Western blots involve electrophoretic separation of B. There are two principal formats for immunoblotting: Western blots and line blots. īetween 19, immunoblotting was the sole serologic technique advised by the CDC to confirm positive or equivocal results from first-tier screening assays thus, immunoblotting has been a critical tool for LD serodiagnosis. The above reports are consistent with prior studies and illustrate the potential for harm associated with false-positive Lyme disease serology. observed that 42% of primary care providers practicing in a high-incidence state attributed chronic neurocognitive symptoms to Lyme disease based solely on positive IgM immunoblot test results, a departure from current guidelines. from a university referral clinic noted that physician misinterpretation of serologic tests, particularly IgM immunoblots, played a significant role in misdiagnosis. Most testing in the US, however, is performed in a setting of low pretest risk (<5%), with overall estimates ranging from 0.6% to 12.0%.

There is general agreement that patients with suspected extra-cutaneous Lyme disease, such as Lyme arthritis, carditis, and neuroborreliosis, should have serologic testing. Experienced physicians practicing in endemic communities can correctly diagnose erythema migrans in 72% to 92% of cases. Because serologic testing is insensitive for early Lyme disease, patients presenting with erythema migrans are best diagnosed on clinical grounds. The most common manifestation of early Lyme disease is erythema migrans, a skin lesion observed in 70% to 90% of cases. Due to limited standardization and high false-positive rates, the presently evaluated single-tier alternative immunoblot interpretive criteria appear inferior to CDC two-tiered criteria. These single-tier alternative interpretive criteria, applied to both IgG and IgM immunoblots, demonstrated significantly more false-positive or equivocal results in healthy controls than two-tiered CDC criteria (12.4% and 35.0% for Criteria A and B, respectively, versus 1.0% for CDC criteria). We compared the two most commonly used alternative immunoblot interpretive criteria (labeled A and B) to CDC criteria using data from multiple FDA-cleared IgG and IgM immunoblot test kits. Published reports concerning alternative immunoblot assays have used relatively small numbers of LD patients and controls to evaluate novel multi-antigen assays and interpretive criteria.

To increase overall sensitivity, single-tier alternative immunoblot assays have been proposed, often utilizing antigens from multiple Borrelia burgdorferi strains or genospecies in a single immunoblot including OspA and OspB in their antigen panel requiring fewer positive bands than permitted by current CDC criteria and reporting equivocal results. The current Centers for Disease Control and Prevention (CDC) interpretive criteria for serodiagnosis of Lyme disease (LD) involve a two-tiered approach, consisting of a first-tier EIA, IFA, or chemiluminescent assay, followed by confirmation of positive or equivocal results by either immunoblot or a second-tier EIA.

Western blot lyme test interpretation