Evaluation of Two‐Test Serodiagnostic Method for Early Lyme Disease in Clinical Practice

Abstract

Epidemiological methods are needed to evaluate community exposure to Borrelia burgdorferi, the caus-ative agent of Lyme disease (LD). For LD serodiagnosis, the Centers for Disease Control and Prevention (CDC) recommends a 2-test approach that involves enzyme immunoassay (EIA) testing and Western immunoblotting (WB) of EIA-equivocal and EIA-positive specimens. The specificity of this approach was evaluated among residents of a LD-endemic community and was compared with WB alone and with a simplified 2-test approach (WB of equivocal EIA only). Participants reporting no previous diagnosis of LD were recruited during a community-wide serosurvey on Block Island, Rhode Island. Of 80 eligible participants, 20 had received LD vaccine. Seven (35%) of 20 vaccinees and 22 (37%) of 60 nonvaccinees reported nonspecific symptoms compatible with LD in the previous year. In this highly LD-endemic community, the overall specificity of the CDC-recommended approach was highest (100%), followed by WB alone (98.7%), then the simplified approach (95%).

Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease

“…In accordance with the results of other studies, simple application of acute-phase serologic tests was very insensitive (45%) and, as with other studies, the use of paired acute-and convalescent-phase sera increased sensitivity among those patients with any laboratory evidence of B. burgdorferi infection to 77% (7,10,14). When coupled with culture results, levels of diagnostic sensitivity of Ͼ90% were obtained.…”

“…Matrices of distilled water, CSF, plasma, and transport medium were tested with the same B. burgdorferi standard DNA to determine their effects on PCR results. Specificity of the PCR assays for (2,14).…”

“…Clinical diagnosis of Lyme disease is usually straightforward with presence of a typical EM rash but in some cases can be difficult because of nonspecific signs and symptoms (10). Diagnosis can be supported by serology, which has limitations in sensitivity and specificity (7,10,14). Previous evaluations of Lyme disease laboratory diagnostics were mainly based upon clinical diagnosis as the gold standard; thus, to determine their relative diagnostic utilities, we evaluated existing diagnostic tests among a cohort of patients that included many with culture-proven disease.…”

Evaluation of a two-test serodiagnostic method for community assessment of Lyme disease in an endemic area.

“…8 In the current study, the specificity of the CDC-recommended approach was evaluated in a highly endemic area for LD and compared with 2 other testing approaches: a simplified 2-test approach (referred to here as the simplified approach), in which WB only follows equivocal EIA findings (and not positive EIA findings); and WB alone. 9 In addition to evaluating the results of serologic testing of asymptomatic people with no history of LD, we tested people with a history of nonspecific symptoms that could be associated with undiagnosed LD and people recently vaccinated for LD by a recombinant B. burgdorferi outer surface protein A (OspA). 10,11 MATERIALS AND METHODS Selection of serosurvey participants.…”

Lyme borreliosis in the horse: A mini-review

“…Antibodies can be detected at 5-6 weeks in Ponies exposed to ticks infected with B. burgdorferi, with the highest antibody levels induced at 3 months after exposure (Chang et al, 2000). Preference might be given to culture of B. burgdorferi from equine skin biopsies (Chang et al, 2000) combined with a two-step serology protocol (ELISA or IFAT supplemented by protein immunoblotting like Western blot or reverse line blot) (Trevejo et al, 1999;Magnarelli et al, 2000;Butler et al, 2005).…”