Two-year evaluation of Borrelia burgdorferi culture and supplemental tests for definitive diagnosis of lyme disease

Peggy Coulter, Clara Lema, Diane Flayhart, Amy S. Linhardt, John Aucott, Paul G Auwaerter, J. Stephen Dumler

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)5080-5084
Number of pages5
JournalJournal of Clinical Microbiology
Volume43
Issue number10
DOIs
StatePublished - Oct 2005

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Borrelia burgdorferi
Lyme Disease
Polymerase Chain Reaction
Skin
Serologic Tests
Biopsy
Serology
Skin Tests

ASJC Scopus subject areas

  • Microbiology (medical)
  • Microbiology

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Two-year evaluation of Borrelia burgdorferi culture and supplemental tests for definitive diagnosis of lyme disease. / Coulter, Peggy; Lema, Clara; Flayhart, Diane; Linhardt, Amy S.; Aucott, John; Auwaerter, Paul G; Dumler, J. Stephen.

In: Journal of Clinical Microbiology, Vol. 43, No. 10, 10.2005, p. 5080-5084.

Research output: Contribution to journalArticle

Coulter, Peggy ; Lema, Clara ; Flayhart, Diane ; Linhardt, Amy S. ; Aucott, John ; Auwaerter, Paul G ; Dumler, J. Stephen. / Two-year evaluation of Borrelia burgdorferi culture and supplemental tests for definitive diagnosis of lyme disease. In: Journal of Clinical Microbiology. 2005 ; Vol. 43, No. 10. pp. 5080-5084.
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