Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2016

Open Access 01-12-2016 | Research article

The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis

Authors: M. M. G. Leeflang, C. W. Ang, J. Berkhout, H. A. Bijlmer, W. Van Bortel, A. H. Brandenburg, N. D. Van Burgel, A. P. Van Dam, R. B. Dessau, V. Fingerle, J. W. R. Hovius, B. Jaulhac, B. Meijer, W. Van Pelt, J. F. P. Schellekens, R. Spijker, F. F. Stelma, G. Stanek, F. Verduyn-Lunel, H. Zeller, H. Sprong

Published in: BMC Infectious Diseases | Issue 1/2016

Login to get access

Abstract

Background

Interpretation of serological assays in Lyme borreliosis requires an understanding of the clinical indications and the limitations of the currently available tests. We therefore systematically reviewed the accuracy of serological tests for the diagnosis of Lyme borreliosis in Europe.

Methods

We searched EMBASE en MEDLINE and contacted experts. Studies evaluating the diagnostic accuracy of serological assays for Lyme borreliosis in Europe were eligible. Study selection and data-extraction were done by two authors independently. We assessed study quality using the QUADAS-2 checklist. We used a hierarchical summary ROC meta-regression method for the meta-analyses. Potential sources of heterogeneity were test-type, commercial or in-house, Ig-type, antigen type and study quality. These were added as covariates to the model, to assess their effect on test accuracy.

Results

Seventy-eight studies evaluating an Enzyme-Linked ImmunoSorbent assay (ELISA) or an immunoblot assay against a reference standard of clinical criteria were included. None of the studies had low risk of bias for all QUADAS-2 domains. Sensitivity was highly heterogeneous, with summary estimates: erythema migrans 50 % (95 % CI 40 % to 61 %); neuroborreliosis 77 % (95 % CI 67 % to 85 %); acrodermatitis chronica atrophicans 97 % (95 % CI 94 % to 99 %); unspecified Lyme borreliosis 73 % (95 % CI 53 % to 87 %). Specificity was around 95 % in studies with healthy controls, but around 80 % in cross-sectional studies. Two-tiered algorithms or antibody indices did not outperform single test approaches.

Conclusions

The observed heterogeneity and risk of bias complicate the extrapolation of our results to clinical practice. The usefulness of the serological tests for Lyme disease depends on the pre-test probability and subsequent predictive values in the setting where the tests are being used. Future diagnostic accuracy studies should be prospectively planned cross-sectional studies, done in settings where the test will be used in practice.
Appendix
Available only for authorised users
Literature
1.
2.
Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379:461473.CrossRef
3.
Mulherin SA, Miller WC. Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation. Ann Intern Med. 2002;137:598602.CrossRef
4.
Knottnerus JA, Muris JW. Assessment of the accuracy of diagnostic tests: the cross-sectional study. J Clin Epidemiol. 2003;56:1118–28.CrossRefPubMed
5.
Rutjes AW, Reitsma JB, Vandenbroucke JP, Glas AS, Bossuyt PM. Case-control and two-gate designs in diagnostic accuracy studies. Clin Chem. 2005;51:1335–41.CrossRefPubMed
6.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529536.CrossRef
7.
8.
Ang CW, Brandenburg AH, van Burgel ND, Bijlmer HA, Herremans T, Stelma FF, et al. Nationale vergelijking van serologische assays voor het aantonen van Borrelia-antistoffen. Nederlands tijdschrift voor Medische Microbiologie. 2012;20:111–9.
9.
Ang CW, Notermans DW, Hommes M, Simoons-Smit AM, Herremans T. Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots. Eur J Clin Microbiol Inf Dis. 2011;30:1027–32.CrossRef
10.
Bergstrom S, Sjostedt A, Dotevall L, Kaijser B, Ekstrand-Hammarstrom B, Wallberg C, et al. Diagnosis of Lyme borreliosis by an enzyme immunoassay detecting immunoglobulin G reactive to purified Borrelia burgdorferi cell components. Eur J Clin Microbiol Inf Dis. 1991;10:422–7.CrossRef
11.
Branda JA, Strle F, Strle K, Sikand N, Ferraro MJ, Steere AC. Performance of United States serologic assays in the diagnosis of Lyme borreliosis acquired in Europe. Clin Infect Dis. 2013;57:333–40.CrossRefPubMed
12.
13.
Cerar T, Ruzic-Sabljic E, Cimperman J, Strle F. Comparison of immunofluorescence assay (IFA) and LIAISON in patients with different clinical manifestations of Lyme borreliosis. Wien Klin Wochenschr. 2006;118:686–90.CrossRefPubMed
14.
Christova I. Enzyme-linked immunosorbent assay, immunofluorescent assay X and recombinant immunoblotting in the serodiagnosis of early Lyme borreliosis. Int J Imm Pharmacol. 2003;16:261–8.
15.
Cinco M, Murgia R. Evaluation of the C6 enzyme-linked immunoadsorbent assay for the serodiagnosis of Lyme borreliosis in north-eastern Italy. New Microbiol. 2006;29:139–41.PubMed
16.
Dessau RB, Ejlertsen T, Hilden J. Simultaneous use of serum IgG and IgM for risk scoring of suspected early Lyme borreliosis: Graphical and bivariate analyses. APMIS. 2010;118:313–23.CrossRefPubMed
17.
Dessau RB. Diagnostic accuracy and comparison of two assays for Borrelia-specific IgG and IgM antibodies: Proposals for statistical evaluation methods, cut-off values and standardization. J Med Microbiol. 2013;62(Pt 12):1835–44.CrossRefPubMed
18.
Flisiak R, Kalinowska A, Bobrowska E, Prokopowicz D. Enzyme immunoassay in the diagnosis of Lyme borreliosis. Roczniki Akademii Medycznej w Bialymstoku. 1996;41:83–9.PubMed
19.
Flisiak R, Wierzbicka I, Prokopowicz D. Western blot banding pattern in early Lyme borreliosis among patients from an endemic region of north-eastern Poland. Roczniki Akademii Medycznej w Bialymstoku. 1998;43:210–20.PubMed
20.
Goettner G, Schulte-Spechtel U, Hillermann R, Liegl G, Wilske B, Fingerle V. Improvement of lyme borreliosis serodiagnosis by a newly developed recombinant immunoglobulin G (IgG) and IgM line immunoblot assay and addition of VlsE and DbpA homologues. J Clin Microbiol. 2005;43:3602–9.CrossRefPubMedPubMedCentral
21.
Goossens HAT, van de Bogaard AE, Nohlmans MKE. Evaluation of fifteen commercially available serological tests for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Inf Dis. 1999;18:551–60.CrossRef
22.
Goossens HAT, Van den Bogaard AE, Nohlmans MKE. Serodiagnosis of Lyme borreliosis using detection of different immunoglobulin (sub)classes by enzyme-linked immunosorbent assay and Western blotting. Clin Lab. 2001;47:41–9.PubMed
23.
Gueglio B, Poinsignon Y, Berthelot JM, Marjolet M. Borreliose De Lyme: Specificite De Western Blot. Med Mal Infect. 1996;26:332–7.CrossRef
24.
Hansen K, Asbrink E. Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. J Clin Microbiol. 1989;27:545–51.PubMedPubMedCentral
25.
Hansen K, Hindersson P, Pedersen NS. Measurement of antibodies to the Borrelia burgdorferi flagellum improves serodiagnosis in Lyme borreliosis. J Clin Microbiol. 1988;26:338–46.PubMedPubMedCentral
26.
Hansen K, Lebech AM. Lyme neuroborreliosis: A new sensitive diagnostic assay for intrathecal synthesis of Borrelia burgdorferi-specific immunoglobulin G, A, and M. Ann Neurol. 1991;30:197–205.CrossRefPubMed
27.
Hernandez-Novoa B, Orduna A, Bratos MA, Eiros JM, Fernandez JM, Gutierrez MP, et al. Utility of a commercial immunoblot kit (BAG-Borrelia blot) in the diagnosis of the preliminary stages of Lyme borreliosis. Diagn Microbiol Inf Dis. 2003;47:321–9.CrossRef
28.
29.
Hofmann H, Meyer-Konig U. Serodiagnostik Bei Dermatologischen Krankheitsbildern Der Borrelia Burgdorferi-Infektion. Hautarzt. 1990;41:424–31.PubMed
30.
Hofstad H, Matre R, Myland H, Ulvestad E. Bannwarth’s syndrome: Serum and CSF IgG antibodies against Borrelia burgdorferi examined by ELISA. Acta Neurol Scand. 1987;75:37–45.CrossRefPubMed
31.
Hunfeld KP, Ernst M, Zachary P, Jaulhac B, Sonneborn HH, Brade V. Development and laboratory evaluation of a new recombinant ELISA for the serodiagnosis of Lyme borreliosis. Wien Klin Wochenschr. 2002;114:580–5.PubMed
32.
Jovicic VL, Grego EM, Lako BL, Ristovic BM, Lepsanovic ZA, Stajkovic NT. Improved serodiagnosis of early Lyme borreliosis: Immunoblot with local Borrelia afzelli strain. APMIS. 2003;111:1053–9.CrossRefPubMed
33.
Kaiser R, Rauer S. Analysis of the intrathecal immune response in neuroborreliosis to a sonicate antigen and three recombinant antigens of Borrelia burgdorferi sensu stricto. Eur J Clin Microbiol Inf Dis. 1998;17:159–66.
34.
Kaiser R, Rauer S. Serodiagnosis of neuroborreliosis: Comparison of reliability of three confirmatory assays. Infection. 1999;27:177–82.CrossRefPubMed
35.
Karlsson M, Granstrom M. An IgM-antibody capture enzyme immunoassay for serodiagnosis of Lyme borreliosis. Serodiagn Immunother Infect Dis. 1989;3:413–21.CrossRef
36.
Karlsson M, Mollegard I, Stiernstedt G, Wretlind B. Comparison of Western blot and enzyme-linked immunosorbent assay for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Inf Dis. 1989;8:871–7.CrossRef
37.
Lahdenne P, Panelius J, Saxen H, Heikkila T, Sillanpaa H, Peltomaa M, et al. Improved serodiagnosis of erythema migrans using novel recombinant borrelial BBK32 antigens. J Med Microbiol. 2003;52:563–7.CrossRefPubMed
38.
Lakos A, Ferenczi E, Komoly S, Granström M. Different B-cell populations are responsible for the peripheral and intrathecal antibody production inneuroborreliosis. Int Immunol. 2005;17:1631–7.CrossRefPubMed
39.
Lange R, Schneider T, Topel U, Mater-Bohm H, Beck A, Kolmel HW. Borrelia burgdorferi antibody-tests: Comparison of IFT. ELISA Western-blot Lab Med. 1991;15:128–9.
40.
Lencakova D, Fingerle V, Stefancikova A, Schulte-Spechtel U, Petko B, Schreter I, et al. Evaluation of recombinant line immunoblot for detection of Lyme borreliosis in Slovakia: Comparison with two other immunoassays. Vector-Borne Zoonot. 2008;8:381–90.CrossRef
41.
Marangoni A, Moroni A, Accardo S, Cevenini R. Borrelia burgdorferi VlsE antigen for the serological diagnosis of Lyme borreliosis. Eur J Clin Microbiol Inf Dis. 2008;27:349–54.CrossRef
42.
Marangoni A, Sparacino M, Cavrini F, Storni E, Mondardini V, Sambri V, et al. Comparative evaluation of three different ELISA methods for the diagnosis of early culture-confirmed Lyme borreliosis in Italy. J Med Microbiol. 2005;54:361–7.CrossRefPubMed
43.
Marangoni A, Sparacino M, Mondardini V, Cavrini F, Storni E, Donati M, et al. Comparative evaluation of two enzyme linked immunosorbent assay methods and three Western Blot methods for the diagnosis of culture-confirmed early Lyme Borreliosis in Italy. New Microbiol. 2005;28:37–43.PubMed
44.
Mathiesen MJ, Christiansen M, Hansen K, Holm A, Asbrink E, Theisen M. Peptide-based OspC enzyme-linked immunosorbent assay for serodiagnosis of Lyme borreliosis. J Clin Microbiol. 1998;36:3474–9.PubMedPubMedCentral
45.
Mathiesen MJ, Hansen K, Axelsen N, Halkier-Sorensen L, Theisen M. Analysis of the human antibody response to outer surface protein C (OspC) of Borrelia burgdorferi sensu stricto, B. garinii, and B. afzelii. Med Microbiol Immunol. 1996;185:121–9.CrossRefPubMed
46.
Nicolini P, Imbs P, Jaulhac B, Piemont Y, Warter JM, Monteil H. Comparaison De L’immunofluorescence Indirecte Et Du Western Blot Pour Le Serodiagnostic Des Infections Neurologiques a Borrelia Burgdorferi. Med Mal Inf. 1992;22:722–6.CrossRef
47.
Nohlmans MKE, Blaauw AAM, Van den Bogaard AEJ, Van Boven CPA. Evaluation of nine serological tests for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Inf Dis. 1994;13:394–400.CrossRef
48.
Oksi J, Uksila J, Marjamaki M, Nikoskelainen J, Viljanen MK. Antibodies against whole sonicated Borrelia burgdorferi spirochetes, 41- kilodalton flagellin, and P39 protein in patients with PCR- or culture- proven late Lyme borreliosis. J Clin Microbiol. 1995;33:2260–4.PubMedPubMedCentral
49.
Olsson I, Von Stedingk LV, Hanson HS, Von Stedingk M, Asbrink E, Hovmark A. Comparison of four different serological methods for detection of antibodies to Borrelia burgdorferi in erythema migrans. Acta Derm-Venereol. 1991;71:127–33.PubMed
50.
Panelius J, Lahdenne P, Saxen H, Heikkila T, Seppala I. Recombinant flagellin A proteins from Borrelia burgdorferi sensu stricto, B. afzelii, and B. garinii in serodiagnosis of Lyme borreliosis. J Clin Microbiol. 2001;39:4013–9.CrossRefPubMedPubMedCentral
51.
Putzker M, Zoller L. Vergleichende Bewertung Kommerzieller Hamagglutinations-, Enzymimmun- Und Immunblottests in Der Serodiagnostik Der Lyane-Borreliose. Klinisches Labor. 1995;41:655–66.
52.
Rauer S, Kayser M, Neubert U, Rasiah C, Vogt A. Establishment of enzyme-linked immunosorbent assay using purified recombinant 83-kilodalton antigen of Borrelia burgdorferi sensu stricto and Borrelia afzelii for serodiagnosis of Lyme borreliosis. J Clin Microbiol. 1995;33:2596–600.PubMedPubMedCentral
53.
Reiber H, Ressel CB, Spreer A. Diagnosis of neuroborreliosis - Improved knowledge base for qualified antibody analysis and cerebrospinal fluid data pattern related interpretations. Neurol Psych Brain Res. 2013;19:159–69.CrossRef
54.
Rijpkema S, Groen J, Molkenboer M, Herbrink P, Osterhaus A, Schellekens J. Serum antibodies to the flagellum of Borrelia burgdorferi measured with an inhibition enzyme-linked immunosorbent assay are diagnostic for Lyme borreliosis. Serodiagn Immunother Infect Dis. 1994;6:61–7.CrossRef
55.
Ruzic-Sabljic E, Maraspin V, Cimperman J, Lotric-Furian S, Strle F. Evaluation of immunofluorescence test (IFT) and immuno (western) blot (WB) test in patients with erythema migrans. Wien Klin Wochenschr. 2002;114:586–90.PubMed
56.
Ryffel K, Peter O, Binet L, Dayer E. Interpretation of immunoblots for Lyme borreliosis using a semiquantitative approach. Clin Microbiol Infect. 1998;4:205–12.CrossRefPubMed
57.
Schulte-Spechtel U, Lehnert G, Liegl G, Fingerle V, Heimerl C, Johnson B, et al. Significant improvement of the recombinant Borrelia IgG immunoblot for serodiagnosis of early neuroborreliosis. Int J Med Microbiol. 2004;293:158–60.PubMed
58.
Smismans A, Goossens VJ, Nulens E, Bruggeman CA. Comparison of five different immunoassays for the detection of Borrelia burgdorferi Igm and IgG antibodies. Clin Microbiol Infect. 2006;12:648–55.CrossRefPubMed
59.
Tjernberg I, Henningsson AJ, Eliasson I, Forsberg P, Ernerudh J. Diagnostic performance of cerebrospinal fluid chemokine CXCL13 and antibodies to the C6-peptide in Lyme neuroborreliosis. J Infect. 2011;62:149–58.CrossRefPubMed
60.
Tjernberg I, Kruger G, Eliasson I. C6 peptide ELISA test in the serodiagnosis of Lyme borreliosis in Sweden. Eur J Clin Microbiol Infect Dis. 2007;26:37–42.CrossRefPubMed
61.
van Burgel ND, Brandenburg A, Gerritsen HJ, Kroes ACM, van Dam AP. High sensitivity and specificity of the C6-peptide ELISA on cerebrospinal fluid in Lyme neuroborreliosis patients. Clin Microbiol Infect. 2011;17:1495–500.CrossRefPubMed
62.
Wilske B, Fingerle V, Herzer P, Hofmann A, Lehnert G, Peters H, et al. Recombinant immunoblot in the serodiagnosis of Lyme borreliosis. Comparison with indirect immunofluorescence and enzyme-linked immunosorbent assay. Med Microbiol Immunol. 1993;182:255–70.CrossRefPubMed
63.
Wilske B, Habermann C, Fingerle V, Hillenbrand B, Jauris-Heipke S, Lehnert G, et al. An improved recombinant IgG immunoblot for serodiagnosis of Lyme borreliosis. Med Microbiol Immunol. 1999;188:139–44.CrossRefPubMed
64.
Zoller L, Haude M, Sonntag HG. Validity of the standard assays in the serodiagnosis of Lyme borreliosis and effects of methodical modifications. Lab Med. 1990;14:404–11.
65.
Albisetti M, Schaer G, Good M, Boltshauser E, Nadal D. Diagnostic value of cerebrospinal fluid examination in children with peripheral facial palsy and suspected Lyme borreliosis. Neurology. 1997;49:817–24.CrossRefPubMed
66.
Barrial K, Roure-Sobas C, Carricajo A, Boibieux A, Tigaud S. Evaluation des performances de quatre immunoblots commercialises pour la confirmation de la borreliose de Lyme dans une population de patients suivis en Rhone-Alpes. Immuno-Analyse et Biologie Specialisee. 2011;26:194–200.CrossRef
67.
Bazovska S, Kondas M, Simkovicova M, Kmety E, Traubner P. Significance of specific antibody determination in Lyme borreliosis diagnosis. Bratisl Lek Listy. 2001;102:454–7.PubMed
68.
Bednarova J. Cerebrospinal-fluid profile in neuroborreliosis and its diagnostic significance. Folia Microbiol. 2006;51:599–603.CrossRef
69.
Bennet R, Lindgren V, Zweygberg Wirgart B. Borrelia antibodies in children evaluated for Lyme neuroborreliosis. Infection. 2008;36:463–6.CrossRefPubMed
70.
Blaauw AAM, Van Loon AM, Schellekens JFP, Bijlsma JWJ. Clinical evaluation of guidelines and two-test approach for Lyme borreliosis. Rheumatology. 1999;38:1121–6.CrossRefPubMed
71.
Blaauw I, Dijkmans B, Bouma P, Van Der Linden S. Rational diagnosis and treatment in unclassified arthritis: How clinical data may guide requests for Lyme serology and antibiotic treatment. Ann Rheum Dis. 1993;52:206–10.CrossRefPubMedPubMedCentral
72.
Blanc F, Jaulhac B, Fleury M, De Seze J, De Martino SJ, Remy V, et al. Relevance of the antibody index to diagnose Lyme neuroborreliosis among seropositive patients. Neurology. 2007;69:953–8.CrossRefPubMed
73.
Cermakova Z, Ryskova O, Honegr K, Cermakova E, Hanovcova I. Diagnosis of Lyme borreliosis using enzyme immunoanalysis. Med Sci Monitor. 2005;11:BR121–BR5.
74.
Davidson MM, Ling CL, Chisholm SM, Wiseman AD, Joss AWL, Ho-Yen DO. Evidence-based diagnosis of Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 1999;18:484–9.CrossRefPubMed
75.
Ekerfelt C, Ernerudh J, Forsberg P, Jonsson AL, Vrethem M, Arlehag L, et al. Lyme borreliosis in Sweden - Diagnostic performance of five commercial Borrelia serology kits using sera from well-defined patient groups. APMIS. 2004;112:74–8.CrossRefPubMed
76.
Jansson C, Carlsson SA, Granlund H, Wahlberg P, Nyman D. Analysis of Borrelia burgdorferi IgG antibodies with a combination of IgG ELISA and VlsE C6 peptide ELISA. Clin Microbiol Infect. 2005;11:147–50.CrossRefPubMed
77.
Kolmel HW, Neumann P, Lange R. Korrelation Zwischen Neurologischer Erkrankung Und Borrelia-Burgdorferi-Antikorpern in 800 Serum/Liquorpaaren. Nervenarzt. 1992;63:619–24.PubMed
78.
Ljostad U, Okstad S, Topstad T, Mygland A, Monstad P. Acute peripheral facial palsy in adults. J Neurol. 2005;252:672–6.CrossRefPubMed
79.
Popperl AF, Noll F. Diagnostic value of serological test-systems used in diagnosis of infection with Borrelia burgdorferi. [German] Diagnostische Wertigkeit serologischer Verfahren bei der Diagnostik einer Infektion mit Borrelia burgdorferi. Lab Med. 2000;24:190–7. German.
80.
Roux F, Boyer E, Jaulhac B, Dernis E, Closs-Prophette F, Puechal X. Lyme meningoradiculitis: Prospective evaluation of biological diagnosis methods. Eur J Clin Microbiol Infect Dis. 2007;26:685–93.CrossRefPubMed
81.
Skarpaas T, Ljostad U, Sobye M, Mygland A. Sensitivity and specificity of a commercial C6 peptide enzyme immuno assay in diagnosis of acute Lyme neuroborreliosis. Eur J Clin Microbiol Infect Dis. 2007;26:675–7.CrossRefPubMed
82.
Skogman BH, Croner S, Forsberg P, Ernerudh J, Lahdenne P, Sillanpaa H, et al. Improved laboratory diagnostics of lyme neuroborreliosis in children by detection of antibodies to new antigens in cerebrospinal fluid. Pediatr Infect Dis J. 2008;27:605–12.CrossRefPubMed
83.
Lijmer JG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. 1999;282:10611066.CrossRef
84.
Leeflang MM, Moons KG, Reitsma JB, Zwinderman AH. Bias in sensitivity and specificity caused by data-driven selection of optimal cutoff values: mechanisms, magnitude, and solutions. Clin Chem. 2008;54:729737.CrossRef
85.
Van Burgel ND. Host-pathogen interactions in Lyme disease and their application in diagnostics. 2013. Doctoral Thesis, Leiden University.
86.
Coumou J, Hovius JW, van Dam AP. Borrelia burgdorferi sensu lato serology in the Netherlands: guidelines versus daily practice. Eur J Clin Microbiol Infect Dis. 2014;33:18031808.CrossRef
87.
Müller I, Freitag MH, Poggensee G, et al. Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis. Clin Dev Immunol. 2012;2012:595427.CrossRefPubMedPubMedCentral
88.
Dessau RB, Bangsborg JM, Ejlertsen T, Skarphedinsson S, Schønheyder HC. Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: survey of patients seen in general practice. BMC Infect Dis. 2010;10:317.CrossRefPubMedPubMedCentral
89.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Standards for Reporting of Diagnostic Accuracy. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003;326:41–4.CrossRefPubMedPubMedCentral
90.
Coumou J, Herkes EA, Brouwer MC, van de Beek D, Tas SW, Casteelen G, van Vugt M, Starink MV, de Vries HJ, de Wever B, Spanjaard L, Hovius JW. Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands. Clin Microbiol Infect. 2015;21(4):368. e11-20.PubMed
91.
De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813–21.CrossRefPubMedPubMedCentral
92.
Rutjes AW, Reitsma JB, Coomarasamy A, Khan KS, Bossuyt PM. Evaluation of diagnostic tests when there is no gold standard. A review of methods. Health Technol Assess. 2007;11:iii. ix-51.CrossRefPubMed
93.
Lord SJ, Irwig L, Bossuyt PM. Using the principles of randomized controlled trial design to guide test evaluation. Med Decis Making. 2009;29:E1–E12.CrossRefPubMed
Metadata
Title
The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis
Authors
M. M. G. Leeflang
C. W. Ang
J. Berkhout
H. A. Bijlmer
W. Van Bortel
A. H. Brandenburg
N. D. Van Burgel
A. P. Van Dam
R. B. Dessau
V. Fingerle
J. W. R. Hovius
B. Jaulhac
B. Meijer
W. Van Pelt
J. F. P. Schellekens
R. Spijker
F. F. Stelma
G. Stanek
F. Verduyn-Lunel
H. Zeller
H. Sprong
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-1468-4

Other articles of this Issue 1/2016

BMC Infectious Diseases 1/2016 Go to the issue

Research article

Vitamin D receptor gene associations with pulmonary tuberculosis in a Tibetan Chinese population

Research article

Pseudobacteremia outbreak of biofilm-forming Achromobacter xylosoxidans – environmental transmission

Research article

Early diagnosis of dengue disease severity in a resource-limited Asian country

Research article

The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases

Case report

Dirofilaria repens: emergence of autochthonous human infections in the Czech Republic (case reports)

Research article

Understanding pneumococcal serotype 1 biology through population genomic analysis

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits