Direct Diagnostic Tests for Lyme Disease

Schutzer, Steven E.; Body, Barbara A.; Boyle, Jeff; Branson, Bernard M.; Dattwyler, Raymond J.; Fikrig, Erol; Gerald, Noel J.; Gomes-Solecki, Maria; Kintrup, Martin; Ledizet, Michel; Levin, Andrew; Lewinski, Michael A.; Liotta, Lance A.; Marques, Adriana; Mead, Paul S.; Mongodin, Emmanuel F.; Pillai, Segaran P.; Rao, P. Appa; Robinson, William H.; Roth, Kristian M.; Schriefer, Martin E.; Slezak, Thomas R.; Snyder, Jessica L.; Steere, Allen C.; Witkowski, Jan; Wong, Susan J.; Branda, John A.

doi:10.1093/cid/ciy614

Cited by 64 publications

(70 citation statements)

References 41 publications

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“…Serological examination is widely used and is available in the clinical setting. Frequently used assays are enzyme-linked immunosorbent assay (ELISA), immunofluorescence assays, and Western blotting (Tugwell, 1997;Schutzer et al, 2018), but false-negative and false-positive results may occur (Schutzer et al, 2018). ELISA is recommended as the initial serological examination.…”

Section: Diagnosismentioning

confidence: 99%

Lyme Endocarditis as an Emerging Infectious Disease: A Review of the Literature

et al. 2020

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Section: Diagnosismentioning

confidence: 99%

Lyme Endocarditis as an Emerging Infectious Disease: A Review of the Literature

et al. 2020

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“…Box 1 consolidates some of the major themes and recommendations explored in this review. Across the board, there is a recognized need for diagnostic tools that capture all stages of the disease, and can be used to monitor the infection status and evaluate microbiological eradication [347]. As high-quality direct-detection techniques evolve from interdisciplinary research, they will in turn accelerate clinical studies by affording investigators a higher resolution biological view of disease progression and treatment outcomes.…”

Section: Conclusion and Future Frontiersmentioning

confidence: 99%

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Bamm

Mainprize

et al. 2019

Pathogens

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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).

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“…Given the well-known limitations of immunoblot-based testing, MTTT provides a promising alternative testing strategy for children and adolescents with suspected Lyme disease. New host-or pathogen-based approaches for the diagnosis of Lyme disease are still needed to avoid both under-and overdiagnosis (19,22).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children

2019

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Conventional two-tiered testing (CTTT) for Lyme disease includes a first-tier enzyme immunoassay (EIA) followed by a supplemental immunoblot, and modified two-tiered testing (MTTT) relies on two different sequential EIAs without the inclusion of an immunoblot. MTTT has shown promising results as an alternative strategy for the diagnosis of Lyme disease in adults but has not yet been evaluated in children. We performed a cross-sectional study of children and adolescents ≤21 years of age undergoing clinical investigation for suspected Lyme disease. Serum specimens were analyzed with both a whole-cell sonicate (WCS) and a C6 EIA, with a supplemental immunoblot if either EIA was positive or equivocal. We compared CTTT (WCS EIA followed by supplemental immunoblot) to MTTT (WCS EIA followed by C6 EIA) using McNemar’s test to evaluate for agreement beyond chance alone. We then used a kappa statistic to measure level of the agreement between testing strategies. We included 1,066 serum specimens, of which 156 (14.6%) had a positive CTTT and 165 (15.5%) had a positive MTTT. There were no significant differences between MTTT and CTTT (P = 0.16). Although the overall agreement between MTTT and CTTT was high (kappa, 0.88; 95% confidence interval, 0.84 to 0.92), 33 children had discordant test results. In a cohort of children and adolescents undergoing investigation for suspected Lyme disease, CTTT and MTTT results agreed in most cases. Since immunoblots are time-consuming, laborious, and challenging to interpret, MTTT provides a promising alternate Lyme disease testing strategy for children.

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Direct Diagnostic Tests for Lyme Disease

Cited by 64 publications

References 41 publications

Lyme Endocarditis as an Emerging Infectious Disease: A Review of the Literature

Lyme Endocarditis as an Emerging Infectious Disease: A Review of the Literature

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children

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