Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.
In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%-40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%-100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics.
Andrew
A
Moore
Christina
C
Nelson
Claudia
C
Molins
Paul
P
Mead
Martin
M
Schriefer
D000907:Antibodies, Bacterial / Q000097:blood; D006801:Humans; D007753:Laboratories / Q000592:standards*; D008193:Lyme Disease / Q000175:diagnosis* / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000592:standards
D000907:Antibodies, Bacterial
Borrelia burgdorferi; Lyme disease; PCR; United States; bacteria; guidelines; laboratory diagnosis; public health; serologic analysis; vector-borne infections