Re: IDSA Guidelines...can anyone tell me what this means?


"the 3rd Man" <derdrittemann2003@xxxxxxxxx> wrote in message
news:1160707014.035214.249530@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

I guess that's what I really want to know...if a doc reaches the
diagnosis...but the blot doesn't confirm...do these guidelines suggest
that he NOT treat?

I would say the doc's *** is covered if he doesn't treat without lab
confirmation.

Repeatedly, the IDSA GL's state that diagnosis should be confirmed by
testing, if not REQUIRED:

"The vast majority of patients with early neurologic Lyme disease are
seropositive [157, 162-164]. Patients should have a total body skin
examination to look for a concurrent erythema migrans lesion and should be
questioned to determine whether one had been present within the preceding
1-2 months. For the small proportion of patients who have neurologic Lyme
disease but are found to be seronegative by 2-tier testing, a
convalescent-phase serum sample obtained 2 weeks after the acute-phase
sample will usually yield positive results. "
"Another diagnostic test that may be helpful in selected cases is a
test for the presence of intrathecal production of antibody to B.
burgdorferi [103, 152, 165, 166]. Tests to determine specific intrathecal
production of antibody are required, because there may be passive transfer
to the CSF of serum antibody to B. burgdorferi. Amplification of B.
burgdorferi DNA in CSF using PCR by a laboratory with excellent quality
control can also be useful [103, 124, 167], but few laboratories are capable
of accurately performing this test. In the absence of erythema migrans,
neurologic manifestations are too nonspecific to warrant a purely clinical
diagnosis; LABORATORY SUPPORT FOR THE DIAGNOSIS IS REQUIRED."


"Under these circumstances, support for the diagnosis REQUIRES the presence
of B. burgdorferi antibody in acute- or convalescent-phase (2-4 weeks after
the acute phase) serum specimens"

"All patients SHOULD BE DETERMINED to be SEROPOSITIVE by 2-tier testing that
includes an ELISA and IgG immunoblot [162, 206]. In a seropositive patient,
a positive PCR test result on a synovial fluid specimen adds increased
diagnostic certainty [206, 207]. Positive PCR results for a joint fluid
specimen from a seronegative patient, however, should be regarded with
skepticism [103]. "


I'm not entirely sure that they do, in fact.

I would think it would be obvious somewhere in the document if a doc was
OKayed to treat without test confirmation. Maybe he could, but the document
does not make a doc feel safe or comfortable or encouraged to make a
diagnosis without lab 'confirmation' in anything except correctly identified
EM rashes.

Rita


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