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relia burgdorferi is the causative agent of Lyme disease - the most general tick-borne disease in North America.However,the diagnosis of the disease has been problematic.Steere et al.2a reported that at least 80% of Lyme disease patients have a specific "bulls-eye', erythema migrans (EM) rash,and generally [link widoczny dla zalogowanych],the presence of this rash is considered the earliest and best indicator of infection. Recent health ministry statistics from Texas, Connecticut. and California, although, show that only 35-59% of Lyme disease patients present with an EM rash.rz,Detection is limited by the place of the tick-bite [link widoczny dla zalogowanych], the awareness of the human who was bitten, and the manner of the rash.r2,26 If untreated,patients can work on to amplify late Lyme disease characterized by .urdiu.,
musculoskeletal, and neurological declarations months to years ifter the initial tick Diagnosis at this stage can be even more complicated,
since the history of the rash and tick bite may be missing and the symptoms are shared with a number of other diseases.Direct observation of the surrogate of Lyme disease using microscopy,culture, nucleic mordant amplification.and antigen detection have restricted sensitivity and/or specificitv.3 Therefore, the clinical introduction namely routinely aided by antibody detection using a two-tiered testing system in the United States.6 In this system [link widoczny dla zalogowanych], an enzyme-linked immunosorbent assay (ELISA) or immunofluorescence antibody (lFA) test is fulfilled u, u />
Following a positive or indeterminate test, the diagnosis is confirmed using a Western Blot (WB) assay. However,even in early Lyme disease, only 33-
49% of patients have a positive ELISA test,r,2 and in late Lyme disease,the ELISA sensitivity may be for cheap for 79%.s Thus the screening assay can
miss truly assured patients.In an attempt apt standardize Lyme testing, the Dearborn Conference held at the Centers as Disease Control and Prevention (CDC) and the Association of State and Territorial Public Health Laboratory Directors(ASTPHLD) in i995 recommended that always indeterminate and assured ELISA tests be confirmed by WB6 using the criteria promulgated by Engstrom et al. Ior the IgM WBro and Dressler et al. as the IgG WB.s Neither of these learned studies valuated samples from patients with additional tick-borne diseases, nor did they attempt to analyze late Lyme disease in patients months alternatively years after the
initial tick bite. The Dearborn CDC criteria have been the standard for WB interpretation since that period.7 The CDC guidelines yet state that IgM or IgG WB criteria should be used during the first four weeks ol cancer, but only IgG criteria should be used further four weeks after the onset of disease, and WB testing should only be performed whether the ELISA or IFA is positive or indeterminate.T To add to the problem of laboratorydiagnosis of Lyme disease, some B.
burgdorferi antigens are specific to the organism, meantime some antigens are shared with other microorganisms,and antibodies evoked by these nonspecific
antigens may not necessarilyindicate Lyme disease. Lysates accustom to arrange WB tests vary in their essay with the tug secondhand,and the antigenic makeup of .8.burgdorferi proteins have variable statement beneath another civilization conditions of the creature.T To increase to the constraints of Lyme testing, antibody expression varies at alter stages of the disease.epoch Because of these complicated issues and the difficulties of studio diagnosis, Lyme disease can be underdiagnosed, especiallyin patients who present months after the initialbite with omens that mock other conditions.
In an attempt to add to the new interpretation of Lyme WB assays,we resolved the IGeneX WB assay specificity and sensitivity using IGeneX criteria and CDC criteria for both IgG and IgM WB using specimens from 3 groups of patients: those understood to be infected with B. burgdorferi, those with other tick-borne diseases, and negative controls.