Lyme disease laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
==Serology== | |||
The [[serology|serological]] laboratory tests most widely available and employed are the [[Western blot]] and [[ELISA]]. 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,<ref name=Sherris /> 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> | |||
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> | |||
[[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. 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''. High titers of either immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to ''Borrelia'' antigens indicate disease, but lower titers can be misleading. 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> | |||
Western blot, ELISA and PCR can be performed by either blood test via [[venipuncture]] or [[cerebral spinal fluid]] (CSF) via [[lumbar puncture]]. 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. 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> | |||
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> 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> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Serology
The serological laboratory tests most widely available and employed are the Western blot and ELISA. A two-tiered protocol is recommended by the CDC: the more sensitive ELISA is performed first, if it is positive or equivocal, the more specific Western blot is run. The reliability of testing in diagnosis remains controversial,[1] however studies show the Western blot IgM has a specificity of 94–96% for patients with clinical symptoms of early Lyme disease.[2][3]
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,[4] as well as herpes simplex virus.[5]
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 false-positive results but can often show false-negative results, and the overall reliability of PCR in this role remains unclear. 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. High titers of either immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to Borrelia antigens indicate disease, but lower titers can be misleading. The IgM antibodies may remain after the initial infection, and IgG antibodies may remain for years.[6]
Western blot, ELISA and PCR can be performed by either blood test via venipuncture or cerebral spinal fluid (CSF) via lumbar puncture. 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. The diagnosis of neurologic infection by Borrelia should not be excluded solely on the basis of normal routine CSF or negative CSF antibody analyses.[7]
New techniques for clinical evaluation if Borrelia infection are under investigation, including Lymphocyte transformation tests [8] and focus floating microscopy.[9] New research indicates chemokine CXCL13 may also be a possible marker for neuroborreliosis.[10]
References
- ↑ Invalid
<ref>tag; no text was provided for refs namedSherris - ↑ Engstrom SM, Shoop E, Johnson RC (1995). "Immunoblot interpretation criteria for serodiagnosis of early Lyme disease" (PDF). J Clin Microbiol. 33 (2): 419–27. PMID 7714202.
- ↑ Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP (1996). "Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease". Arch Intern Med. 156 (18): 2105–9. PMID 8862103.
- ↑ Goossens HA, Nohlmans MK, van den Bogaard AE (1999). "Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis". Infection. 27 (3): 231. PMID 10378140.
- ↑ Strasfeld L, Romanzi L, Seder RH, Berardi VP (2005). "False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection". Clin Infect Dis. 41 (12): 1826–7. PMID 16288417.
- ↑ Burdash N, Fernandes J (1991). "Lyme borreliosis: detecting the great imitator". The Journal of the American Osteopathic Association. 91 (6): 573–4, 577–8. PMID 1874654.
- ↑ Coyle PK, Schutzer SE, Deng Z; et al. (1995). "Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease". Neurology. 45 (11): 2010–5. PMID 7501150.
- ↑ Valentine-Thon E, Ilsemann K, Sandkamp M (2007). "A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis". Diagn. Microbiol. Infect. Dis. 57 (1): 27–34. doi:10.1016/j.diagmicrobio.2006.06.008. PMID 16876371.
- ↑ Eisendle K, Grabner T, Zelger B (2007). "Focus floating microscopy: "gold standard" for cutaneous borreliosis?". Am. J. Clin. Pathol. 127 (2): 213–22. doi:10.1309/3369XXFPEQUNEP5C. PMID 17210530.
- ↑ Cadavid D (2006). "The mammalian host response to borrelia infection". Wien. Klin. Wochenschr. 118 (21–22): 653–8. doi:10.1007/s00508-006-0692-0. PMID 17160603.