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Laboratory Evaluation in the Diagnosis of Lyme Disease
- Peter Tugwell, MD;
- David T. Dennis, MD;
- Arthur Weinstein, MD;
- George Wells, PhD;
- Beverley Shea, BScN;
- Graham Nichol, MD;
- Robert Hayward, MD;
- Robert Lightfoot, MD;
- Philip Baker, BSc; and
- Allen C. Steere, MD
- From the University of Ottawa, Ottawa, Ontario, Canada; Centers for Disease Control and Prevention, Fort Collins, Colorado; New York Medical College, Valhalla, New York; New England Medical Center, Boston, Massachusetts; and McMaster University Medical Centre, Hamilton, Ontario, Canada. Acknowledgment: The authors thank Diane Gagnon for support in preparing this manuscript. Requests for Reprints: Peter Tugwell, MD, Department of Medicine, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. Current Author Addresses: Dr. Tugwell: Department of Medicine, University of Ottawa and Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Abstract
Purpose: To provide a quantitative and qualitative evaluation of the predictive value of the laboratory diagnosis of Lyme disease and to use the resultant data to formulate guidelines for clinical diagnosis.
Data Sources: A MEDLINE search of English-language articles or articles with English-language abstracts published from 1982 to 1996.
Data Extraction: Sensitivity, specificity, and likelihood ratios were calculated, and a random-effects model was used to combine the proportions from the eligible studies. Prespecified criteria were used to determine which studies were eligible for analysis.
Data Synthesis: Laboratory testing in general is not clinically useful if the pretest probability of Lyme disease is less than 0.20 or greater than 0.80. When the pretest probability is 0.20 to 0.80, sequential testing with enzyme-linked immunosorbent assay and Western blot is the most accurate method for ruling in or ruling out the possibility of Lyme disease.
Conclusions: Laboratory testing is recommended only in patients whose pretest probability of Lyme disease is 0.20 to 0.80. If the pretest probability is less than 0.20, testing will result in more false-positive results than true-positive results; a negative test result in this situation effectively rules out the disease.
- Copyright ©2004 by the American College of Physicians
