Subject(s)
Lyme Disease , Randomized Controlled Trials as Topic , Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Confounding Factors, Epidemiologic , Double-Blind Method , Humans , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Patient Selection , Research Design/standardsSubject(s)
Borrelia burgdorferi Group , Lyme Disease/drug therapy , Antibodies, Bacterial/blood , Antibodies, Bacterial/cerebrospinal fluid , Borrelia burgdorferi Group/immunology , Borrelia burgdorferi Group/isolation & purification , Chronic Disease , Controlled Clinical Trials as Topic , Diagnosis, Differential , Humans , Lyme Disease/complications , Patient SelectionABSTRACT
A two-step approach for diagnosis of Lyme disease, consisting of an initial EIA followed by a confirmatory Western immunoblot, has been advised by the Centers for Disease Control and Prevention (CDC). However, these criteria do not examine the influence of the prior probability of Lyme disease in a given patient on the predictive value of the tests. By using Bayesian analysis, a mathematical algorithm is proposed that computes the probability that a given patient's Western blot result represents Lyme disease. Assuming prior probabilities of early Lyme disease of 1%-10%, the current CDC minimum criteria for IgM immunoblot interpretation yield posttest probabilities of 4%-32%. The value of the two-step approach for diagnosis of early Lyme disease may be limited in populations at lower risk of disease or when patients present with atypical signs and symptoms.
Subject(s)
Immunoglobulin M/blood , Lyme Disease/diagnosis , Blotting, Western , Humans , Molecular Weight , Probability , Serologic TestsABSTRACT
Clonal spread of vancomycin-resistant Enterococcus faecium among seven patients on one ward of a community teaching hospital was identified by contour-clamped homogeneous electric-field gel electrophoresis. Environmental cultures isolated the same strain from the handle of a shared electronic ear-probe thermometer. Cross-contamination of the clonal strain between two geographically separate units on this ward, sharing equipment but not personnel, suggests the possibility of an environmental source.
