title: Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.
abstract: BACKGROUND
  Lyme disease is diagnosed by 2-tiered serologic testing in patients with a compatible clinical illness, but the significance of positive test results in low-prevalence regions has not been investigated.
  
  
  METHODS
  We reviewed the medical records of patients who tested positive for Lyme disease with standardized 2-tiered serologic testing between 2005 and 2010 at a single hospital system in a region with little endemic Lyme disease. Based on clinical findings, we calculated the positive predictive value of Lyme disease serology. Next, we reviewed the outcome of serologic testing in patients with select clinical syndromes compatible with disseminated Lyme disease (arthritis, cranial neuropathy, or meningitis).
  
  
  RESULTS
  During the 6-year study period 4723 patients were tested for Lyme disease, but only 76 (1.6%) had positive results by established laboratory criteria. Among 70 seropositive patients whose medical records were available for review, 12 (17%; 95% confidence interval, 9%-28%) were found to have Lyme disease (6 with documented travel to endemic regions). During the same time period, 297 patients with a clinical illness compatible with disseminated Lyme disease underwent 2-tiered serologic testing. Six of them (2%; 95% confidence interval, 0.7%-4.3%) were seropositive, 3 with documented travel and 1 who had an alternative diagnosis that explained the clinical findings.
  
  
  CONCLUSIONS
  In this low-prevalence cohort, fewer than 20% of positive Lyme disease tests are obtained from patients with clinically likely Lyme disease. Positive Lyme disease test results may have little diagnostic value in this setting.
authors.affiliation: Divisions of Pediatric Infectious Diseases General Internal Medicine.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
authors.affiliation: Department of Pathology, Massachusetts General Hospital.
authors.forename: John A
authors.initials: JA
authors.lastname: Branda
authors.affiliation: General Internal Medicine.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boggan
authors.affiliation: General Internal Medicine.
authors.forename: Saumil M
authors.initials: SM
authors.lastname: Chudgar
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wilson
authors.affiliation: Infectious Diseases.
authors.forename: Felicia
authors.initials: F
authors.lastname: Ruffin
authors.affiliation: Infectious Diseases.
authors.forename: Vance
authors.initials: V
authors.lastname: Fowler
authors.affiliation: Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Auwaerter
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Massachusetts.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008193:Lyme Disease / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012698:Serologic Tests / Q000379:methods*; D055815:Young Adult
keywords: Borrelia burgdorferi; Lyme; diagnostic testing; positive predictive value; serology