Literature reviewA Review of the Centers for Disease Control and Prevention’s Guidelines for the Clinical Laboratory Diagnosis of Lyme Disease
Introduction
There are misconceptions regarding the clinical laboratory diagnosis of Lyme disease, and clinicians may not be aware of the established guidelines for testing. Because symptoms can be nonspecific, it can be difficult for clinicians to determine when it is appropriate to order Lyme disease testing. Inappropriate testing contributes to increased health care costs. It may also lead to misdiagnosis and cause the patient to be exposed to unnecessary antimicrobial treatment. To use and interpret a laboratory test correctly, the clinician must understand its limitations, its diagnostic sensitivity and specificity, and what the test is specifically measuring or detecting. Patients may seek treatment from a doctor of chiropractic for the joint pain, myalgias, and neurologic symptoms that often accompany Lyme disease. The purpose of this review is to provide a brief summary of Lyme disease, present the current laboratory test recommendations by the Centers for Disease Control and Prevention (CDC), describe the diagnostic sensitivity and specificity of laboratory tests, and provide interpretation of test results.
Section snippets
Methods
The CDC's website was reviewed to determine their current recommendations for the clinical laboratory testing of Lyme disease.
Results
The current testing algorithm recommended by the CDC involves 2-tiered serologic testing that detects immunoglobulins in serum against B burgdorferi (Fig 1).1, 2
Historical Review
In 1975, the Connecticut State Health Department was contacted regarding cases of 12 children in the community of Old Lyme who had arthritis that was initially diagnosed as juvenile rheumatoid arthritis. Steere et al first acknowledged “Lyme arthritis” as a separate disease process and speculated that it was transmitted by an arthropod vector. They first described “Lyme arthritis” in published reports in 1977.3
Burgdorfer et al identified the etiologic agent in 1981.4 He and his research team
Conclusions
The CDC recommends the use of a 2-tiered serologic testing algorithm to evaluate patients with suspected Lyme disease. It is important for doctors of chiropractic to be aware of the proper diagnosis and laboratory test ordering protocols for Lyme disease, because patients may present for treatment of associated symptoms. This ensures that the patient receives an accurate and timely diagnosis and will allow for proper treatment to prevent the development of accompanying sequelae.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): C.M.M.
Design (planned the methods to generate the results): C.M.M.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): C.M.M.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): C.M.M.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): C.M.M.
Literature search (performed
References (42)
- et al.
The expanding Lyme Borrelia complex – clinical significance of genomic species?
Clin Microbiol Infect
(2011) - et al.
Clinical tests: sensitivity and specificity
Contin Educ Anaesth Crit Care Pain
(2008) Two-step laboratory testing process
(2015)Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease
MMWR Morb Mortal Wkly Rep
(1995)- et al.
Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities
Arthritis Rheum
(1977) - et al.
Lyme disease—a tick-borne spirochetosis?
Science
(1982) - et al.
Surveillance for Lyme disease—United States, 1992-2006
MMWR Morb Mortal Wkly Rep
(2008) Lyme disease—life cycle of blacklegged ticks
(2011)Lyme disease
N Engl J Med
(2001)- et al.
The Challenges of Lyme Disease: From Clinical Diagnosis to Testing Methodology
(2015)