Yield of Large‐Volume Blood Cultures in Patients with Early Lyme Disease

Wormser, Gary P.; Bittker, Susan; Cooper, Denise R.; Nowakowski, John; Nadelman, Robert B.; Pavia, Charles S.

doi:10.1086/323424

Cited by 95 publications

(89 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar results were obtained with clinical and laboratory criteria, and the 64% frequency of disseminated disease is consistent with previous reports (36). However, since spirochetal dissemination may occur in the absence of symptoms and since dissemination is intermittent (36), it is likely that some patients who were clas- sified as not having evidence of disseminated disease did in fact have spirochetal dissemination. As previously noted (27,37), we found that some B. burgdorferi strains were more often associated with clinical or laboratory evidence of dissemination than others.…”

Section: Discussionsupporting

confidence: 91%

Borrelia burgdorferi Genetic Markers and Disseminated Disease in Patients with Early Lyme Disease

et al. 2006

View full text Add to dashboard Cite

Three genetic markers of Borrelia burgdorferi have been associated with disseminated disease: the OspC type, the 16S-23S rRNA intergenic spacer type (RST), and vlsE. Here, we modified previous methods so as to identify the three markers by PCR and restriction fragment length polymorphism in parallel, analyzed B. burgdorferi isolates from erythema migrans (EM) skin lesions in 91 patients, and correlated the results with evidence of dissemination. OspC type A was found approximately twice as frequently in patients with disseminated disease, whereas type K was identified approximately twice as often in those without evidence of dissemination, but these trends were not statistically significant. The remaining seven types identified were found nearly equally in patients with or without evidence of dissemination. RST 1 strains were significantly associated with dissemination (P ‫؍‬ 0.03), whereas RST 2 and RST 3 strains tended to have an inverse association with this outcome. The vlsE gene was identified in all 91 cases, using primer sets specific for an N-terminal sequence of B. burgdorferi strain B31 (vlsE B31 ) or strain 297 (vlsE 297 ), but neither marker was associated with dissemination. Specific combinations of the three genetic markers usually occurred together. OspC type A was always found with RST 1 and vlsE B31 , type K was always identified with RST 2 and more often with vlsE 297 , and types E and I were almost always found with RST 3 and equally often with vlsE B31 and vlsE 297 . We conclude that B. burgdorferi strains vary in their capacity to disseminate, but almost all strains isolated from EM lesions sometimes caused disseminated disease.

show abstract

Section: Discussionsupporting

confidence: 91%

Borrelia burgdorferi Genetic Markers and Disseminated Disease in Patients with Early Lyme Disease

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Laboratory verification of Lyme borreliosis (LB) relies mainly on serology, because culture of the causative agent from clinical samples or PCR-based methods seem to be too insensitive and therefore unfeasible in clinical practice Sigal, 1998;Wormser et al, 1998). For serologic confirmation of Borrelia burgdorferi infection, a two-step approach with ELISA as a screening test and Western blotting as a confirmatory test is recommended by the Centers for Disease Control (CDC) (Brown et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Antigenicity of borrelial protein BBK32 fragments in early Lyme borreliosis

Lahdenne

Sarvas

Kajanus

et al. 2006

Journal of Medical Microbiology

View full text Add to dashboard Cite

Recombinantly produced borrelial BBK32 protein fragments originating from Borrelia burgdorferi sensu stricto, Borrelia garinii and Borrelia afzelii were evaluated as antigens in the serology of Lyme borreliosis (LB). In ELISA, a mid-portion hydrophilic fragment reacted with LB patient sera. Of the 23 patients with culture-or PCR-positive erythema migrans (EM), 43 % at diagnosis and 52 % at convalescence were positive for at least one Borrelia species-specific variant BBK32 fragment antigen. In parallel ELISAs with BBK32 whole proteins from the three borrelial subspecies as antigens, 17 % at diagnosis and 26 % at convalescence were positive. These results suggest that BBK32 protein fragments may improve the early IgG serology of LB compared to the BBK32 whole protein.

show abstract

“…However, when accepted signs and/or symptoms are unsatisfactory or inconclusive, laboratory testing may be needed for improving diagnostic certainty. Serologic testing is the mainstay for laboratory-based diagnosis, although modern technologies have provided other tools that variably contribute, including PCR and culture (5,9,10,15). The utility of specific laboratory diagnostics, culture in particular, has also been emphasized given the need for gold standards for evaluation of new diagnostic tests and for use in laboratory authentication of Lyme disease in investigations of new treatments and vaccines (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…The utility of specific laboratory diagnostics, culture in particular, has also been emphasized given the need for gold standards for evaluation of new diagnostic tests and for use in laboratory authentication of Lyme disease in investigations of new treatments and vaccines (10)(11)(12). The utility of high-volume blood cultures for diagnosis of Lyme disease has been primarily advanced by a single investigational group (15). The studies reported here using similar methodologies strongly support this approach for in vitro recovery of B. burgdorferi as a definitive diagnostic method.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease

et al. 2005

View full text Add to dashboard Cite

Lyme disease is usually diagnosed and treated based on clinical manifestations. However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies. Although cultivation of Borrelia burgdorferi is definitive, prior investigations have shown that no single test is optimal for Lyme disease diagnosis. We applied high-volume blood culture, skin biopsy culture, PCR, and serodiagnosis to a cohort of patients with suspected Lyme disease acquired in Maryland and southern Pennsylvania. The study was performed to confirm the relative utility of culture and to identify laboratory testing algorithms that will supplement clinical diagnosis. Overall, 30 of 86 patients (35%) were culture positive, whereas an additional 15 of 84 (18%) were seropositive only (51% total sero-and culture positive), and PCR on skin biopsy identified 4 additional patients who were neither culture nor seropositive. Among 49 laboratory test-positive patients, the highest sensitivity (100%) for diagnosis was obtained when culture, skin PCR, and serologic tests were used, although serologic testing with skin PCR was almost as sensitive (92%). Plasma PCR was infrequently positive and provided no additional diagnostic value. Although culture is definitive and has a relatively high sensitivity, the results required a mean of 3.5 weeks to recovery. The combination of acute-phase serology and skin PCR was 75% sensitive, offering a practical and relatively rapid alternative for confirming clinical impression. The full battery of tests could be useful for patients with confusing clinical signs or for providing strong laboratory support for clinical studies of Lyme disease.

show abstract

Yield of Large‐Volume Blood Cultures in Patients with Early Lyme Disease

Cited by 95 publications

References 10 publications

Borrelia burgdorferi Genetic Markers and Disseminated Disease in Patients with Early Lyme Disease

Borrelia burgdorferi Genetic Markers and Disseminated Disease in Patients with Early Lyme Disease

Antigenicity of borrelial protein BBK32 fragments in early Lyme borreliosis

Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease

Contact Info

Product

Resources

About