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Diagnostic Tests for Lyme Disease-Reply

Brian S. Schwartz, MD, MS; Michael D. Goldstein, MD, MPH
JAMA. 1990;264(6):692-693. doi:10.1001/jama.1990.03450060038014.
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In Reply.—  Our article attempted to assess the interlaboratory and intralaboratory reliability of serological tests for Lyme disease. The two most commonly performed methods for these tests are indirect fluorescent antibody procedures and enzyme-linked immunosorbent assays.1 Although one of these test methods reports titers from serial dilutions (eg, 1:128) and the other reports an optical density, the clinician usually is most interested in whether the laboratory is reporting the sample as "positive" or "negative." Thus, we disagree with Dr Gambino's contention that we "mix apples and oranges" in our article, as these two methods both report the presence (positive) or absence (negative) of antibody to Borrelia burgdorferi. We do not disagree that enzymelinked immunosorbent assays are probably a better test method; however, many laboratories, including those in state departments of health, commercial laboratories, and research laboratories, are still performing immunofluorescent antibody tests. Thus, it was important to consider this

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