Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department

Nigrovic, Lise E.; Bennett, Jonathan E.; Balamuth, Fran; Levas, Michael N.; Chenard, Rachel L.; Maulden, Alexandra B.; Garro, Aris; Net, for Pedi Lyme

doi:10.1542/peds.2017-1975

Cited by 22 publications

(10 citation statements)

References 37 publications

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“…In a previous prospective study of >1000 patients presenting to the ED for evaluation of Lyme disease, clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease. 23 This work reveals PEDIATRICS Volume 141, number 5, May 2018 5 28,29 and several patients had a history of previous Lyme disease. In fact, 1 patient with septic arthritis and a positive Lyme disease 2-tiered serology result was assumed to have previous immunity.…”

Section: Discussionmentioning

confidence: 80%

Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area

et al. 2018

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Section: Discussionmentioning

confidence: 80%

Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area

et al. 2018

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“…Some physicians, faced with deciding whether or not to treat a patient for LD solely on the basis of clinical signs, but without serologic confirmation, opt for treatment with antibiotics. 23 Antibiotics are sometimes offered to patients who seek treatment for chronic fatigue, intermittent or persistent pain, and/or neurocognitive dysfunction, among other symptoms; this is controversial (see below). Some patients believe they may be suffering from “chronic LD”, a clinical syndrome for which there is no precise definition, diagnostic test, or definitive immediate response to appropriate antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

Disease-Associated Multimolecular Signature in the Urine of Patients with Lyme Disease Detected Using Raman Spectroscopy and Chemometrics

Senger

Issa²,

Agnor

et al. 2022

Appl Spectrosc

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A urine-based screening technique for Lyme disease (LD) was developed in this research. The screen is based on Raman spectroscopy, iterative smoothing-splines with root error adjustment (ISREA) spectral baselining, and chemometric analysis using Rametrix software. Raman spectra of urine from 30 patients with positive serologic tests (including the US Centers for Disease Control [CDC] two-tier standard) for LD were compared against subsets of our database of urine spectra from 235 healthy human volunteers, 362 end-stage kidney disease (ESKD) patients, and 17 patients with active or remissive bladder cancer (BCA). We found statistical differences ( p < 0.001) between urine scans of healthy volunteers and LD-positive patients. We also found a unique LD molecular signature in urine involving 112 Raman shifts (31 major Raman shifts) with significant differences from urine of healthy individuals. We were able to distinguish the LD molecular signature as statistically different ( p < 0.001) from the molecular signatures of ESKD and BCA. When comparing LD-positive patients against healthy volunteers, the Rametrix-based urine screen performed with 86.7% for overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively. When considering patients with ESKD and BCA in the LD-negative group, these values were 88.7% (accuracy), 83.3% (sensitivity), 91.0% (specificity), 80.7% (PPV), and 92.4% (NPV). Additional advantages to the Raman-based urine screen include that it is rapid (minutes per analysis), is minimally invasive, requires no chemical labeling, uses a low-profile, off-the-shelf spectrometer, and is inexpensive relative to other available LD tests.

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“…This prevalence is high enough that all children presenting with facial nerve palsy in endemic areas should have Lyme serology performed. This is particularly important as it has been demonstrated that clinical features alone perform poorly at being able to determine the likelihood of Lyme aetiology (14), and outcomes following treatment of Lyme disease are excellent, recently confirmed by large adult population studies in Europe of Lyme neuroborreliosis (15).…”

Section: Discussionmentioning

confidence: 99%

High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region

Munro

Dorey

Owens

et al. 2020

International Journal of Pediatric Otorhinolaryngology

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Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease.Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st 2010 and December 31st 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management.Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. Conclusion:Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.

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Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department

Abstract: Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis.

Cited by 22 publications

References 37 publications

Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area

Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area

Disease-Associated Multimolecular Signature in the Urine of Patients with Lyme Disease Detected Using Raman Spectroscopy and Chemometrics

High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region

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