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NHS Primary Care Question Answering Service - What is a recognised means of diagnosing Lyme Disease?

Author(s)TRIP
AbstractA search of the TRIP Database located a number of guidelines and eTextbook articles that discuss diagnosis. A recent American guideline reports on the diagnosis of Lyme Disease [1]. It has a section “Diagnostic Concerns” which discusses various aspects of diagnosis. This is summarised in the key recommendations as:
“Since there is currently no definitive test for Lyme disease, laboratory results should not be used to exclude an individual from treatment.
Lyme disease is a clinical diagnosis and tests should be used to support rather than supersede the physician’s judgment.”
However, the guideline discusses many other aspects and we recommend you read these at http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=4836
eMedicine, an American online textbook, has a chapter on Lyme Disease [2]. This also has an extensive discussion of diagnosis which, due to length, cannot be reproduced here. Therefore, we recommend you read the relevant section at http://www.emedicine.com/med/topic1346.htm
Finally, GP Notebook, has a section on the diagnosis of Lyme Disease [3] which states:
“It is worth assessing the risks by considering the pathogenesis and clinical features of Lyme disease - negative serology does not exclude the diagnosis.
In more than half of people affected by this condition there is no history of tick bite.
The diagnosis is confirmed by serologic testing by indirect immunofluorescence or enzyme-linked immunosorbent assays. IgM peaks at 3-6 weeks; IgG appears more slowly and may take months or years.
The diagnosis is unreliable early. Check Treponema pallidum haemoglutination is negative before accepting a positive result.
The antibody is not affected by treatment. ESR is elevated.
Use of the polymerase chain reaction to detect the presence of Borrelia burgdorferi DNA in specimens from patients may become the most reliable means of determining who has been infected with this organism and when infection has been eliminated.”
References
1)Evidence-based guidelines for the management of Lyme disease. Expert Rev Antiinfect Ther 2004;2(1 Suppl):S1-13. (http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=4836)
2)eMedicine. Lyme Disease. 2005 (http://www.emedicine.com/med/topic1346.htm)
3)GP Notebook. Lyme Disease. (http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1610219503&linkID=21419&cook=yes)

The NLH Question Answering Service aims to answer questions quickly, it is not a systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. The NLH and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document
Date of publishing09/07/2005
Date of last review by us02/14/2006
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