Department of Pathology, New York University School of Medicine, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY 10016, USA.
Expert Rev Mol Diagn. 2015 Jan;15(1):1-4. doi: 10.1586/14737159.2015.989837. Epub 2014 Dec 8.
The diagnosis of Lyme disease is a controversial topic. Most practitioners and scientists recognize that Lyme disease is associated with certain objective clinical manifestations supported by laboratory evidence of infection with Borrelia burgdorferi sensu lato (the etiologic agent). There are others, however, who believe that patients with Lyme disease may have a wide variety of entirely nonspecific symptoms without any objective clinical manifestation and that laboratory evidence of infection by B. burgdorferi is not required to support the diagnosis. In reality, this perspective is not evidence based and would inevitably lead to innumerable misdiagnoses, given the high frequency of medically unexplained symptoms, such as fatigue and musculoskeletal pains, in the general population. Although those espousing this viewpoint do not believe that a positive laboratory test is required, nevertheless, they often seek out and promote alternative, unapproved testing methods that frequently provide false-positive results to justify their diagnosis. Herein, we provide a brief overview of Lyme disease testing, emphasizing current usage and limitations. We also discuss the use of nonvalidated procedures and the prospects for a reduction in such testing practices in the future.
莱姆病的诊断是一个有争议的话题。大多数医生和科学家都认识到，莱姆病与某些特定的临床表现有关，这些表现得到感染伯氏疏螺旋体（感染的病原体）的实验室证据的支持。然而，也有一些人认为，莱姆病患者可能有各种各样的完全非特异性症状，没有任何客观的临床表现，而且不需要伯氏疏螺旋体感染的实验室证据来支持诊断。实际上，这种观点没有任何依据，如果考虑到一般人群中经常出现的无法解释的疲劳和肌肉骨骼疼痛等医学症状，这种观点必然会导致无数的误诊。尽管那些持这种观点的人不认为需要进行阳性实验室检测，但他们经常寻求和推广替代的、未经批准的检测方法，这些方法经常提供假阳性结果来证明他们的诊断。本文简要概述了莱姆病检测，强调了当前的使用和局限性。我们还讨论了非验证程序的使用以及未来减少此类检测的前景。
