We read with interest the article by Agre and Schwartz1 published in AJDC on the efficacy of early antibiotic treatment of deer tick bites to prevent Lyme disease (LD). We would like to comment on some aspects of this issue.
The diagnosis of LD is made clinically, using supporting serologie evidence of an antibody response to Borrelia burgdorferi. As Agre and Schwartz1 point out, false-negative results have been recorded. The implementation of more sensitive techniques, such as enzymelinked immunosorbent assays and Western immunoblotting, may broaden test reliability. However, many clinicians and scientists admit that seronegative LD, although rare, exists. These patients may have a poor antibody response and circulating immune complexes. Antibodies may escape detection unless methods to dissociate immune complexes are used.2
Antimicrobial treatment of early disease can abort a detectable antibody response.3 Thus, frequency of disease, based on a titer of 1:32, should be