 |
|
Accuracy of IgM Immunoblotting to Confirm the Clinical Diagnosis of Early Lyme Disease
Steven L. Sivak, MD;
Maria E. Aguero-Rosenfeld, MD;
John Nowakowski, MD;
Robert B. Nadelman, MD;
Gary P. Wormser, MD
Arch Intern Med. 1996;156(18):2105-2109.
Abstract
| |
Background
A 2-test approach for the serologic diagnosis of Lyme disease has recently been proposed. A positive or equivocal result on a first-stage test (eg, an enzyme immunoassay) is followed by a Western immunoblot test. For a sample to be considered seropositive for Lyme disease, the immunoblot result must be positive.
Objectives
To assess the accuracy of IgM immunoblotting for detection of early Lyme disease and to establish interpretative criteria for a commercially available immunoblot assay.
Methods
Serum samples from 44 patients with erythema migrans were tested by an IgM immunoblot assay. All patients were culture-positive for Borrelia burgdorferi. Serum samples from 2 different control groups were also tested. Interpretative criteria were developed using receiver operating characteristic curves.
Results
The presence of any 2 IgM bands was found to be the optimal criterion for a positive test result, and in patients with illness of less than 7 days' duration, this was significantly more sensitive than the criterion of any 2 of the 3 specific bands defined by the Centers for Disease Control and Prevention/Association of State and Territorial Public Health Laboratory Directors Lyme Disease Workgroup (P<.05). Specificity of the criterion of any 2 bands was 100% for 1 group of controls but only 96% for the more clinically relevant control group; this small difference had a large impact on the positive predictive value in populations at low risk for Lyme disease.
Conclusions
Using a commercially available immunoblot test kit, the presence of any 2 IgM bands is proposed as a positive result. The predictive value of a positive IgM immunoblot result, however, is poor in patients with minimal clinical evidence for Lyme disease.
Arch Intern Med. 1996;156:2105-2109
Author Affiliations
From St Vincent's Hospital and Medical Center, New York, NY (Dr Sivak); Divisions of General Medicine (Dr Sivak) and Infectious Diseases (Drs Nowakowski, Nadelman, and Wormser), Department of Medicine, and Department of Pathology (Dr Aguero-Rosenfeld), New York Medical College, Valhalla; and Lyme Disease Diagnostic Center, Westchester County Medical Center, Valhalla (Drs Nowakowski, Nadelman, and Wormser).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Diagnosis of Lyme Borreliosis
Aguero-Rosenfeld et al.
Clin. Microbiol. Rev. 2005;18:484-509.
ABSTRACT
| FULL TEXT
C-Terminal Region of Outer Surface Protein C Binds Borreliacidal Antibodies in Sera from Patients with Lyme Disease
Jobe et al.
CVI 2003;10:573-578.
ABSTRACT
| FULL TEXT
Ability of the Borreliacidal Antibody Test To Confirm Lyme Disease in Clinical Practice
Callister et al.
CVI 2002;9:908-912.
ABSTRACT
| FULL TEXT
Recombinant Assay for Serodiagnosis of Lyme Disease Regardless of OspA Vaccination Status
Gomes-Solecki et al.
J. Clin. Microbiol. 2002;40:193-197.
ABSTRACT
| FULL TEXT
Effects of OspA Vaccination on Lyme Disease Serologic Testing
Aguero-Rosenfeld et al.
J. Clin. Microbiol. 1999;37:3718-3721.
ABSTRACT
| FULL TEXT
Lyme Disease Serology: Problems and Opportunities
Wormser et al.
JAMA 1999;282:79-80.
FULL TEXT
Comparison of Immunodot and Western Blot Assays for Diagnosing Lyme Borreliosis
Fawcett et al.
CVI 1998;5:503-506.
ABSTRACT
| FULL TEXT
Immunoglobulin M Capture Assay for Serologic Confirmation of Early Lyme Disease: Analysis of Immune Complexes with Biotinylated Borrelia burgdorferi Sonicate Enhanced with Flagellin Peptide Epitope
Brunner et al.
J. Clin. Microbiol. 1998;36:1074-1080.
ABSTRACT
| FULL TEXT
Analysis of ROC Curves Applied to the Diagnosis of Lyme Disease
Solomon
Arch Intern Med 1997;157:1266-1266.
ABSTRACT
|
