Quality of Lyme disease tests

Article Abstract:

Lyme disease (LD) is an infectious disease transmitted to humans by ticks. Symptoms can include a distinctive rash, arthritis, fever, fatigue and headache; heart and nerve damage may also result. Physicians have discovered that symptoms vary from person to person, and the characteristic rash does not appear in all patients. Given the potential for serious complications from LD, prompt diagnosis is critical. Consequently, a demand arose for a blood test to diagnose exposure and serum antibody testing was developed. Unfortunately many laboratories have worked independently to develop test kits and not all the tests are equivalent. This means that the same blood sample might be evaluated as positive for LD by one facility and negative by another. While techniques for blood testing have improved somewhat, diagnostic standards are still uncoordinated throughout the country. A committee with members from the Centers for Disease Control has been formed to establish guidelines for evaluating LD test kits and laboratory procedures. But the antibody testing available so far cannot identify cases of LD within the first few weeks of infection. Another type of test is needed that will detect the antigen (infectious agent), even before the patient's immune system has manufactured antibodies. In conclusion, physicians should rely primarily on clinical findings and only secondarily on blood test results to diagnose LD at this time. Quality control measures must be taken immediately so that blood testing will soon be a reliable means of diagnosis.

Standards, Quality management, Diagnostic services, editorial

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Antibody testing in Lyme disease: a comparison of results in four laboratories

Article Abstract:

Tests for Lyme disease performed by different laboratories in New Jersey yielded a wide variation in results. Lyme disease is an infectious disease spread by ticks which can involve a skin rash, arthritis, muscle pain, malaise, and neurological and heart problems. Blood samples from 132 outdoor workers were sent to as many as four laboratories, including a state department of health laboratory, a large commercial laboratory, and two research laboratories. Agreement among the four laboratories was relatively poor. Error within the commercial laboratory was almost as great as disagreement among the different facilities. It was concluded that testing procedures for Lyme disease should be standardized in order to improve agreement and make test results more comparable between laboratories. Test accuracy and reliability must also be measured. Physicians who order Lyme disease tests for their patients need to be aware of the possibility that the results may be inaccurate, and subsequent treatment decisions may be based on an incorrect diagnosis.

Case studies, New Jersey, Diagnostic errors, Statistics

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Pitfalls in the diagnosis and treatment of Lyme disease in children

Article Abstract:

Lyme disease appears to be over-diagnosed and over-treated. Lyme disease is an infection caused by a spiral bacterium transmitted by a deer tick. Symptoms of Lyme disease include stiff neck, headache, fatigue and joint pain. A skin rash called erythema migrans may appear after two to 30 days from the site of the tick bite. Of 146 pediatric patients evaluated in Connecticut, 58 were over-diagnosed. Eighteen were over-treated for Lyme disease. Fifty-six patients (38%) were diagnosed as having Lyme disease but did not. Twelve patients (8%) had Lyme disease but were not diagnosed. Seventy-five patients (51%) were diagnosed appropriately, but 19 (25%) of these did not receive proper treatment.

Children, Child health

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