of patients diagnosed with PTLDS and recovered patients with similar Lyme
disease manifestations. Using matched serum and cerebrospinal fluid (CSF),
we mapped the primary reactive B. burgdorferi epitopes associated with
PTLDS. We found that VlsE had a greater antibody response within the PTLDS
cohort than recovered patients. The reactivity to OspC-specific epitopes
revealed a predominance of antibodies to OspC type K and A in the PTLDS
cohort. However, the major immunodominant epitopes were similar in PTLDS
and recovered patients, and we were unable to identify specific diagnostic
targets for PTLDS. We found a more robust reactivity in the serum over CSF
and did not identify antigenic regions that were specifically associated
with the infection of the central nervous system.