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Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
Published on: February 4, 2018
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Patterns Testing for Tick-Borne Diseases and Implications for Surveillance in the Southeastern US
Amanda Brown Marusiak1, Brandon D Hollingsworth2, Haley Abernathy2
1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
JAMA Network Open
|May 16, 2022
Summary
Diagnostic testing for tick-borne diseases (TBD) like Lyme disease and ehrlichiosis in the Southeast often falls short of guidelines, potentially leading to underdiagnosis and hindering epidemiological understanding.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Tick-borne diseases (TBD), including spotted fever group rickettsiosis (SFGR), ehrlichiosis, and Lyme disease, are a significant public health issue in the southeastern US.
- Current diagnostic testing methods have limitations, creating uncertainty in understanding the true epidemiology of these diseases.
Purpose of the Study:
- To analyze diagnostic testing patterns for TBD within a large academic healthcare system.
- To determine the incidence rates of SFGR, ehrlichiosis, and Lyme disease based on testing data.
- To identify deficiencies in diagnostic testing protocols and their impact on disease surveillance.
Main Methods:
- A cross-sectional study analyzed TBD diagnostic test results from January 2017 to November 2020 at UNC Health.
- Included individuals undergoing testing for SFGR, ehrlichiosis, or Lyme disease.
- Evaluated test positivity rates, testing completeness (e.g., paired convalescent samples), and calculated incidence rates.
Main Results:
- Over 20,000 tests were performed on over 11,000 individuals.
- Confirmed incidence rates were 4.7% for SFGR, 7.1% for ehrlichiosis, and 0.7% for Lyme disease.
- Significant testing deficiencies were noted, including a lack of paired convalescent samples for SFGR and ehrlichiosis, and underrecognition of ehrlichiosis (tested in only 55% of SFGR-suspected cases), potentially missing hundreds of cases.
Conclusions:
- Most patients suspected of TBD were not tested according to established guidelines, limiting epidemiological insights.
- A notable gap exists between the actual disease burden and the testing conducted.
- There is a critical need for enhanced, active surveillance strategies to accurately assess TBD burden and pathogen distribution.
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