Serologic studies of erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans with indirect immunofluorescence and enzyme-linked immunosorbent assays.

To determine whether antibodies to Borrelia spirochetes were present, sera from 88 patients with uncomplicated erythema chronicum migrans Afzelius (ECMA), from 9 patients with ECMA-related extracutaneous complications and from 26 patients with acrodermatitis chronica atrophicans (ACA) were submitted to an enzyme-linked immunosorbent assay (ELISA) and an indirect immunofluorescence (IF) assay. The assays were calculated to be 95% specific. There was good correlation between the IF test with a polyvalent conjugate and IgG ELISA. Of patients with uncomplicated ECMA, 18% were seropositive by IgG ELISA and 11% by IgM ELISA, and 15% showed elevated IF titers. Elevated serum antibody levels of IgG as measured by ELISA and elevated IF titers were found in all patients with extracutaneous complications and in the patients with ACA. Declining IgG titers were observed at follow-up 6-12 months after therapy, but the majority of the patients with ACA were still seropositive.