Interpretation criteria in Western blot diagnosis of Lyme borreliosis.
Mavin S, McDonagh S, Evans R, Milner RM, Chatterton JM, Ho-Yen DO
Br. J. Biomed. Sci. 2011 04; 68 (1): 5-10
This study reviews the Lyme borreliosis Western blot interpretation
process, including what bands are classed as specific, the number of
bands needed for a positive result, the role of band intensity and the
use of clinical information.
In 2008, 3688 patients (4223 serum samples) were tested by enzyme
immunoassay (EIA), with 832 patients tested by confirmatory in-house IgG
Western blot: 272 patients were Western blot-positive, 170 were weak
positive, 156 were equivocal and 234 were negative.
These results were assessed, and a review of interpretation criteria
from both the USA and Europe was carried out.
New interpretation criteria and a testing algorithm were developed. The
revised criteria changed the results in 109/3688 (3%) patients and
produced significantly more Western blot-positive and weak-positive
patients than with the current criteria (485 vs. 442, P < 0.0001).
In total, 76 patients who were negative/equivocal became positive, which
may have led to a change in their management. Conversely, 33 patients
who were weak-positive became equivocal but their management may not
have been affected.
The authors believe that the revised criteria have simplified blot
interpretation and improved the sensitivity and robustness of their
Western blot method. Using a protocol tailored to patients that
incorporates clinical characteristics means that the entire process will
be easier and will aid the management of patients.
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