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Purpose: The evaluation of the correspondence between positive Borrelia burgdorferi antibody response and the clinical symptoms attributed to Lyme disease is especially important in labour rights-related issues among forestry workers., Material and Methods: Between 1992 and 1995, 1670 forestry workers were surveyed and tested serologically for Lyme borreliosis in Hungary. The collected data was analysed retrospectively., Results: In the case histories of the forestry employees erythema migrans, polyneuropathy and large joint arthritis were mentioned in 128 (7.7%), 192 (11.5%), and 93 (5.6%) workers, respectively. We found positive Borrelia burgdorferi s.l. antibody reaction in 622 workers out of whom 280 (45%) were free of any signs or symptoms referring to B. burgdorferi s.l. infection in their case histories. The frequency of seropositivity increased with age, number of registered tick bites, and erythema migrans in case history, as well as arthralgia. The frequency of polyneuropathy was somewhat more closely corresponding with age than seropositivity. Women gave account of a smaller number of tick bites, and were less likely seropositive while fewer of them were symptom-free. Since the 45% of seropositive forestry workers were symptom-free and they could not recall any symptoms suggestive for present or past Lyme borreliosis, the positive predictive value of Borrelia antibody testing in this high-risk group is surprisingly low, less than 5%., Conclusion: Positive Borrelia antibody test result may be especially misleading in a high-risk population.

Objective: By using the published incidence of Lyme borreliosis in endemic regions of the World, and the sensitivity and specificity data of the best Lyme serological tests, we computed the positive predictive value of Borrelia burgdorferi antibody testing., Methods: The calculation of predictive value was based on Bayes' theorem. We also analyzed the frequency distribution of the specific and non-specific symptoms and complaints of 27,194 patients sent to the Centre for Tick-borne Diseases in Budapest from 1986 to 2008., Results: This evaluation demonstrated that practitioners often use Lyme serology in a "trial and error" way, without any reasonable ground. According to our calculation the positive predictive value of the best Lyme antibody tests if applied in this way is <9.1%., Conclusion: Our study suggests that the present practice of applying Lyme serological tests may result in more harm than benefit.

Background: There is disagreement regarding whether Lyme borreliosis is associated with adverse pregnancy outcome., Methods: We performed a review of the data from 95 women with Lyme borreliosis during pregnancy, evaluated at the Center for Tick-borne Diseases, Budapest over the past 22 years., Results: Treatment was administered parenterally to 66 (69.5%) women and orally to 19 (20%). Infection remained untreated in 10 (10.5%) pregnancies. Adverse outcomes were seen in 8/66 (12.1%) parentally treated women, 6/19 (31.6%) orally treated women, and 6/10 (60%) untreated women. In comparison to patients treated with antibiotics, untreated women had a significantly higher risk of adverse pregnancy outcome (odds ratio (OR) 7.61, p=0.004). While mothers treated orally had an increased chance (OR 3.35) of having an adverse outcome compared to those treated parenterally, this difference was not statistically significant (p=0.052). Erythema migrans did not resolve by the end of the first antibiotic course in 17 patients. Adverse pregnancy outcome was more frequent among these 'slow responder' mothers (OR 2.69), but this was not statistically significant (p=0.1425) . Loss of the pregnancy (n=7) and cavernous hemangioma (n=4) were the most prevalent adverse outcomes in our series. The other complications were heterogeneous., Conclusion: Our results indicate that an untreated maternal Borrelia burgdorferi s.l. infection may be associated with an adverse outcome, although bacterial invasion of the fetus cannot be proven. It appears that a specific syndrome representing 'congenital Lyme borreliosis' is unlikely., (Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)