Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives, 2018, Lohr et al

Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives

Lohr, B., Fingerle, V., Norris, D. E., & Hunfeld, K.-P.

Abstract

This review is directed at physicians and laboratory personnel in private practice and clinics who treat and diagnose Lyme borreliosis (LB) in patients as part of their daily work.

A major objective of this paper is to bring together background information on Borrelia (B.) burgdorferi sensu lato (s.l.) and basic clinical knowledge of LB, which is one of the most frequently reported vector-borne diseases in the Northern Hemisphere.

The goal is to provide practical guidance for clinicians and for laboratory physicians, and scientists for a better understanding of current achievements and ongoing obstacles in the laboratory diagnosis of LB, an infectious disease that still remains one of the diagnostic chameleons of modern clinical medicine.

Moreover, in bringing together current scientific information from guidelines, reviews, and original papers, this review provides recommendations for selecting the appropriate tests in relation to the patient’s stage of disease to achieve effective, stage-related application of current direct and indirect laboratory methods for the detection of B. burgdorferi s.l.

Additionally, the review aims to discuss the current state of the art concerning the diagnostic potential and limitations of the assays and test methods currently in use to optimize LB patient management and provide insight into the possible future prospects of this rapidly changing area of laboratory medicine.

https://www.tandfonline.com/doi/abs/10.1080/10408363.2018.1450353

Full article Sci Hub: https://sci-hub.se/10.1080/10408363.2018.1450353

 

@CRG, this is a very good review.

Their conclusion is summed up nicely in the last paragraph:

"The limitations of the array of assays and test methods currently in use to diagnose LB strongly underline the need for more research to develop new clinical markers and better diagnostic tests to optimize the management of patients with LB."

Also, they mention the possibility of expanding the VlsE option from just the C6. This has actually recently happened in the US. So in the US there are now TWO CDC-approved diagnostics: The conventional 2 Tier, and now a Modified Two-Tier Test that blends two first tier tests, i.e. no Western Blot. Instead, you have a first tier ELISA or IFA, and then a second specific first tier that has to be the VlsE1/pepc10. This second test more or less replaced the C6.

 

The ability to detect lyme based bacteria is really terrible is what I got from this paper. Worse is the fact they can't even having detected it determine if the treatment even worked.