title: Feedback on difficulties raised by the interpretation of serological tests for the diagnosis of Lyme disease.
abstract: OBJECTIVE
  We had for objectives: i) to evaluate the accuracy of serologic testing for Lyme borreliosis performed in a private medical laboratory (PML); ii) to evaluate the impact of these tests on the practices of infectious diseases specialists (IDS).
  
  
  METHODS
  This study was performed in two steps: i) retrospective study of patients followed in a university hospital infectious diseases outpatient clinic for suspected Lyme borreliosis, tested (ELISA and Western blot) by both the PML and the National Reference Center (NRC); ii) national survey on IDS practices concerning patients consulting for suspected Lyme borreliosis.
  
  
  RESULTS
  Between July 2008 and July 2011, 128 patients consulting for suspected Lyme borreliosis were tested by both laboratories. Serological tests came back positive in 91% of cases from the PML versus 8% of cases from the NRC. Lyme borreliosis was the IDS's final diagnosis for 3.6% of patients. The survey on practices revealed that: i) the modal duration of consultation for suspected Lyme borreliosis was 30-60 minutes; ii) for 33% of patients, serologic test results performed at the PML were the only reason to suspect Lyme borreliosis; iii) 60% of patients had no indication for antibiotics.
  
  
  CONCLUSIONS
  The serological test performed in the PML were positive most of the time, but were not confirmed by tests performed at the NRC. This discrepancy lead to multiple and prolonged consultations in infectious diseases clinics, and discordance in the indications for antibiotics.
authors.affiliation: Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France. Electronic address: yves.hansmann@chru-strasbourg.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Hansmann
authors.affiliation: Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Leyer
authors.affiliation: Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Lefebvre
authors.affiliation: Service des maladies infectieuses et réanimation médicale, université de Rennes-I, CHU Pontchaillou, 35033 Rennes cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Revest
authors.affiliation: Service des maladies infectieuses et tropicales, hôpitaux de Brabois, CHU de Nancy, 54511 Vandœuvre-lès-Nancy cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Rabaud
authors.affiliation: Service des maladies infectieuses et réanimation médicale, hôpital Gustave-Dron, CHRU de Lille, 59208 Tourcoing cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.affiliation: Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Christmann
authors.affiliation: Service des maladies infectieuses et réanimation médicale, université de Rennes-I, CHU Pontchaillou, 35033 Rennes cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D015153:Blotting, Western; D025065:Borrelia burgdorferi / Q000276:immunology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004797:Enzyme-Linked Immunosorbent Assay / Q000523:psychology*; D005188:False Negative Reactions; D005189:False Positive Reactions; D030141:Feedback, Psychological; D005602:France; D006077:Government Agencies; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D055552:Infectious Disease Medicine / Q000458:organization & administration; D007753:Laboratories / Q000706:statistics & numerical data*; D008193:Lyme Disease / Q000097:blood / Q000175:diagnosis*; D010044:Outpatient Clinics, Hospital; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017149:Private Sector; D012015:Reference Standards; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000523:psychology*; D016037:Single-Blind Method
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial
keywords: Borrelia; Lyme disease; Lyme serology; Maladie de Lyme; Sérologie Lyme