Lyme disease overdiagnosis in a large healthcare system: a population-based, retrospective study

Webber, Bryant J.; Burganowski, Rachael P; Colton, L.; Escobar, James D; Pathak, Sonal; Gambino-Shirley, Kelly

doi:10.1016/j.cmi.2019.02.020

Cited by 45 publications

(37 citation statements)

References 25 publications

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“…Overdiagnosis and overtreatment of LB is common, with increased patient morbidity related to unnecessary intravenous and oral antibiotics [18,19]. The scientific community has recently focused on the accuracy of diagnosing LB and the complexity of irrelevant LB-related antimicrobial treatments [20,21].…”

Section: Introductionmentioning

confidence: 99%

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Kortela

Kanerva

Kurkela

et al. 2021

Clinical Microbiology and Infection

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Objective: To evaluate the conditions behind the symptoms in patients with suspected Lyme borreliosis (LB) who were referred to an infectious diseases clinic. Methods: In this retrospective, population-based study, we collected data from the medical records of all patients referred for infectious disease consultations in 2013 due to presumed LB from a population of 1.58 million. The patients were classified according to the certainty of LB on the basis of their symptoms, signs and laboratory results. Data on the outcomes and subsequent alternative diagnoses during the 4year follow-up period were reviewed from all of the available patient records from public, private and occupational healthcare providers. Results: A total of 256 patients (16/100 000) were referred as a result of suspicion of LB; 30 (12%) of 256 were classified with definite, 36 (14%) with probable and 65 (25%) with possible LB. LB was unlikely in 121 (47%) patients. A novel diagnosis was discovered in the background symptoms in 73 (29%) of patients. Previously diagnosed comorbidities caused at least some of the symptoms in 48 (19%) patients. Other explanations for symptoms were found in 81 (67%) of 121 of unlikely and 22 (34%) of 65 of possible LB patients. The spectrum of conditions behind the symptoms was quite broad and most often were musculoskeletal, neurological, psychological or functional disorders. Conclusions: LB was unlikely in half of the patients with presumed LB. In most cases the patients had other conditions that explained their symptoms.

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Section: Introductionmentioning

confidence: 99%

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Kortela

Kanerva

Kurkela

et al. 2021

Clinical Microbiology and Infection

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“…Whether the predictive value of MTTT would be sufficient in areas of lower prevalence or whether the increased specificity provided by IBs is necessary for optimal results requires further study. Given that most EIAs are polyvalent and measure both IgM and IgG antibodies, there is a theoretical concern about false positives based on the IgM component of the assay (38,39). As such, there may be instances where identifying a specific IgG response will be helpful if there is ongoing diagnostic uncertainty, such as cases of arthritis.…”

Section: Discussionmentioning

confidence: 99%

Performance of a Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease in Nova Scotia

Davis

McNeil

Allen³

et al. 2020

J Clin Microbiol

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Compared to the standard two-tiered testing (STTT) algorithm for Lyme disease serology using an enzyme immunoassay (EIA) followed by Western blotting, data from the United States suggest that a modified two-tiered testing (MTTT) algorithm employing two EIAs has improved sensitivity to detect early localized Borrelia burgdorferi infections without compromising specificity. From 2011 to 2014, in the Canadian province of Nova Scotia, where Lyme disease is hyperendemic, sera submitted for Lyme disease testing were subjected to a whole-cell EIA, followed by C6 EIA and subsequently IgM and/or IgG immunoblots on sera with EIA-positive or equivocal results. Here, we evaluate the effectiveness of the MTTT algorithm compared to the STTT approach in a Nova Scotian population. Retrospective chart reviews were performed on patients testing positive with the whole-cell and C6 EIAs (i.e., the MTTT algorithm). Patients were classified as having Lyme disease if they had a positive STTT result, a negative STTT result but symptoms consistent with Lyme disease, or evidence of seroconversion on paired specimens. Of the 10,253 specimens tested for Lyme disease serology, 9,806 (95.6%) were negative. Of 447 patients who tested positive, 271 charts were available for review, and 227 were classified as patients with Lyme disease. The MTTT algorithm detected 25% more early infections with a specificity of 99.56% (99.41 to 99.68%) compared to the STTT. These are the first Canadian data to show that serology using a whole-cell sonicate EIA followed by a C6 EIA (MTTT) had improved sensitivity for detecting early B. burgdorferi infection with specificity similar to that of two-tiered testing using Western blots.

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“…Repeated serological tests, insufficiently documented cases, and patients with a past medical history of Lyme borreliosis were excluded. Of the 212 cases, 113 (53.3%) were considered as false positives and 91/113 (80.5%) received an unnecessary antibiotic therapy (Webber et al, 2019). As a consequence, four criteria should be systematically sought when an IgM test for Borrelia is found positive without IgG: (i) verification of the positivity criteria for serology; (ii) high probability of tick exposure (depending on the geographic area and of the season); (iii) symptoms and clinical signs highly evocative of early Lyme borreliosis; (iv) IgG seroconversion on retesting more than 4 weeks later.…”

Section: Poor Specificity Of Igmmentioning

confidence: 99%

Immunoserological Diagnosis of Human Borrelioses: Current Knowledge and Perspectives

Talagrand-Reboul

Raffetin

Zachary

et al. 2020

Front. Cell. Infect. Microbiol.

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Lyme disease overdiagnosis in a large healthcare system: a population-based, retrospective study

Cited by 45 publications

References 25 publications

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Performance of a Modified Two-Tiered Testing Enzyme Immunoassay Algorithm for Serologic Diagnosis of Lyme Disease in Nova Scotia

Immunoserological Diagnosis of Human Borrelioses: Current Knowledge and Perspectives

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