Overdiagnosis and overtreatment of Lyme neuroborreliosis are preventable.
The problems of diagnosis and treatment of Lyme neuroborreliosis can be minimised by strictly following the clinical diagnostic criteria, and understanding the pitfalls of laboratory tests. The diagnosis is based solely on objective clinical findings, with serologic test results used only to confirm the diagnosis. It must be underscored that serologic testing, when ordered without regard for clinical presentation (i.e., used as a screen), may be misleading due to its extremely low positive predictive value. Enzyme-linked immunosorbent assay should always be confirmed by Western blot. The cerebrospinal fluid Borrelia burgdorferi antibody index is more meaningful than simple titres of specific antibody. Polymerase chain reaction is still a research tool and should not be utilised without clinical correlation. All serologic tests and polymerase chain reaction may remain positive long after successful treatment. Overdiagnosis and overtreatment can be minimised by following these guidelines.
Prasad
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Department of Neurology, New York University Medical Center, NY 10016, USA.
Sankar
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D000465:Algorithms; D015748:Borrelia burgdorferi Group; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy; D010406:Penicillins / Q000627:therapeutic use; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D012698:Serologic Tests
D007074:Immunoglobulin G; D010406:Penicillins