title: Laboratory diagnostic techniques for patients with early Lyme disease associated with erythema migrans: a comparison of different techniques.
abstract: Recently, a number of refinements in diagnostic modalities for detection of Borrelia burgdorferi infection have been developed. These include large-volume blood cultures, quantitative polymerase chain reaction (PCR) techniques, and 2-stage serologic testing. In the present study, we compared 6 diagnostic modalities in 47 adult patients who had a clinical diagnosis of erythema migrans. Quantitative PCR on skin biopsy-derived material was the most sensitive diagnostic method (80.9%), followed by 2-stage serologic testing of convalescent-phase samples (66.0%), conventional nested PCR (63.8%), skin culture (51.1%), blood culture (44.7%), and serologic testing of acute-phase samples (40.4%). Results of all assays were negative for 3 patients (6.4%). We conclude that the clinical diagnosis of erythema migrans is highly accurate in an area where B. burgdorferi is endemic if it is made by experienced health care personnel, but some patients with this diagnosis may not have B. burgdorferi infection. No single diagnostic modality is suitable for detection of B. burgdorferi in every patient with erythema migrans.
authors.affiliation: Division of Infectious Diseases and Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, 10595, USA. John_Nowakowski@nymc.edu
authors.forename: J
authors.initials: J
authors.lastname: Nowakowski
authors.forename: I
authors.initials: I
authors.lastname: Schwartz
authors.forename: D
authors.initials: D
authors.lastname: Liveris
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.forename: M E
authors.initials: ME
authors.lastname: Aguero-Rosenfeld
authors.forename: G
authors.initials: G
authors.lastname: Girao
authors.forename: D
authors.initials: D
authors.lastname: McKenna
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: L F
authors.initials: LF
authors.lastname: Cavaliere
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D001706:Biopsy; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D018929:Cell Culture Techniques; D019411:Clinical Laboratory Techniques; D015787:Erythema Chronicum Migrans / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D012698:Serologic Tests