Abstract
Objective
By using the published incidence of Lyme borreliosis in endemic regions of the World, and the sensitivity and specificity data of the best Lyme serological tests, we computed the positive predictive value of Borrelia burgdorferi antibody testing.
Methods
The calculation of predictive value was based on Bayes’ theorem. We also analyzed the frequency distribution of the specific and non-specific symptoms and complaints of 27,194 patients sent to the Centre for Tick-borne Diseases in Budapest from 1986 to 2008.
Results
This evaluation demonstrated that practitioners often use Lyme serology in a “trial and error” way, without any reasonable ground. According to our calculation the positive predictive value of the best Lyme antibody tests if applied in this way is <9.1%.
Conclusion
Our study suggests that the present practice of applying Lyme serological tests may result in more harm than benefit.
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Abbreviations
- ACA:
-
Acrodermatitis chronica atrophicans
- BL:
-
Borrelia lymphocytoma
- ELISA:
-
Enzyme linked immunosorbent assay
- EM:
-
Erythema migrans
- Lb:
-
Lyme borreliosis
- LMR:
-
Lymphocytic meningoradiculitis
- TIBOLA:
-
Tick-borne lymphadenopathy
References
Binnicker MJ, Jespersen DJ, Harring JA, Rollins LO, Bryant SC, Beito EM. Evaluation of two commercial systems for automated processing, reading, and interpretation of Lyme borreliosis Western blots. J Clin Microbiol. 2008;46:2216–21.
Tugwell P, Dennis DT, Weinstein A, Wells G, Shea B, Nichol G, et al. Laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med. 1997;127:1109–23.
Centers for Disease Control, Prevention—CDC. Lyme disease—United States, 2003–2005. Morb Mortal Wkly Rep. 2007;56:573–6.
Bacon RM, Biggerstaff BJ, Schriefer ME, Gilmore RD, Philipp MT, Steere AC, et al. Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole-cell lysates. J Infect Dis. 2003;187:1187–99.
Robertson J, Guy E, Andrews N, Wilske B, Anda P, Granström M, et al. A European multicenter study of immunoblotting in serodiagnosis of Lyme borreliosis. J Clin Microbiol. 2000;38:2097–102.
Steere AC, McHugh G, Damle N, Sikand VK. Prospective study of serologic tests for lyme disease. Clin Infect Dis. 2008;47:188–95.
Smith R, Takkinen J. (Eurosurveillance editorial office) Lyme borreliosis: Europe-wide coordinated surveillance and action needed? Eur Surveill. 2006; 11: 6. http://www.eurosurveillance.org/ew/2006/060622.asp. Accessed 5 July 2009.
WHO. The vector-borne human infections in Europe. Their distribution and burden on public health. 2004. http://www.euro.who.int/document/e82481.pdf. Accessed 12 Jan 2008.
Spiegelhalter DJ, Abrams KR, Myles JP. Bayesian approaches to clinical trials and health care evaluation. Chichester: Wiley; 2004.
Carrier M, Wells PS, Rodger MA. Excluding pulmonary embolism at the bedside with low pre-test probability and D-dimer: safety and clinical utility of 4 methods to assign pre-test probability. Thromb Res. 2006;117:469–74.
Khairy P. Programmed ventricular stimulation for risk stratification in patients with tetralogy of Fallot: a Bayesian perspective. Nat Clin Pract Cardiovasc Med. 2007;4:292–3.
Van Woerden HC, Howard A, Lyons M, Westmoreland D, Thomas M. Use of pre- and post-test probability of disease to interpret meningococcal PCR results. Eur J Clin Microbiol Infect Dis. 2004;23:658–60.
Lakos A. Tick-borne lymphadenopathy—a new rickettsial disease? Lancet. 1997;350:1006.
Steere AC, Sikand VK, Schoen RT, Nowakowski J. Asymptomatic infection with Borrelia burgdorferi. J Clin Infect Dis. 2003;37:528–32.
European Union Concerted Action on Lyme borreliosis (EUCALB). http://meduni09.edis.at/eucalb/cms/index.php?searchword=60-80%25&option=com_search&Itemid=5. Accessed 3 July 2009.
Steere AC. Lyme disease. N Engl J Med. 2001;345:115–25.
Liang FT, Steere AC, Marques AR, Johnson BJ, Miller JN, Philipp MT. Sensitive and specific serodiagnosis of Lyme disease by enzyme-linked immunosorbent assay with a peptide based on an immunodominant conserved region of Borrelia burgdorferi VlsE. J Clin Microbiol. 1999;37:3990–6.
Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of Lyme borreliosis. Clin Microbiol Rev. 2005;18:484–509.
Lakos A. Lyme borreliosis in Hungary—epidemiological analysis of 1175 cases. Report of WHO workshop on Lyme borreliosis diagnosis and surveillance. Warsaw, June 1995. WHO/CDS/VPH/95. 1995; 141: 84–102.
Berglund J, Eitrem R, Ornstein K, Lindberg A, Ringér A, Elmrud H, et al. An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med. 1995;333:1319–27.
Immunetics. Laboratory management of Lyme disease using a C6 peptide based ELISA assay. November 2, 2008. Package Insert.
Weinstein A. Editorial commentary: laboratory testing for Lyme disease: time for a change? Clin Infect Dis. 2008;47:196–7.
Cizman M, Avsic-Zupanc T, Petrovec M, Ruzic-Sabljic E, Pokorn M. Seroprevalence of ehrlichiosis, Lyme borreliosis and tick-borne encephalitis infections in children and young adults in Slovenia. Wien Klin Wochenschr. 2000;112:842–5.
Pierer K, Köck T, Freidl W, Stünzner D, Pierer G, Marth E, et al. Prevalence of antibodies to Borrelia burgdorferi flagellin in Styrian blood donors. Zentralbl Bakteriol. 1993;279:239–43.
Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57:656–65.
Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58:15–25.
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58:26–35.
Lakos A. Comparison of four serological tests for Borrelia burgdorferi in Bell’s palsy. Serod Immunother. 1990;4:271–5.
Brown SL, Hansen SL, Langone JJ. Role of serology in the diagnosis of Lyme disease. JAMA. 1999;282:62–6.
Yudkowsky ES. An intuitive explanation of Bayes’ theorem. http://yudkowsky.net/rational/bayes. Accessed 20 Dec 2009.
Casscells W, Schoenberger A, Graboys TB. Interpretation by physicians of clinical laboratory results. N Engl J Med. 1978;299:999–1001.
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The study has not been supported financially by any source.
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Lakos, A., Reiczigel, J. & Solymosi, N. The positive predictive value of Borrelia burgdorferi serology in the light of symptoms of patients sent to an outpatient service for tick-borne diseases. Inflamm. Res. 59, 959–964 (2010). https://doi.org/10.1007/s00011-010-0209-1
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DOI: https://doi.org/10.1007/s00011-010-0209-1