Utilization of tests for Lyme disease antibody at a university hospital

Nachamkin, Irving; Riddle, Donald L; Feldman, Michael; Edelstein, P. H.

doi:10.1128/cdli.3.3.287-289.1996

Cited by 7 publications

(1 citation statement)

References 14 publications

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“…Retrospective studies of the clinical context in which serologic testing for LD has been performed have called into question physicians' use of these tests. 12,13 For editorial comment see p 239.…”

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confidence: 99%

Tick Bites and Lyme Disease in an Endemic Setting

Fix

Strickland²,

Grant³

1998

JAMA

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Context.-The use of serologic testing to diagnose Lyme disease (LD) is a source of controversy. Expert recommendations also discourage the routine use of antibiotic therapy for prophylaxis of LD following tick bites, but the extent to which physicians in endemic areas have adopted these recommendations is not known. Objective.-To assess the pattern of use of serologic testing and antibiotic therapy for tick bites and LD and associated charges for management in an endemic area. Design.-Active surveillance of patient-physician encounters for tick bites and LD. Setting.-Primary care practices on the Eastern Shore of Maryland. Patients.-Consecutive sample of 232 patients with tick bites, LD (defined by physician diagnosis in medical record), and suspected LD (physician notation of possible, but not definite LD) seen in 1995. Main Outcome Measures.-Serologic testing for LD, test results, antibiotic therapy, and direct costs of management. Results.-Surveillance identified 142 patients (61.2%) with diagnoses of tick bites, 40 patients (17.2%) with LD, and 50 patients (21.6%) with suspected LD. Of the 142 patients seen for tick bites, 95 (67%) underwent serologic testing for LD. Of these, 93 patients had initial negative or equivocal results; 24 (26%) of the 93 had convalescent testing, with 1 seroconversion. Seventy-eight patients (55%) with a diagnosis of tick bite received antibiotic therapy. No patients with tick bite developed clinical LD. Serologic testing for LD was performed for 36 patients (90%) with a diagnosis of LD and 46 patients (92%) with suspected LD. In most cases, antibiotics were prescribed before serologic test results became available. Convalescent testing was not performed for 37 (86%) of the 43 patients with suspected LD who had initial negative or equivocal results. Of these 37 patients, 25 (68%) did not receive antibiotic therapy. Direct charges for treatment of these 232 patients totaled $47 595, one third of which was attributable to serologic testing. A total of 32% of direct charges were for patients with tick bites, 48% were for patients with LD, and 20% were for patients with suspected LD. Conclusions.-In this setting, most patients consulting physicians for tick bites received prophylactic antibiotic therapy of unproven efficacy and underwent unnecessary, costly serologic testing. Despite almost universal use in this study, serologic testing for LD did not appear to influence treatment of patients diagnosed as having LD.

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confidence: 99%

Tick Bites and Lyme Disease in an Endemic Setting

Fix

Strickland²,

Grant³

1998

JAMA

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Tests de confirmation pour la borréliose de Lyme

Binet

Girardet

Péter

1997

Immuno-analyse & Biologie Spécialisée

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Combinatorial search for diagnostic agents: Lyme antibody H9724 as an example

Tu¹,

Yu²,

Chu

1998

Clinical Chemistry

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Two peptide libraries, Ac-MXXXXXBBRM and Ac-VXXXXXBBRM, were constructed on TentaGel solid support to search for ligands that bind tightly with the H9724 Lyme antibody. By using an on-bead ELISA, approximately 120 ligands were selected as candidates for further study. Matrix-assisted laser desorption ionization mass spectrometry analysis of the candidate ligands indicated a high rate of occurrence of certain amino acids at the randomized positions. On the basis of the initial screening results, a small library was designed and iteratively synthesized. Subsequent library screenings led to the identification of four peptides, Ac-PQEEGX-NH2 (X = R, K, A, D), that showed specific affinity to the antibody. This combination of solid-phase screening and iterative synthesis is an effective strategy for rapid identification of ligands that bind tightly with disease-specific antibodies and should be applicable, at least in principle, to other ligand-receptor systems. This combinatorial library approach can also be a useful tool for the discovery of novel diagnostic agents.

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Utilization of tests for Lyme disease antibody at a university hospital

Cited by 7 publications

References 14 publications

Tick Bites and Lyme Disease in an Endemic Setting

Tick Bites and Lyme Disease in an Endemic Setting

Tests de confirmation pour la borréliose de Lyme

Combinatorial search for diagnostic agents: Lyme antibody H9724 as an example

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