Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

Moore, Andrew; Nelson, Christina; Molins, Claudia R.; Mead, Paul S.; Schriefer, Martin E.

doi:10.3201/eid2207.151694

Cited by 133 publications

(69 citation statements)

References 36 publications

(76 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From the perspective of both clinical care and biomedical research, it is imperative to be able to identify disease cases accurately, and also to monitor the trajectory and response to intervention. The diagnostic workup for LD traditionally involves an assessment of the patient's risk, objective signs (such as an EM) and symptoms, supported by laboratory findings where appropriate [27]. In practice, this can be confounded by a number of factors, some of which are described below.…”

Section: Detecting and Characterizing Lyme Diseasementioning

confidence: 99%

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Bamm

Mainprize

et al. 2019

Pathogens

View full text Add to dashboard Cite

Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).

show abstract

Section: Detecting and Characterizing Lyme Diseasementioning

confidence: 99%

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Bamm

Mainprize

et al. 2019

Pathogens

View full text Add to dashboard Cite

show abstract

“…The standard of care for diagnosing disseminated Lyme disease is a two-tiered serologic approach that garners approximately 70–100% sensitivity and a specificity of approximately 95% [7]. The first tier involves either enzyme immunoassay (EIA) or an immunofluorescence assay (IFA) measuring the overall antibody response to either IgM or IgG [7].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The first tier involves either enzyme immunoassay (EIA) or an immunofluorescence assay (IFA) measuring the overall antibody response to either IgM or IgG [7]. If either of these results is equivocal or positive, an immunoblot should be used to detect antibodies against B. burgdorferi (Figure 3) [7]. The immunoblot detects antibody reactivity to specific preselected B. burgdorferi antigens and is considered positive if bands are equal or greater than the intensity of the control [7].…”

Section: Discussionmentioning

confidence: 99%

“…If either of these results is equivocal or positive, an immunoblot should be used to detect antibodies against B. burgdorferi (Figure 3) [7]. The immunoblot detects antibody reactivity to specific preselected B. burgdorferi antigens and is considered positive if bands are equal or greater than the intensity of the control [7]. …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Bilateral Facial Diplegia: A Rare Presenting Symptom of Lyme

Ashurst

Perry

2017

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

Lyme disease is a common disease that is faced by the physician but also acts a mimicker of many other disease processes. Facial palsies, especially bilateral, are a relatively rare presenting symptom of Lyme disease and may warrant further investigation. A thorough history and physical examination coupled with precision testing may aid the physician when faced with a patient with the diagnostic dilemma of facial diplegia.

show abstract

Lyme Disease in 2018

Shapiro

Wormser

2018

JAMA

View full text Add to dashboard Cite

With warmer weather come the annual warnings about tick-borne infections and, in particular, about Lyme disease. There has been considerable publicity about substantial increases in the incidence of Lyme disease; however, even though the incidence of Lyme disease has increased from 2007 to 2016, there has not been a statistically significant increase in the number of reported cases of Lyme disease in the United States during the most recent 4 years (2013)(2014)(2015)(2016) for which data are available. 1 In 2016, a total of 26 203 confirmed cases of Lyme disease were reported in the United States (incidence = 8.1 cases/100 000 population), 1 although an estimate suggests that approximately 300 000 cases occur annually. 2 The geographic distribution of Lyme disease (although still limited primarily to New England, the Middle Atlantic states, and Wisconsin and neighboring states) has increased, with evidence of spread to new areas, generally in locations that are adjacent to recognized endemic areas.Lyme disease is caused by infection with Lyme Borrelia, which include Borrelia burgdorferi, Borrelia garinii, and others, and are transmitted to humans through the bite of infected Ixodes ticks; in the United States, primarily by Ixodes scapularis-the deer tick. The vast majority of patients with Lyme disease (Ն90%) develop the characteristic skin lesion, erythema migrans. Extracutaneous manifestations may include facial nerve palsy, lymphocytic meningitis, radiculopathy, heart block from myopericarditis, and pauciarticular large joint arthritis.

show abstract

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

Abstract: Clinicians must consider patient medical history, timeline of symptoms, and hazards of alternative laboratory tests.

Cited by 133 publications

References 36 publications

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Bilateral Facial Diplegia: A Rare Presenting Symptom of Lyme

Lyme Disease in 2018

Contact Info

Product

Resources

About