A Concise Critical Analysis of Serologic Testing for the Diagnosis of Lyme Disease

DeBiasi, Roberta L.

doi:10.1007/s11908-014-0450-9

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Her blood smears demonstrated Babesia (figure 1) including some showing classic ‘Maltese cross’ formation as well as confirmatory serological evidence of Lyme disease. The US Centers for Disease Control and Prevention (CDC) recommends a two-step testing approach for the diagnosis of active Lyme disease, which requires confirmation of a positive enzyme immunoassay test (eg, C6 peptide antibody) with IgM and IgG western blot if the patient is less than 30 days from symptom onset or only an IgG western blot for individuals with symptoms greater than 30 days 10. Our patient's Lyme test results were compatible with infection acquired over 30 days.…”

Section: Discussionmentioning

confidence: 64%

Fatal multiple deer tick-borne infections in an elderly patient with advanced liver disease

Chabria

Ogbuagu

2015

BMJ Case Reports

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SUMMARY We present a case of a 66-year-old woman with decompensated alcoholic liver cirrhosis and poorly controlled non-insulin-dependent diabetes mellitus who was admitted with a 1 day history of altered mental status, high-grade fevers, worsening jaundice and generalised malaise with subsequent development of hypotension requiring intensive care. She was diagnosed with severe babesiosis with high-grade parasitaemia. She was also found to have Lyme disease coinfection. Despite aggressive therapeutic measures including appropriate antibiotics and multiple exchange blood transfusions, she developed septic shock and fulminant multiple organ failure with eventual demise. In this article, we highlight multiple tick-borne illnesses in a vulnerable host, in this case an elderly patient with liver cirrhosis, as risk factors for severe morbidity and potentially fatal outcomes.

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Section: Discussionmentioning

confidence: 64%

Fatal multiple deer tick-borne infections in an elderly patient with advanced liver disease

Chabria

Ogbuagu

2015

BMJ Case Reports

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“…Sensitivity of serologic testing is poor in early localized disease. Specificity was uniformly excellent in all disease settings at 99% [13,14].…”

Section: Discussionmentioning

confidence: 91%

“…To date all 3 standard tests have 100% sensitivity in late Lyme disease. Over all the positive predictive value and negative predictive value of these tests only make sense when applied with good history, clinical inspection of the patient and the location of occurrence of infection [14,15].…”

Section: Vlse Is a Surface Protein Of B Burgdorferi It Is Encoded Bmentioning

confidence: 99%

Neuro Sarcoidosis Masquerading as Neuroborreliosis

Pingili¹,

Obaid²,

Dettbarn³

et al. 2017

Microbiol Infect Dis

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Background: Medical syndromes often overlap in clinical presentations. Often there is one or more than underlying etiology responsible for the patient's Clinical presentation. We are reporting a patient who was initially admitted with fevers and joint pains.Lymes IGG was positive .He was discharged home on Doxycycline and Prednisone suspecting gout. Patient however was re admitted twice within 3 weeks with cognitive impairment. Lymph node biopsy was positive for non Caseating granulomas suggesting Sarcoidosis. Clinically he responded dramatically to steroids. Case Report: 74 year old white male was admitted with fever and multiple joint pains. Tmax was 100.5.WBC was 15 with normal CBC. LFTs were elevated .Rest of the labs were normal.Lymes IGG was positive. He underwent extensive Rheumatological and virological evaluation. Sonogram of the abdomen was negative. He responded to IV Ceftriaxone and was discharged home on Doxycycline for 3 weeks and Prednisone taper for a week .He was readmitted within 2 weeks with weakness and confusion. After ruling out multiple etiologies he was discharged home on IV Ceftriaxone suspecting Neuroborreliosis.But he was re admitted with worsening mentation in a week. This time he was diagnosed with Neurosarcoidosis with a lymph node biopsy. He responded dramatically to IV steroids, Methotrexate and one dose of Infliximab. Patient continues to follow up with the clinic and is now at his base line with no recurrence. Conclusion: He is one patient where an underlying disabling pathology was missed twice. He is a case of chronic Lyme that was successfully treated to begin with. However he is also a case of Neurosarcoidosis Masquerading as Nueroborreliosis. Rarely is a clinical encounter so perplexing. This case also supports the existing literature that extended use of antibiotics for Lyme disease has no short term or long term benefits; instead it will put the patient at a risk of drug toxicity. From Palliative care evaluation in the hospital this gentleman is now back to his base line and is totally independent for activities of daily living.

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“…Diagnostic testing for Lyme disease is traditionally achieved by determination of the serologic responses to B. burgdoferi sensu lato, with the exception of the very early localized phase of disease (EM < 10 days), in which the diagnosis must be done clinically due to the recognized lack of antibody availabe for detection by serologic assays 37 . In this study, we show that we can detect culture confirmed clinically characterized LD using an assay suitable for use at the point of care.…”

Section: Discussionmentioning

confidence: 99%

Microfluidics-based point-of-care test for serodiagnosis of Lyme Disease

Nayak

Sridhara

Melo

et al. 2016

Sci Rep

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Currently, diagnostic testing for Lyme disease is done by determination of the serologic responses to Borrelia burgdorferi antigens, with the exception of the early localized phase of disease where diagnosis must be done clinically. Here, we describe the use of microfluidics technology to develop a multiplexed rapid lab-on-a-chip point of care (POC) assay for the serologic diagnosis of human Lyme disease. Following ELISA screening of 12 candidate antigens, we tested 8 on a microfluidic diagnostic system, called mChip-Ld, using a set of 60 serological samples. The mChip-Ld test, which can be performed in 15 minutes at the point of care, showed promising performance for detection of antibodies to B. burgdorferi using the PPO triplex test (rP100 + PepVF + rOspC-K, AUC of 0.844) compared to a gold-standard reference of culture confirmed clinical samples. The performance is comparable to the commonly used C6 peptide by lab-based ELISA. In addition, the mChip-Ld test showed promising performance for early-stage diagnosis of the disease using the antigen OspC-K (sensitivity and specificity of 84% and 92%, respectively; AUC of 0.877). Overall, this study underscores the potential of using microfluidics to aid the diagnosis of Lyme disease at the point of care.

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A Concise Critical Analysis of Serologic Testing for the Diagnosis of Lyme Disease

Cited by 12 publications

References 19 publications

Fatal multiple deer tick-borne infections in an elderly patient with advanced liver disease

Fatal multiple deer tick-borne infections in an elderly patient with advanced liver disease

Neuro Sarcoidosis Masquerading as Neuroborreliosis

Microfluidics-based point-of-care test for serodiagnosis of Lyme Disease

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