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Diagnostic Tests for Lyme Disease

Raymond Gambino, MD
JAMA. 1990;264(6):692. doi:10.1001/jama.1990.03450060038013.
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To the Editor.—  The article entitled "Antibody Testing in Lyme Disease"1 correctly concludes that serological tests for Lyme disease need to be standardized. But the article is misleading in several respects. First, the authors mix apples and oranges when they compare two immunofluorescent antibody tests and two enzyme-linked immunosorbent assays. It is widely recognized that immunofluorescent antibody tests are more subjective than enzyme-linked immunosorbent assays and that results of immunofluorescent antibody tests can vary greatly from laboratory to laboratory.2 Next, the study did not include any Western blot analyses. A Western blot assay is essential in any comparison study to have a reference point for evaluation of data. Finally, the authors err when they state that MetPath, Inc performed 56 591 serological tests for Lyme disease on residents of New Jersey in 1988. The correct figure is 25% of 62 851, or 15 713. The article also fails

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