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July 20, 1994

Test for Lyme Disease in a Prepaid Health Plan

Author Affiliations

Imugen, Inc Norwood, Mass

JAMA. 1994;272(3):203. doi:10.1001/jama.1994.03520030043023

To the Editor.  —The article entitled "The Use of Serologic Tests for Lyme Disease in a Prepaid Health Plan in California" by Ms Ley and colleagues reports a total lack of correlation between patients' clinical condition and serologic test results. The authors' discussion includes what appears to have become an obligatory statement in every article on Lyme disease: "The currently available serologic tests have both relatively poor specificity and low sensitivity."Like most truisms, the statement is only partially true; the study's findings stem in large part from its use of an obsolete (albeit inexpensive) method of Lyme serology, ie, indirect immunofluorescent antibody (IFA), clearly and repeatedly documented to be the least sensitive and least specific of commonly used assays for antibody to Borrelia burgdorferi.2 Enzyme-linked immunosorbent assay (ELISA) is somewhat better than IFA, but the detection of B burgdorferi—specific IgM, IgG, and IgA by antibody capture has

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