Misdiagnosis of Late-Onset Lyme Arthritis by Inappropriate Use of Borrelia burgdorferi Immunoblot Testing with Synovial Fluid
Misdiagnosis of Late-Onset Lyme Arthritis by Inappropriate Use of Borrelia burgdorferi Immunoblot Testing with Synovial Fluid
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DOI：
10.1128/cvi.00383-12
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发表时间：
2012-11-01
影响因子：
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通讯作者：
Auwaerter, Paul G.
中科院分区：
文献类型：
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作者：
Barclay, Sam S.;Melia, Michael T.;Auwaerter, Paul G.
本研究的主要目的是确定是否与假定晚发性莱姆病关节炎的基础上滑液伯氏疏螺旋体IgM和IgG免疫印迹测试由商业实验室提供的患者满足莱姆病关节炎诊断的常规标准。次要目的包括评估既往相关抗生素治疗的持续时间和反应性。我们对2007年至2009年期间转诊至学术医疗中心传染病诊所的11例患者进行了回顾性分析，这些患者根据先前获得的滑液B诊断为莱姆病。burgdorferi免疫印迹试验。根据滑液B的解释，11例患者中有10例（91%）诊断为晚发性莱姆关节炎。burgdorferi免疫印迹试验为血清阴性，不满足晚发性莱姆病关节炎的诊断标准。尽管平均疗程为72天，但10名患者中没有一名对先前接受的抗生素有临床反应。莱姆关节炎的诊断不应基于滑液B。burgdorferi免疫印迹试验。这种未经验证的测试似乎对莱姆病的诊断没有用处，这项研究加强了长期以来使用B的建议。Burgdorferi免疫印迹检测仅对血清样本进行，而不对其他体液进行。对“阳性”滑液免疫印迹的错误解释可能导致不适当的抗生素疗程和其他关节疾病的诊断延误。
The primary objective of this study was to determine whether patients with putative late-onset Lyme arthritis based upon synovial fluid Borrelia burgdorferi IgM and IgG immunoblot testing offered by commercial laboratories satisfied conventional criteria for the diagnosis of Lyme arthritis. Secondary objectives included assessing the prior duration and responsiveness of associated antibiotic therapy. We conducted a retrospective analysis of 11 patients referred to an academic medical center infectious disease clinic during the years 2007 to 2009 with a diagnosis of Lyme disease based upon previously obtained synovial fluid B. burgdorferi immunoblot testing. Ten of the 11 (91%) patients with a diagnosis of late-onset Lyme arthritis based upon interpretation of synovial fluid B. burgdorferi immunoblot testing were seronegative and did not satisfy published criteria for the diagnosis of late-onset Lyme arthritis. None of the 10 patients had a clinical response to previously received antibiotics despite an average course of 72 days. Diagnosis of Lyme arthritis should not be based on synovial fluid B. burgdorferi immunoblot testing. This unvalidated test does not appear useful for the diagnosis of Lyme disease, and this study reinforces the longstanding recommendation to use B. burgdorferi immunoblot testing only on serum samples and not other body fluids. Erroneous interpretations of "positive" synovial fluid immunoblots may lead to inappropriate antibiotic courses and delays in diagnosis of other joint diseases.