STUDY 2 yr evaluation of tests for LYME

Discussion in 'Fibromyalgia Main Forum' started by victoria, Nov 15, 2005.

  1. victoria

    victoria New Member

    http://jcm.asm.org/cgi/content/abstract/43/10/5080


    Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease
    Peggy Coulter,1 Clara Lema,1 Diane Flayhart,1 Amy S. Linhardt,1 John N. Aucott,2 Paul G. Auwaerter,2 and J. Stephen Dumler1*

    Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland,1 Divisions of General Internal Medicine and Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland2

    Received 14 April 2005/ Returned for modification 22 April 2005/ Accepted 13 July 2005

    Lyme disease is usually diagnosed and treated based on clinical manifestations. However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies.

    Although cultivation of Borrelia burgdorferi is definitive, prior investigations have shown that no single test is optimal for Lyme disease diagnosis.

    We applied high-volume blood culture, skin biopsy culture, PCR, and serodiagnosis to a cohort of patients with suspected Lyme disease acquired in Maryland and southern Pennsylvania. The study was performed to confirm the relative utility of culture and to identify laboratory testing algorithms that will supplement clinical diagnosis.

    Overall, 30 of 86 patients (35%) were culture positive, whereas an additional 15 of 84 (18%) were seropositive only (51% total sero- and culture positive), and PCR on skin biopsy identified 4 additional patients who were neither culture nor seropositive.

    Among 49 laboratory test-positive patients, the highest sensitivity (100%) for diagnosis was obtained when culture, skin PCR, and serologic tests were used, although serologic testing with skin PCR was almost as sensitive (92%).

    Plasma PCR was infrequently positive and provided no additional diagnostic value. Although culture is definitive and has a relatively high sensitivity, the results required a mean of 3.5 weeks to recovery.

    The combination of acute-phase serology and skin PCR was 75% sensitive, offering a practical and relatively rapid alternative for confirming clinical impression. The full battery of tests could be useful for patients with confusing clinical signs or for providing strong laboratory support for clinical studies of Lyme disease.

    ---------------------------------


    * Corresponding author. Mailing address: Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 624, Baltimore, MD 21205.

    ---------------------------------
    Journal of Clinical Microbiology, October 2005, p. 5080-5084, Vol. 43, No. 10
    0095-1137/05/$08.00+0 doi:10.1128/JCM.43.10.5080-5084.2005
  2. victoria

    victoria New Member


    from another website, another side to the 2001 NIH study about treatment for chronic Lyme:
    --------
    "One of the many knowledgeable MDs trying to make the world a little better for their current patients and those out there still struggling to get properly diagnosed and treated.

    "Letters by Raphael Stricker, MD, as published on various Lyme lists, compiled by Melissa Kaplan.

    "Mary Duenwald (Science Times, May 20) tells us that "many of the people in Lyme disease country and their doctors have decided that the illness is not going to alarm them so much anymore". This sophistic statement is based on a recent study showing that early Lyme disease can be "cured" by a 10-day course of antibiotics in "more than 85%" of cases.

    "What Ms. Duenwald fails to tell us is that the study in question had a 45% dropout rate (81 of 180 patients failed to complete the trial). By any rational standard, this enormous dropout rate invalidates the study results, and the biggest mystery is how the trial ever got published.

    "Ms. Duenwald also mentions a 2001 Lyme disease trial that failed to show any benefit of "longterm" antibiotic therapy. The most ironic of many flaws in that study was the absence of any antibiotic regimen that could reasonably be considered "longterm" therapy (see www.ilads.org).

    "Unfortunately, based on these studies we are now seeing an orgy of self-congratulation among healthcare providers and insurance companies who no longer need to worry about, or pay for, adequate treatment of Lyme disease. Sadly, the patients who suffer the serious consequences of inadequately treated Lyme disease do not share this rosy outlook. They continue to suffer.

    "Before patients and doctors can "decide" not to be alarmed by a potentially devastating illness like Lyme disease, they better be d*** sure that their nonchalance is based on valid data.

    "As long as flawed Lyme disease studies are embraced by the medical establishment and touted by the press, we will continue to see a growing parade of patients with inadequately treated illness, pleading for help from a smug society that has turned a deaf ear on Lyme disease sufferers.

    Raphael Stricker, MD
    2001
    ---------------
    [This Message was Edited on 11/16/2005]