Empiric Antibiotic Treatment of Patients Who Are Seropositive for Lyme Disease but Lack Classic Features

Luft, B. J.; Gardner, Pierce; Lightfoot, Robert W.

doi:10.1093/clinids/18.1.112

Cited by 4 publications

(2 citation statements)

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“…This concern has also led to inappropriate use of serological tests for Lyme disease as a screening test (often ordered as a result of requests by patients) in an attempt to identify the cause of widely prevalent, nonspecific symptoms such as pain and fatigue [40,67,68]. This has, in turn, led to a virtual epidemic of overdiagnosis and overtreatment of patients for Lyme disease, which only serves to perpetuate the myth that Lyme disease is commonly associated with severe, long-term morbidity [69][70][71][72][73][74][75][76][77]. Most studies indicate that with rare exceptions, the outcomes for persons with Lyme disease are excellent [12,13,[78][79][80][81][82].…”

Section: Lyme Anxietymentioning

confidence: 99%

Lyme Disease

Shapiro

Gerber

2000

Clinical Infectious Diseases

127

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Lyme disease, which is caused by Borrelia burgdorferi and transmitted in the United States primarily by Ixodes scapularis (the deer tick), is the most common vector borne disease in the United States. Its most frequent manifestation, a characteristic, expanding annular rash (erythema migrans), sometimes accompanied by myalgia, arthralgia, and malaise, occurs in nearly 90% of persons with symptomatic infection. Other manifestations of Lyme disease include seventh cranial nerve palsy, aseptic meningitis, and arthritis. Extensive coverage in the press about the serious effects of Lyme disease has led to widespread anxiety about this illness that is far out of proportion to the actual morbidity that it causes. This problem is exacerbated by the frequent use of serological tests to eliminate the possible diagnosis of Lyme disease in persons with only nonspecific symptoms (such as arthralgia or fatigue) who have a very low probability that Lyme disease is the cause of their symptoms. Consequently, misdiagnosis is frequent and is the most common cause of failure of treatment. The prognosis for most persons with Lyme disease is excellent.

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Section: Lyme Anxietymentioning

confidence: 99%

Lyme Disease

Shapiro

Gerber

2000

Clinical Infectious Diseases

127

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“…Over the past few years, it has become quite clear that serologic tests for Lyme disease are not optimal in terms of sensitivity and specificity (13). Furthermore, the lack of standardization of serologic tests has created difficulties in interpreting serologic tests performed in different laboratories (1,9).…”

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confidence: 99%

Utilization of tests for Lyme disease antibody at a university hospital

Nachamkin

Riddle

Feldman

et al. 1996

Clin Diagn Lab Immunol

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We performed a retrospective study on patients who had a positive screening antibody test result for antibody to Borrelia burgdorferi to determine the clinical indicators used by physicians to order this test. Eighty-two evaluable patients who were screen positive (indirect enzyme-linked immunosorbent assay) between August 1991 and March 1993 were included. Additional tests, isotype-specific capture immunoglobulin enzyme immunoassay and Western blot (immunoblot) analysis (immunoglobulin G), were performed on positive samples. Of 82 patients with a positive screening test result, 54 (66%) had no serologic evidence of Lyme disease on the basis of additional testing (positive predictive value, 34%). Only 28 of 82 patients (34%) had clinical indicators suggestive of Lyme disease. Antibody screening tests may provide misleading information if they are not accompanied by more specific assays. Inappropriate testing of patients without indications of Lyme disease is frequently performed, and the ordering practices of physicians should be reassessed.

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