Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.
Abstract
BACKGROUND: Lyme disease is diagnosed by 2-tiered serologic testing in patients with
a compatible clinical illness, but the significance of positive test results in low-prevalence
regions has not been investigated. METHODS: We reviewed the medical records of patients
who tested positive for Lyme disease with standardized 2-tiered serologic testing
between 2005 and 2010 at a single hospital system in a region with little endemic
Lyme disease. Based on clinical findings, we calculated the positive predictive value
of Lyme disease serology. Next, we reviewed the outcome of serologic testing in patients
with select clinical syndromes compatible with disseminated Lyme disease (arthritis,
cranial neuropathy, or meningitis). RESULTS: During the 6-year study period 4723 patients
were tested for Lyme disease, but only 76 (1.6%) had positive results by established
laboratory criteria. Among 70 seropositive patients whose medical records were available
for review, 12 (17%; 95% confidence interval, 9%-28%) were found to have Lyme disease
(6 with documented travel to endemic regions). During the same time period, 297 patients
with a clinical illness compatible with disseminated Lyme disease underwent 2-tiered
serologic testing. Six of them (2%; 95% confidence interval, 0.7%-4.3%) were seropositive,
3 with documented travel and 1 who had an alternative diagnosis that explained the
clinical findings. CONCLUSIONS: In this low-prevalence cohort, fewer than 20% of positive
Lyme disease tests are obtained from patients with clinically likely Lyme disease.
Positive Lyme disease test results may have little diagnostic value in this setting.
Type
Journal articleSubject
Borrelia burgdorferiLyme
diagnostic testing
positive predictive value
serology
Adolescent
Adult
Aged
Aged, 80 and over
Child
Female
Humans
Incidence
Lyme Disease
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Serologic Tests
Young Adult
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https://hdl.handle.net/10161/13905Published Version (Please cite this version)
10.1093/cid/civ584Publication Info
Lantos, PM; Branda, JA; Boggan, JC; Chudgar, SM; Wilson, EA; Ruffin, F; ... Nigrovic,
LE (2015). Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low
Disease Incidence. Clin Infect Dis, 61(9). pp. 1374-1380. 10.1093/cid/civ584. Retrieved from https://hdl.handle.net/10161/13905.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joel Boggan
Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety,
and medical education across the UME, GME, and CME environments. My current QI and
research projects include work on readmissions, inpatient ORYX and patient experience
measures, clinical documentation improvement, medication reconciliation, and appropriate
utilization of inpatient resources. Alongside this work, I serve as the lead mentor
for our Durham VA Chief Resident in Quality and Safety within the Depart
Saumil Mahendra Chudgar
Professor of Medicine
Medical Education Assessment of Clinical Skills Clinical Reasoning Simulation Curriculum
Development
Vance Garrison Fowler Jr.
Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial
ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health
Paul Michael Lantos
Professor of Medicine
I am interested in the spatial epidemiology of infectious diseases. My research utilizes
geographic information systems (GIS) and geostatistical analyses to understand the
spatial and spatiotemporal distribution of diseases, and their relationship with environmental
and demographic factors. I currently have active studies evaluating the spatial distribution
of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19),
cytomegalovirus, influenza, and Lyme disease. A
Felicia Ruffin
Research Program Leader, Tier 1
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