To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis

被引：99

作者：

Dessau, R. B. ^{[1
]}

van Dam, A. P. ^{[2
,3
]}

Fingerle, V. ^{[4
]}

Gray, J. ^{[5
]}

Hovius, J. W. ^{[6
]}

Hunfeld, K-P ^{[7
,8
]}

Jaulhac, B. ^{[9
]}

Kahl, O. ^{[10
]}

Kristoferitsch, W. ^{[11
]}

Lindgren, P-E ^{[12
]}

Markowicz, M. ^{[13
]}

Mavin, S. ^{[14
]}

Ornstein, K. ^{[15
]}

Rupprecht, T. ^{[16
]}

Stanek, G. ^{[13
]}

Strle, F. ^{[17
]}

机构：

[1] Slagelse Hosp, Dept Clin Microbiol, Ingemannsvej 46, DK-4200 Slagelse, Region Sjaellan, Denmark

[2] OLVG Gen Hosp, Amsterdam, Netherlands

[3] Publ Hlth Lab, Amsterdam, Netherlands

[4] Natl Reference Ctr Borrelia, Oberschleissheim, Germany

[5] Univ Coll Dublin, UCD Sch Biol & Environm Sci, Dublin, Ireland

[6] Univ Amsterdam, Acad Med Ctr, Ctr Expt & Mol Med, Amsterdam, Netherlands

[7] Goethe Univ, Med Fac, Acad Teaching Hosp, Northwest Med Ctr, Frankfurt, Germany

[8] INSTAND eV, Dusseldorf, Germany

[9] Hop Univ Strasbourg, Natl Reference Ctr Borrelia, Strasbourg, France

[10] Tick Radar GmbH, Berlin, Germany

[11] Karl Landsteiner Inst Neuroimmunol & Neurodegener, Vienna, Austria

[12] Linkoping Univ, Linkoping, Sweden

[13] Med Univ Vienna, Inst Hyg & Appl Immunol, Vienna, Austria

[14] Raigmore Hosp, Natl Lyme Borreliosis Testing Lab, Inverness, Scotland

[15] Skanevard Kryh, Div Med, Lund, Region Skane, Sweden

[16] HELIOS Klinikum Munchen West, Dept Neurol, Munich, Germany

[17] Univ Med Ctr Ljubljana, Dept Infect Dis, Ljubljana, Slovenia

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2018年 / 24卷 / 02期

关键词：

Antibody testing; Borrelia burgdorferi; Laboratory diagnosis; Lyme borreliosis; Polymerase chain reaction; Serology; BURGDORFERI-SENSU-LATO; STANDARDIZED WESTERN BLOTS; CEREBROSPINAL-FLUID; ERYTHEMA MIGRANS; IMMUNOGLOBULIN-G; INTERPRETATION CRITERIA; ANTIBODY-RESPONSES; CHEMOKINE CXCL13; TICK BITES; SERUM IGG;

D O I：

10.1016/j.cmi.2017.08.025

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: Lyme borreliosis (LB) is a tick-borne infection caused by Borrelia burgdorferi sensu lato. The most frequent clinical manifestations are erythema migrans and Lyme neuroborreliosis. Currently, a large volume of diagnostic testing for LB is reported, whereas the incidence of clinically relevant disease manifestations is low. This indicates overuse of diagnostic testing for LB with implications for patient care and cost-effective health management. Aim: The recommendations provided in this review are intended to support both the clinical diagnosis and initiatives for a more rational use of laboratory testing in patients with clinically suspected LB. Sources: This is a narrative review combining various aspects of the clinical and laboratory diagnosis with an educational purpose. The literature search was based on existing systematic reviews, national and international guidelines and supplemented with specific citations. Implications: The main recommendations according to current European case definitions for LB are as follows. Typical erythema migrans should be diagnosed clinically and does not require laboratory testing. The diagnosis of Lyme neuroborreliosis requires laboratory investigation of the spinal fluid including intrathecal antibody production, and the remaining disease manifestations require testing for serum antibodies to B. burgdorferi. Testing individuals with non-specific subjective symptoms is not recommended, because of a low positive predictive value. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

引用

页码：118 / 124

页数：7

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