Skip to main content
NCBI home page
Clinical and Diagnostic Laboratory Immunology logoLink to Clinical and Diagnostic Laboratory Immunology
. 1996 May;3(3):287–289. doi: 10.1128/cdli.3.3.287-289.1996

Utilization of tests for Lyme disease antibody at a university hospital.

I Nachamkin 1, D L Riddle 1, M Feldman 1, P H Edelstein 1
PMCID: PMC170332  PMID: 8705670

Abstract

We performed a retrospective study on patients who had a positive screening antibody test result for antibody to Borrelia burgdorferi to determine the clinical indicators used by physicians to order this test. Eighty-two evaluable patients who were screen positive (indirect enzyme-linked immunosorbent assay) between August 1991 and March 1993 were included. Additional tests, isotype-specific capture immunoglobulin enzyme immunoassay and Western blot (immunoblot) analysis (immunoglobulin G), were performed on positive samples. Of 82 patients with a positive screening test result, 54 (66%) had no serologic evidence of Lyme disease on the basis of additional testing (positive predictive value, 34%). Only 28 of 82 patients (34%) had clinical indicators suggestive of Lyme disease. Antibody screening tests may provide misleading information if they are not accompanied by more specific assays. Inappropriate testing of patients without indications of Lyme disease is frequently performed, and the ordering practices of physicians should be reassessed.

Full Text

The Full Text of this article is available as a PDF (156.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bakken L. L., Case K. L., Callister S. M., Bourdeau N. J., Schell R. F. Performance of 45 laboratories participating in a proficiency testing program for Lyme disease serology. JAMA. 1992 Aug 19;268(7):891–895. [PubMed] [Google Scholar]
  2. Berardi V. P., Weeks K. E., Steere A. C. Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. J Infect Dis. 1988 Oct;158(4):754–760. doi: 10.1093/infdis/158.4.754. [DOI] [PubMed] [Google Scholar]
  3. Burdge D. R., O'Hanlon D. P. Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. Clin Infect Dis. 1993 Apr;16(4):558–560. doi: 10.1093/clind/16.4.558. [DOI] [PubMed] [Google Scholar]
  4. Dressler F., Whalen J. A., Reinhardt B. N., Steere A. C. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis. 1993 Feb;167(2):392–400. doi: 10.1093/infdis/167.2.392. [DOI] [PubMed] [Google Scholar]
  5. Fallon B. A., Nields J. A. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994 Nov;151(11):1571–1583. doi: 10.1176/ajp.151.11.1571. [DOI] [PubMed] [Google Scholar]
  6. Lachs M. S., Nachamkin I., Edelstein P. H., Goldman J., Feinstein A. R., Schwartz J. S. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann Intern Med. 1992 Jul 15;117(2):135–140. doi: 10.7326/0003-4819-117-2-135. [DOI] [PubMed] [Google Scholar]
  7. Ley C., Le C., Olshen E. M., Reingold A. L. The use of serologic tests for Lyme disease in a prepaid health plan in California. JAMA. 1994 Feb 9;271(6):460–463. [PubMed] [Google Scholar]
  8. Luft B. J., Gardner P., Lightfoot R. W., Jr Empiric antibiotic treatment of patients who are seropositive for Lyme disease but lack classic features. American College of Rheumatology and the Infectious Diseases Society of America. Clin Infect Dis. 1994 Jan;18(1):112–112. doi: 10.1093/clinids/18.1.112. [DOI] [PubMed] [Google Scholar]
  9. Rahn D. W., Malawista S. E. Lyme disease: recommendations for diagnosis and treatment. Ann Intern Med. 1991 Mar 15;114(6):472–481. doi: 10.7326/0003-4819-114-6-472. [DOI] [PubMed] [Google Scholar]
  10. Ransohoff D. F., Feinstein A. R. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978 Oct 26;299(17):926–930. doi: 10.1056/NEJM197810262991705. [DOI] [PubMed] [Google Scholar]
  11. Rose C. D., Fawcett P. T., Gibney K. M., Doughty R. A. The overdiagnosis of Lyme disease in children residing in an endemic area. Clin Pediatr (Phila) 1994 Nov;33(11):663–668. doi: 10.1177/000992289403301105. [DOI] [PubMed] [Google Scholar]
  12. Steere A. C., Berardi V. P., Weeks K. E., Logigian E. L., Ackermann R. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J Infect Dis. 1990 Jun;161(6):1203–1209. doi: 10.1093/infdis/161.6.1203. [DOI] [PubMed] [Google Scholar]
  13. Steere A. C. Lyme disease: a growing threat to urban populations. Proc Natl Acad Sci U S A. 1994 Mar 29;91(7):2378–2383. doi: 10.1073/pnas.91.7.2378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Steere A. C., Taylor E., McHugh G. L., Logigian E. L. The overdiagnosis of Lyme disease. JAMA. 1993 Apr 14;269(14):1812–1816. [PubMed] [Google Scholar]

Articles from Clinical and Diagnostic Laboratory Immunology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES