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Guidelines for Laboratory Evaluation in the Diagnosis of Lyme Disease
- American College of Physicians. This paper, written by Peter Tugwell, MD; David T. Dennis, MD; Arthur Weinstein, MD; George Wells, PhD; Graham Nichol, MD; Beverley Shea, BScN; Robert Hayward, MD; Robert Lightfoot, MD; Philip Baker, BSc; and Allen C. Steere, MD, was developed for the Education Committee by the Clinical Efficacy Assessment Subcommittee: George E. Thibault, MD, Chair; John R. Feussner, MD, Co-Chair; Anne-Marie J. Audet, MD; Keith I. Marton, MD; Gottlieb C. Freisinger II, MD; Valerie Anne Palda, MD; Daniel L. Kent, MD; and Humberto J. Vidaillet Jr., MD. This paper was approved by the Board of Regents on 10 February 1996. Requests for Reprints: Customer Service Representative, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, “Laboratory Evaluation in the Diagnosis of Lyme Disease,” which is part II of this Guideline (see pages 1109-1123).
Lyme disease is the most common tick-borne disease in North America. From 1982 to 1994, more than 70 000 cases were reported in North America, most of them in the United States. It is important that clinicians diagnose Lyme disease correctly because efficacious therapy is available and delayed or inadequate treatment may lead to various morbid sequelae. On the other hand, inappropriate testing and therapy are costly and expose the patient to risk of the adverse effects of administered antibiotics.
Lyme disease is a complex, multisystem disease caused by the spirochete Borrelia burgdorferi. It affects persons of all ages and both sexes. Since the disease was recognized in Connecticut in 1975, areas in which it is endemic have been identified in several regions in the United States and Canada. In more restricted areas in some northeastern and upper midwestern states, Lyme disease has assumed the characteristics of an emerging epidemic. Its true incidence is almost certainly underestimated as a result of under-reporting.
In the classic presentation, patients develop a distinctive rash, erythema migrans, which is accompanied by such constitutional symptoms as fatigue, headache, mild stiff neck, musculoskeletal aches, and fever. Some weeks after initial exposure, untreated patients may develop symptoms and signs of disseminated disease, particularly neurologic, cardiac, or articular disease.
The Centers for Disease Control and Prevention (CDC) has developed a set of diagnostic criteria for Lyme disease for surveillance purposes [1.3]. These criteria are also applicable to the clinical diagnosis of Lyme disease.
Requests for laboratory testing for Lyme disease are rapidly increasing. In most tested patients, the clinical presentation consists of nonspecific …
