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| {{Lyme disease}}
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| {{CMG}} {{AE}} {{IMD}}
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| ==Overview==
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| Laboratory blood tests are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease. [[Polymerase chain reaction]] (PCR) tests for Lyme disease have also been developed to detect the genetic material ([[DNA]]) of the Lyme disease spirochete.
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| ==Laboratory Findings==
| | {{CMG}}; {{AE}} {{Anmol}} |
| * Lyme disease is diagnosed based on:
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| #Signs and symptoms
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| #A history of possible exposure to infected blacklegged ticks
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| * Laboratory blood tests are helpful if used correctly and performed with validated methods.
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| * Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease.
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| * Just as it is important to correctly diagnose Lyme disease when a patient has it, it is important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else.
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| ===Serology=== | | ==Tables== |
| *The [[serology|serological]] laboratory tests most widely available and employed are the [[Western blot]] and [[ELISA]].
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| *A two-tiered protocol is recommended by the [[Centers for Disease Control|CDC]]: the more sensitive ELISA is performed first, if it is positive or equivocal, the more [[Specificity (tests)|specific]] Western blot is run. The reliability of testing in diagnosis remains controversial, however studies show the Western blot [[IgM]] has a specificity of 94–96% for patients with clinical symptoms of early Lyme disease.<ref name="Engstrom">{{cite journal | author=Engstrom SM, Shoop E, Johnson RC | title=Immunoblot interpretation criteria for serodiagnosis of early Lyme disease | journal=J Clin Microbiol | year=1995 | pages=419-27 | volume=33 | issue=2 | pmid = 7714202 | url=http://jcm.asm.org/cgi/reprint/33/2/419.pdf | format=PDF}}</ref><ref name="Sivak">{{cite journal | author=Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP | title=Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease | journal=Arch Intern Med | year=1996 | pages=2105-9 | volume=156 | issue=18 | pmid = 8862103}}</ref>
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| | | !Diagnosis |
| * Erroneous test results have been widely reported in both early and late stages of the disease. These errors can be caused by several factors, including [[antibody]] cross-reactions from other infections including [[Epstein-Barr virus]] and [[Cytomegalovirus]],<ref name="Gossens">{{cite journal | author=Goossens HA, Nohlmans MK, van den Bogaard AE | title=Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis | journal=Infection | year=1999 | pages=231 | volume=27 | issue=3 | pmid= 10378140}}</ref> as well as [[Herpes simplex virus]].<ref name="Strasfeld">{{cite journal | author=Strasfeld L, Romanzi L, Seder RH, Berardi VP | title=False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection | journal=Clin Infect Dis | year=2005 | pages=1826-7 | volume=41 | issue=12 | pmid= 16288417}}</ref>
| | !Lab findings |
| | | ! |
| * [[Polymerase chain reaction]] (PCR) tests for Lyme disease have also been developed to detect the genetic material ([[DNA]]) of the Lyme disease spirochete. PCR tests are rarely susceptible to [[Type I and type II errors|false-positive]] results but can often show [[Type I and type II errors|false-negative]] results, and the overall reliability of PCR in this role remains unclear.
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| * With the exception of PCR, there is no currently practical means for detection of the presence of the organism, as serologic studies only test for [[antibodies]] of ''Borrelia''.
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| * High titers of either immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to ''Borrelia'' antigens indicate disease, but lower titers can be misleading.
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| * The IgM antibodies may remain after the initial infection, and IgG antibodies may remain for years.<ref>{{cite journal |author=Burdash N, Fernandes J |title=Lyme borreliosis: detecting the great imitator |journal=The Journal of the American Osteopathic Association |volume=91 |issue=6 |pages=573-4, 577-8 |year=1991 |pmid=1874654 |url=http://www.jaoa.org/cgi/content/abstract/91/6/573}}</ref>
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| * Western blot, ELISA and PCR can be performed by either blood test via [[venipuncture]] or [[cerebral spinal fluid]] (CSF) via [[lumbar puncture]].
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| * Though lumbar puncture is more definitive of diagnosis, antigen capture in the CSF is much more elusive, reportedly CSF yields positive results in only 10-30% of patients cultured.
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| * The diagnosis of neurologic infection by ''Borrelia'' should not be excluded solely on the basis of normal routine CSF or negative CSF antibody analyses.<ref>{{cite journal |author=Coyle PK, Schutzer SE, Deng Z, ''et al'' |title=Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease |journal=Neurology |volume=45 |issue=11 |pages=2010-5 |year=1995 |pmid=7501150 }}</ref>
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| * New techniques for clinical evaluation if ''Borrelia'' infection are under investigation, including ''Lymphocyte transformation tests'' <ref>{{cite journal |author=Valentine-Thon E, Ilsemann K, Sandkamp M |title=A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=1 |pages=27-34 |year=2007 |pmid=16876371 |doi=10.1016/j.diagmicrobio.2006.06.008}}</ref> and ''focus floating microscopy''.<ref>{{cite journal |author=Eisendle K, Grabner T, Zelger B |title=Focus floating microscopy: "gold standard" for cutaneous borreliosis? |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=213-22 |year=2007 |pmid=17210530 |doi=10.1309/3369XXFPEQUNEP5C}}</ref>
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| * New research indicates [[chemokine]] [[CXCL13]] may also be a possible marker for neuroborreliosis.<ref>{{cite journal |author=Cadavid D |title=The mammalian host response to borrelia infection |journal=Wien. Klin. Wochenschr. |volume=118 |issue=21-22 |pages=653-8 |year=2006 |pmid=17160603 |doi=10.1007/s00508-006-0692-0}}</ref>
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| ===Other Types of Laboratory Testing===
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| * Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established.
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| * These tests include urine antigen tests, immunofluorescent staining for cell wall-deficient forms of Borrelia burgdorferi, and lymphocyte transformation tests.
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| * In general, CDC does not recommend these tests.
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| * Patients are encouraged to ask their physicians whether their testing for Lyme disease was performed using validated methods and whether results were interpreted using appropriate guidelines.
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| ===Testing Ticks===
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| * Patients who have removed a tick often wonder if they should have it tested.
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| * In general, the identification and testing of individual ticks is not useful for deciding if a person should get antibiotics following a tick bite.
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| [[Category:Needs overview]]
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| [[Category:Bacterial diseases]]
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| [[Category:Insect-borne diseases]]
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| [[Category:Lyme disease]]
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| [[Category:Zoonoses]]
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| [[Category:Spirochaetes]]
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| [[Category:Disease]]
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| [[Category:Infectious disease]]
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| [[Category:Dermatology]]
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| [[Category:Emergency medicine]]
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| [[Category:Intensive care medicine]]
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