Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis

Gary P. Wormser, Harold W. Horowitz, John Nowakowski, Donna McKenna, J. Stephen Dumler, Shobha Varde, Ira Schwartz, Carol Carbonaro, Maria Aguero-Rosenfeld

Research output: Contribution to journalArticle

Abstract

In 10 consecutive patients with an acute febrile illness, human granulocytic ehrlichiosis was confirmed with specific polymerase chain reaction studies, serologic conversion, or both. Although no patients had the clinical features most suggestive of early Lyme disease (eg, erythema migrans or cranial nerve palsy), tests for antibody to Borrelia burgdorferi produced a reaction in most patients. In 6 of 7 patients (86%) with evaluable results, enzyme-linked immunosorbent assay yielded positive or equivocal findings, and an immunoblot technique yielded positive findings in 60% to 90% of patients, depending on the criteria used for interpretation. Inasmuch as approximately 25% of nymphal Ixodes scapularis ticks in Westchester County, New York, are infected with B burgdorferi, the probability that at least 9 of these patients were coinfected with B burgdorferi and human granulocytic ehrlichiosis by the same tick bite is estimated to be .00003. These observations suggest that serodiagnosis is insufficient to establish the presence of coinfection with B burgdorferi.

Original languageEnglish (US)
Pages (from-to)142-147
Number of pages6
JournalAmerican Journal of Clinical Pathology
Volume107
Issue number2
StatePublished - Feb 1997

Fingerprint

Ehrlichiosis
Lyme Disease
Serology
Tick Bites
Cranial Nerve Diseases
Ixodes
Borrelia burgdorferi
Serologic Tests
Ticks
Erythema
Coinfection
Fever
Enzyme-Linked Immunosorbent Assay
Polymerase Chain Reaction
Antibodies

Keywords

  • Borrelia burgdorferi
  • Human granulocytic ehrlichiosis
  • Lyme disease

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Wormser, G. P., Horowitz, H. W., Nowakowski, J., McKenna, D., Dumler, J. S., Varde, S., ... Aguero-Rosenfeld, M. (1997). Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. American Journal of Clinical Pathology, 107(2), 142-147.

Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. / Wormser, Gary P.; Horowitz, Harold W.; Nowakowski, John; McKenna, Donna; Dumler, J. Stephen; Varde, Shobha; Schwartz, Ira; Carbonaro, Carol; Aguero-Rosenfeld, Maria.

In: American Journal of Clinical Pathology, Vol. 107, No. 2, 02.1997, p. 142-147.

Research output: Contribution to journalArticle

Wormser, GP, Horowitz, HW, Nowakowski, J, McKenna, D, Dumler, JS, Varde, S, Schwartz, I, Carbonaro, C & Aguero-Rosenfeld, M 1997, 'Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis', American Journal of Clinical Pathology, vol. 107, no. 2, pp. 142-147.
Wormser GP, Horowitz HW, Nowakowski J, McKenna D, Dumler JS, Varde S et al. Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. American Journal of Clinical Pathology. 1997 Feb;107(2):142-147.
Wormser, Gary P. ; Horowitz, Harold W. ; Nowakowski, John ; McKenna, Donna ; Dumler, J. Stephen ; Varde, Shobha ; Schwartz, Ira ; Carbonaro, Carol ; Aguero-Rosenfeld, Maria. / Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. In: American Journal of Clinical Pathology. 1997 ; Vol. 107, No. 2. pp. 142-147.
@article{1573abcde1a2457d8ff04db94b3afd0a,
title = "Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis",
abstract = "In 10 consecutive patients with an acute febrile illness, human granulocytic ehrlichiosis was confirmed with specific polymerase chain reaction studies, serologic conversion, or both. Although no patients had the clinical features most suggestive of early Lyme disease (eg, erythema migrans or cranial nerve palsy), tests for antibody to Borrelia burgdorferi produced a reaction in most patients. In 6 of 7 patients (86{\%}) with evaluable results, enzyme-linked immunosorbent assay yielded positive or equivocal findings, and an immunoblot technique yielded positive findings in 60{\%} to 90{\%} of patients, depending on the criteria used for interpretation. Inasmuch as approximately 25{\%} of nymphal Ixodes scapularis ticks in Westchester County, New York, are infected with B burgdorferi, the probability that at least 9 of these patients were coinfected with B burgdorferi and human granulocytic ehrlichiosis by the same tick bite is estimated to be .00003. These observations suggest that serodiagnosis is insufficient to establish the presence of coinfection with B burgdorferi.",
keywords = "Borrelia burgdorferi, Human granulocytic ehrlichiosis, Lyme disease",
author = "Wormser, {Gary P.} and Horowitz, {Harold W.} and John Nowakowski and Donna McKenna and Dumler, {J. Stephen} and Shobha Varde and Ira Schwartz and Carol Carbonaro and Maria Aguero-Rosenfeld",
year = "1997",
month = "2",
language = "English (US)",
volume = "107",
pages = "142--147",
journal = "American Journal of Clinical Pathology",
issn = "0002-9173",
publisher = "American Society of Clinical Pathologists",
number = "2",

}

TY - JOUR

T1 - Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis

AU - Wormser, Gary P.

AU - Horowitz, Harold W.

AU - Nowakowski, John

AU - McKenna, Donna

AU - Dumler, J. Stephen

AU - Varde, Shobha

AU - Schwartz, Ira

AU - Carbonaro, Carol

AU - Aguero-Rosenfeld, Maria

PY - 1997/2

Y1 - 1997/2

N2 - In 10 consecutive patients with an acute febrile illness, human granulocytic ehrlichiosis was confirmed with specific polymerase chain reaction studies, serologic conversion, or both. Although no patients had the clinical features most suggestive of early Lyme disease (eg, erythema migrans or cranial nerve palsy), tests for antibody to Borrelia burgdorferi produced a reaction in most patients. In 6 of 7 patients (86%) with evaluable results, enzyme-linked immunosorbent assay yielded positive or equivocal findings, and an immunoblot technique yielded positive findings in 60% to 90% of patients, depending on the criteria used for interpretation. Inasmuch as approximately 25% of nymphal Ixodes scapularis ticks in Westchester County, New York, are infected with B burgdorferi, the probability that at least 9 of these patients were coinfected with B burgdorferi and human granulocytic ehrlichiosis by the same tick bite is estimated to be .00003. These observations suggest that serodiagnosis is insufficient to establish the presence of coinfection with B burgdorferi.

AB - In 10 consecutive patients with an acute febrile illness, human granulocytic ehrlichiosis was confirmed with specific polymerase chain reaction studies, serologic conversion, or both. Although no patients had the clinical features most suggestive of early Lyme disease (eg, erythema migrans or cranial nerve palsy), tests for antibody to Borrelia burgdorferi produced a reaction in most patients. In 6 of 7 patients (86%) with evaluable results, enzyme-linked immunosorbent assay yielded positive or equivocal findings, and an immunoblot technique yielded positive findings in 60% to 90% of patients, depending on the criteria used for interpretation. Inasmuch as approximately 25% of nymphal Ixodes scapularis ticks in Westchester County, New York, are infected with B burgdorferi, the probability that at least 9 of these patients were coinfected with B burgdorferi and human granulocytic ehrlichiosis by the same tick bite is estimated to be .00003. These observations suggest that serodiagnosis is insufficient to establish the presence of coinfection with B burgdorferi.

KW - Borrelia burgdorferi

KW - Human granulocytic ehrlichiosis

KW - Lyme disease

UR - http://www.scopus.com/inward/record.url?scp=0031019220&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031019220&partnerID=8YFLogxK

M3 - Article

VL - 107

SP - 142

EP - 147

JO - American Journal of Clinical Pathology

JF - American Journal of Clinical Pathology

SN - 0002-9173

IS - 2

ER -