Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Fix and colleagues1 warn against the practice of overtreating unconfirmed LD and of prophylactic treatment for tick bite exposure. They recall the Centers for Disease Control and Prevention recommendation of a 2-step serologic diagnosis with enzyme immunoassay (EIA) and Western blot (WB) analysis in suspected cases. However, a diagnosis of Lyme borreliosis can hardly be a serologic one, because a confirmatory WB test also may be confusing. In the absence of erythema migrans (common in Europe), a positive WB result may be misleading if the diagnosis is not supported by stringent clinical criteria.
Piras MA, Porqueddu EM, Porcu P, Aceti A. Diagnosis, Treatment, and Prevention of Lyme Disease. JAMA. 1998;280(12):1049-1051. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-12-jbk0923