ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017
Evaluation of Modified 2-Tiered Serodiagnostic Testing Algorithms for Early Lyme Disease.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 1 of them a synthesis that pooled it.
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Who cites it
58 citing papers in PubMed, 1 synthesis or guideline pooled it, 121 citations in OpenAlex.
- Global seroprevalence and sociodemographic characteristics ofBMJ global health · 2022Pooled it
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- Lyme disease control 2.0: Advances and opportunities coming with Lyme disease vaccine VLA15.PLoS pathogens · 2025Article
- A novel single-tier serologic test to diagnose all stages of Lyme disease.Journal of clinical microbiology · 2025Article
- Class and isotype of VlsE-specific antibody differentiates Lyme disease stage.Journal of clinical microbiology · 2025Article
- Comparison of the Serodiagnostic Accuracy Tests for Lyme Disease in Adults and Children: A Network Meta-Analysis.Pathogens (Basel, Switzerland) · 2025Review
- Borrelia surface proteins: new horizons in Lyme disease diagnosis.Applied microbiology and biotechnology · 2025Review
- Diagnostic validation of novel Borrelia antigens discovered by whole-proteome microarray: Advancing early detection and test of cure for Lyme disease.Cell reports. Medicine · 2025Article
- Nano-Infrared Detection and Identification of Bacteria at the Single-Cell Level.Analytical chemistry · 2025Article
- External Validation of Raman Spectroscopy for Lyme Disease Diagnostics.Journal of biophotonics · 2025Article
- Histological staining of tick bite skin biopsies for spirochetes and Powassan virus RNA.Microbiology spectrum · 2025Article
- Pediatric Lyme Disease in Northern Italy: An 18-Year Single-Center Case Series.Microorganisms · 2024Article
- Surveillance for Lyme Disease After Implementation of a Revised Case Definition - United States, 2022.MMWR. Morbidity and mortality weekly report · 2024Article
- Microbes and Mental Illness: Past, Present, and Future.Healthcare (Basel, Switzerland) · 2023Review
- Diagnostic Precision in Lyme borreliosis: Assessing VlsE and C6 Antigens in a Pediatric Cohort.Diagnostics (Basel, Switzerland) · 2023Article
- Lyme borreliosis diagnosis: state of the art of improvements and innovations.BMC microbiology · 2023Review
- Improving Lyme disease testing with data driven test design in pediatrics.Journal of pathology informatics · 2023Article
- Evolution of theMicrobiology spectrum · 2022Article
- Multicenter Clinical Evaluation of Modified Two-Tiered Testing Algorithms for Lyme Disease Using Zeus Scientific Commercial Assays.Journal of clinical microbiology · 2022Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The conventional 2-tiered serologic testing protocol for Lyme disease (LD), an enzyme immunoassay (EIA) followed by immunoglobulin M and immunoglobulin G Western blots, performs well in late-stage LD but is insensitive in patients with erythema migrans (EM), the most common manifestation of the illness. Western blots are also complex, difficult to interpret, and relatively expensive. In an effort to improve test performance and simplify testing in early LD, we evaluated several modified 2-tiered testing (MTTT) protocols, which use 2 assays designed as first-tier tests sequentially, without the need of Western blots. Methods: The MTTT protocols included (1) a whole-cell sonicate (WCS) EIA followed by a C6 EIA; (2) a WCS EIA followed by a VlsE chemiluminescence immunoassay (CLIA); and (3) a variable major protein-like sequence, expressed (VlsE) CLIA followed by a C6 EIA. Sensitivity was determined using serum from 55 patients with erythema migrans; specificity was determined using serum from 50 patients with other illnesses and 1227 healthy subjects. Results: Sensitivity of the various MTTT protocols in patients with acute erythema migrans ranged from 36% (95% confidence interval [CI], 25%-50%) to 54% (95% CI, 42%-67%), compared with 25% (95% CI, 16%-38%) using the conventional protocol (P = .003-0.3). Among control subjects, the 3 MTTT protocols were similarly specific (99.3%-99.5%) compared with conventional 2-tiered testing (99.5% specificity; P = .6-1.0). Conclusions: Although there were minor differences in sensitivity and specificity among MTTT protocols, each provides comparable or greater sensitivity in acute EM, and similar specificity compared with conventional 2-tiered testing, obviating the need for Western blots.
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