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February 2, 2000

Long-term Outcomes and Management of Patients With Lyme Disease

Author Affiliations

Author Affiliation: Department of Medicine, Infectious Disease Division, State University of New York at Stony Brook School of Medicine.

JAMA. 2000;283(5):658-659. doi:10.1001/jama.283.5.658

Although Lyme disease was first recognized 25 years ago, serologic methods of diagnosis have not been well standardized, and there is significant variability between laboratories.13 In the absence of a criterion standard blood test, the diagnosis of Lyme disease is based on a characteristic clinical picture in the appropriate epidemiologic setting (often supported by serologic data). Because the initial IgM response to the causative spirochete Borrelia burgdorferi characteristically begins 1 to 2 weeks after infection, patients with early classic Lyme disease may be antibody-negative.4 Conversely, B burgdorferi expresses cross-reactive antigens and false-positive test results may occur, even using the recommended 2-step system of enzyme-linked immunosorbent assay (ELISA) screening (high sensitivity) followed by Western immunoblot (high specificity).5 To further complicate the issue, all the currently licensed ELISA tests contain the OspA surface antigen and, therefore, are invalid for individuals who have received the Lyme disease vaccine (composed of purified OspA).6

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