Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early lyme disease

被引:29
作者
Sivak, SL
AgueroRosenfeld, ME
Nowakowski, J
Nadelman, RB
Wormser, GP
机构
[1] WESTCHESTER CTY MED CTR,DIV INFECT DIS,LYME DIS DIAGNOST CTR,VALHALLA,NY 10595
[2] ST VINCENT HOSP & MED CTR,NEW YORK,NY
[3] NEW YORK MED COLL,DIV GEN MED,VALHALLA,NY 10595
[4] NEW YORK MED COLL,DIV INFECT DIS,VALHALLA,NY 10595
[5] NEW YORK MED COLL,DEPT MED,VALHALLA,NY 10595
[6] NEW YORK MED COLL,DEPT PATHOL,VALHALLA,NY 10595
关键词
D O I
10.1001/archinte.156.18.2105
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 leg, 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.
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页码:2105 / 2109
页数:5
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