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Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.

dc.contributor.author Auwaerter, PG
dc.contributor.author Boggan, Joel
dc.contributor.author Branda, JA
dc.contributor.author Chudgar, Saumil
dc.contributor.author Fowler, Vance Garrison Jr
dc.contributor.author Lantos, Paul
dc.contributor.author Nigrovic, LE
dc.contributor.author Ruffin, Felicia
dc.contributor.author Wilson, Elizabeth A
dc.coverage.spatial United States
dc.date.accessioned 2017-04-01T13:28:38Z
dc.date.available 2017-04-01T13:28:38Z
dc.date.issued 2015-11-01
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26195017
dc.identifier civ584
dc.identifier.uri http://hdl.handle.net/10161/13905
dc.description.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.
dc.language eng
dc.relation.ispartof Clin Infect Dis
dc.relation.isversionof 10.1093/cid/civ584
dc.subject Borrelia burgdorferi
dc.subject Lyme
dc.subject diagnostic testing
dc.subject positive predictive value
dc.subject serology
dc.subject Adolescent
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Child
dc.subject Female
dc.subject Humans
dc.subject Incidence
dc.subject Lyme Disease
dc.subject Male
dc.subject Middle Aged
dc.subject Predictive Value of Tests
dc.subject Retrospective Studies
dc.subject Serologic Tests
dc.subject Young Adult
dc.title Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26195017
pubs.begin-page 1374
pubs.end-page 1380
pubs.issue 9
pubs.organisational-group Basic Science Departments
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine, Hospitalists
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Molecular Genetics and Microbiology
pubs.organisational-group Pediatrics
pubs.organisational-group Pediatrics, Infectious Diseases
pubs.organisational-group School of Medicine
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 61
dc.identifier.eissn 1537-6591


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