ArticleJournal of clinical microbiology2018
Evaluation of Modified Two-Tiered Testing Algorithms for Lyme Disease Laboratory Diagnosis Using Well-Characterized Serum Samples.
Article in Journal of clinical microbiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.
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Who cites it
46 citing papers in PubMed, 1 synthesis or guideline pooled it, 94 citations in OpenAlex.
- Global seroprevalence and sociodemographic characteristics ofBMJ global health · 2022Pooled it
- News Fluorescence-Based Polarization Immunoassays as a Frontline Test for the Rapid Detection of Acute and Late Phase Lyme-Borreliosis Disease.Molecules (Basel, Switzerland) · 2026Article
- Silent Spread ofHealthcare (Basel, Switzerland) · 2025Article
- A novel single-tier serologic test to diagnose all stages of Lyme disease.Journal of clinical microbiology · 2025Article
- Update on North American tick-borne diseases and how to diagnose them.Journal of clinical microbiology · 2025Review
- Comparison of the Serodiagnostic Accuracy Tests for Lyme Disease in Adults and Children: A Network Meta-Analysis.Pathogens (Basel, Switzerland) · 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
- Real-world Lyme disease testing results using modified vs standard two-tier test protocols.PloS one · 2025Article
- Evaluation of different standard and modified two-tier testing strategies for the laboratory diagnosis of lyme borreliosis in a European setting.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2024Article
- Performance of two modified two-tier algorithms for the serologic diagnosis of Lyme disease.Journal of clinical microbiology · 2024Article
- Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA.Emerging infectious diseases · 2024Article
- Pediatric Lyme Disease in Northern Italy: An 18-Year Single-Center Case Series.Microorganisms · 2024Article
- Diagnostic Precision in Lyme borreliosis: Assessing VlsE and C6 Antigens in a Pediatric Cohort.Diagnostics (Basel, Switzerland) · 2023Article
- Immunoblot Criteria for Diagnosis of Lyme Disease: A Comparison of CDC Criteria to Alternative Interpretive Approaches.Pathogens (Basel, Switzerland) · 2023Article
- Direct Detection of Lyme Borrelia: Recent Advancement and Use of Aptamer Technology.Biomedicines · 2023Review
- Cholesterol Contributes to Risk, Severity, and Machine Learning-Driven Diagnosis of Lyme Disease.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- ClassicalLife (Basel, Switzerland) · 2023Article
- Common Neurologic Features of Lyme Disease That May Present to a Rheumatologist.Pathogens (Basel, Switzerland) · 2023Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Standard two-tiered testing (STTT) is the recommended algorithm for laboratory diagnosis of Lyme disease (LD). Several limitations are associated with STTT that include low sensitivity in the early stages of disease, as well as technical complexity and subjectivity associated with second-tier immunoblotting; therefore, modified two-tiered testing (MTTT) algorithms that utilize two sequential first-tier tests and eliminate immunoblotting have been evaluated. Recently, a novel MTTT that uses a VlsE chemiluminescence immunoassay followed by a C6 enzyme immunoassay has been proposed. The purpose of this study was to evaluate the performance of the VlsE/C6 MTTT using well-characterized serum samples. Serum samples from the CDC Lyme Serum Repository were tested using three MTTTs, VlsE/C6, whole-cell sonicate (WCS)/C6, and WCS/VlsE, and three STTTs (immunoblotting preceded by three different first-tier assays: VlsE, C6, and WCS). Significant differences were not observed between the results of the MTTTs assessed; however, the VlsE/C6 MTTT resulted in the highest specificity (100%) when other diseases were tested and the lowest sensitivity (75%) for LD samples. Significant differences were present between the results for various MTTTs and STTTs evaluated. Specifically, all MTTTs resulted in higher sensitivities than the STTTs for all LD groups combined and were significantly more accurate (i.e., higher proportion of correct classifications) for this group, with the exception of the WCS/ViraStripe STTT. Additionally, when other diseases were tested, only the results of the VlsE/C6 MTTT differed significantly from those of the WCS/ViraStripe STTT, with the VlsE/C6 MTTT resulting in a 6.2% higher accuracy. Overall, the VlsE/C6 MTTT offers an additional laboratory testing algorithm for LD with equivalent or enhanced performance compared to that of the other MTTTs and STTTs evaluated in this study.
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