Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, US

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Martian
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Location: Friesland, the Netherlands

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, US

Post by Martian » Sat 2 Jul 2016 3:27

Author affiliations: University of Virginia School of Medicine, Charlottesville, Virginia, USA (A. Moore); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (C. Nelson, C. Molins, P. Mead, M. Schriefer)

PubMed abstract:
Emerg Infect Dis. 2016 Jul;22(7). doi: 10.3201/eid2207.151694.

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.

Moore A, Nelson C, Molins C, Mead P, Schriefer M.

Abstract

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.

KEYWORDS:

Borrelia burgdorferi; Lyme disease; PCR; United States; bacteria; guidelines; laboratory diagnosis; public health; serologic analysis; vector-borne infections

PMID: 27314832
PMCID: PMC4918152 [Available on 2016-07-01]
Original source and free full text:

http://wwwnc.cdc.gov/eid/article/22/7/15-1694_article

duncan
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Joined: Wed 5 Sep 2012 18:48

Re: Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, US

Post by duncan » Sun 3 Jul 2016 2:59

"Recurrent large-joint arthritis is the hallmark of late disseminated disease. Late neurologic Lyme is uncommon in the United States."

:shock:

Boy, didn't that train leave the station years ago? Do these people have any idea how they sound to much of the greater Lyme community?

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ChronicLyme19
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Location: NY, USA

Re: Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, US

Post by ChronicLyme19 » Sun 10 Jul 2016 21:07

Well of course, because all the late neurolyme cases get misdiagnosed as other neurological diseases....

We need to email them and tell them to go talk to Dr. Brian Fallon of Columbia, he could probably set them straight.
Half of what you are taught is incorrect, but which half? What if there's another half missing?

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