ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2020
Diagnostic parameters of modified two-tier testing in European patients with early Lyme disease.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 21 citations in OpenAlex.
- 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
- A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases.Scientific reports · 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
- Twenty Years of Lyme Borreliosis in the Netherlands: Temporal Trends in Seroprevalence and Risk Factors.Microorganisms · 2024Article
- Pathogenicity and virulence ofVirulence · 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
- ClassicalLife (Basel, Switzerland) · 2023Article
- Linear Peptide Epitopes Derived from ErpP, p35, and FlaB in the Serodiagnosis of Lyme Disease.Pathogens (Basel, Switzerland) · 2022Article
- Multicenter Clinical Evaluation of Modified Two-Tiered Testing Algorithms for Lyme Disease Using Zeus Scientific Commercial Assays.Journal of clinical microbiology · 2022Article
- The Performance of Nine Commercial Serological Screening Assays for the Diagnosis of Lyme Borreliosis: a Multicenter Modified Two-Gate Design Study.Microbiology spectrum · 2022Article
- Diagnostic performance of the ZEUS Borrelia VlsE1/pepC10 assay in European LB patients: a case-control study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Article
- Diagnostic Performance of the Novel BioPlex Lyme Serological Assays in European Patients with Lyme Disease.Journal of clinical microbiology · 2021Article
- Optimizing use of multi-antibody assays for Lyme disease diagnosis: A bioinformatic approach.PloS one · 2021Article
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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
Modified two-tier testing (MTTT) for Lyme borreliosis (i.e. confirmation with an EIA instead of an immunoblot) has been shown to have improved sensitivity compared with standard two-tier testing (STTT) in samples from American patients, without losing specificity. The current study assesses the sensitivity and specificity of various algorithms of MTTT in European patients with erythema migrans (EM) as a model disease for early Lyme borreliosis, and in appropriate controls. Four different immunoassays were used in the first tier, followed by either an immunoblot or the C6-EIA, or were used as standalone single-tier test. These tests were performed on consecutively collected sera of 228 Dutch patients with physician-diagnosed EM in the setting of general practice, 231 controls from the general population, and 50 controls with potentially cross-reactive antibodies. All the variants of MTTT that were studied had significantly higher sensitivity compared with their equivalent STTT, while retaining comparable specificity. Within the MTTT algorithms, classifying equivocal results as positive yielded better diagnostic parameters than classifying equivocal results as negative. The best diagnostic parameters were found using the Enzygnost-2 assay in the first tier, followed by a C6-ELISA in the second tier (sensitivity 77.6%, 95% CI 71.7-82.9; specificity 96.1%, 95% CI 92.7-98.2). This algorithm performed significantly better than the equivalent STTT algorithm in terms of sensitivity (p < 0.001), while maintaining comparable specificity (population controls p = 0.617). Our results show that MTTT can be a useful tool for the serodiagnosis of European patients with early Lyme borreliosis.
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