1
|
Stadelmann K, Forestier E, Richalet G, Monnet V, Epaulard O. Seroprevalence of Infection by Borrelia Species Responsible for Lyme Disease in the French Alps: Analysis of 27,360 Serology Tests, 2015-2020. Vector Borne Zoonotic Dis 2024; 24:196-200. [PMID: 38441498 DOI: 10.1089/vbz.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objectives: Lyme borreliosis incidence is increasing in several areas; moreover, it has recently gained the public's attention. Apart from erythema migrans, Lyme disease diagnosis relies (among others) on serology test; however, the prevalence of positive enzyme-linked immunosorbent assay (ELISA) and western blot (WB) assay has been poorly studied in the general population. We aimed to approach the seroprevalence of infection by Borrelia species responsible for Lyme disease in the French Isere department using city laboratories data. Patients and Methods: We retrieved all serological tests for Borrelia species responsible for Lyme disease performed in the two main networks of city laboratories between 2015 and 2020. All patients with both ELISA and WB IgG were considered seropositive. Results: We analyzed 27,360 tests (ELISA/ELISA+WB). Mean age was 50.9 ± 20.3 years (ranges: 0-101), with 57.1% females. Overall, 11.7% had IgG detected by ELISA, and 4.7% had IgG detected by both ELISA and WB assay. Seropositive status was more frequent in males (7.0% vs. 2.9%, p < 0.001). Seropositivity rate increased with age after a first peak in childhood; men aged 61-70 years had the highest seropositivity rate (10.3%). In addition, seropositivity rate was higher in persons from a rural area. In multivariate analysis, older age, male gender and living in a rural area were independently associated with seropositivity. Seropositivity rate was stable on the 2017-2020 period. Conclusion: The seroprevalence of infection by Borrelia species responsible for Lyme disease is high in Isere; this probably reduces the predictive positive value for Lyme disease of ELISA and WB IgG, suggesting that this serological test should not be performed for nonspecific symptoms.
Collapse
Affiliation(s)
- Kevin Stadelmann
- Groupe de Recherche en Infectiologie Clinique, CIC1406, Inserm-Université Grenoble Alpes-CHUGA, Grenoble, France
| | - Emmanuel Forestier
- Infectious Disease Unit, Centre Hospitalier Métropole Savoie, Chambéry, France
| | | | | | - Olivier Epaulard
- Groupe de Recherche en Infectiologie Clinique, CIC1406, Inserm-Université Grenoble Alpes-CHUGA, Grenoble, France
- Infectious Disease Unit, Centre Hospitalier Unversitaire Grenoble-Alpes, Grenoble, France
| |
Collapse
|
2
|
Bonnet C, Figoni J, Souty C, Septfons A, de Martino S, de Valk H, Fournier L, Hanslik T, Jaulhac B, Blanchon T. Prevalence and factors associated with a prescription of a Lyme borreliosis serology for erythema migrans diagnosis in general practice: a study from the French sentinel network, 2009-2020. BMC PRIMARY CARE 2023; 24:163. [PMID: 37620763 PMCID: PMC10464237 DOI: 10.1186/s12875-023-02108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Serological testing of patients consulting for typical erythema migrans (EM) is not recommended in European recommendations for diagnosis of Lyme borreliosis (LB). Little is known on the level of adherence of French general practitioners to these recommendations. The objectives were to estimate the proportion of Lyme borreliosis serological test prescription in patients with erythema migrans seen in general practice consultations in France, and to study the factors associated with this prescription. METHODS LB cases with an EM reported by the French general practitioners (GPs) of the Sentinelles network between January 2009 and December 2020 were included. To assess the associations with a prescription of a serological test, multilevel logistic regression models were used. RESULTS Among the 1,831 EM cases included, a prescription for a LB serological test was requested in 24.0% of cases. This proportion decreased significantly over the study period, from 46.8% in 2009 to 15.8% in 2020. A LB serological prescription was associated with patients with no reported tick bite (Odds Ratio (OR): 1.95; 95% confidence interval [1.23-3.09]), multiple EM (OR: 3.82 [1.63-8.92]), EM of five centimeters or more (OR: 4.34 [2.33-8.08]), and GPs having diagnosed less than one EM case per year during the study period (OR: 5.28 [1.73-16.11]). CONCLUSIONS Serological testing of patients consulting for EM is not recommended in European recommendations for diagnosis of Lyme borreliosis. Therefore, the significant decrease in the rate of LB serological test for EM over the study period is encouraging. The factors identified in this study can be used to improve messaging to GPs and patients. Further efforts are needed to continue to disseminate diagnostic recommendations for LB to GPs, especially those who rarely see patients with EM.
Collapse
Affiliation(s)
- Camille Bonnet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France.
| | - Julie Figoni
- Santé publique France, Saint-Maurice, F94410, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | | | - Sylvie de Martino
- CNR des Borrelia et Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, CHRU Strasbourg, UR7290, ITI InnoVec, Strasbourg, 67000, France
| | | | - Lucie Fournier
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
- Service de Médecine Interne, APHP, Hôpital Ambroise Paré, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France
- Université Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine Simone Veil, Versailles, France
| | - Benoît Jaulhac
- CNR des Borrelia et Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, CHRU Strasbourg, UR7290, ITI InnoVec, Strasbourg, 67000, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| |
Collapse
|
3
|
Liu X, Tabibzada N, Lindgren H, Sjöstedt A. Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden. Front Cell Infect Microbiol 2023; 13:1192038. [PMID: 37465761 PMCID: PMC10350645 DOI: 10.3389/fcimb.2023.1192038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.
Collapse
Affiliation(s)
- Xijia Liu
- Umeå School of Business, Economics and Statistics, Statistics, Västerbotten, Sweden
| | | | - Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
Knudtzen FC, Jensen TG, Andersen NS, Johansen IS, Hovius JW, Skarphédinsson S. An intervention in general practice to improve the management of Lyme borreliosis in Denmark. Eur J Public Health 2022; 32:436-442. [PMID: 35323885 PMCID: PMC9159330 DOI: 10.1093/eurpub/ckac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Our objectives were to improve the following outcomes in patients with Lyme borreliosis (LB) through an educational intervention in general practice: (i) increase the number of hospital referrals on suspicion of LB, (ii) increase the number of cerebrospinal fluid (CSF) tests examined for Borrelia burgdorferi antibody index, (iii) decrease the number of serum-B. burgdorferi antibody tests ordered, (iv) shorten delay from symptom onset to hospital in Lyme neuroborreliosis (LNB) patients, (v) increase LB knowledge among general practitioners. Methods A prospective non-blinded non-randomized intervention trial on the island of Funen, Denmark. The intervention included oral and written education about LB and was carried out in areas with an LNB incidence ≥4.7/100.000 between 22 January 2019 and 7 May 2019. Results were compared between the intervention group (49 general practices) and the remaining general practices in Funen (71 practices) 2 years before and after the intervention. Results In the study period, 196 patients were referred on suspicion of LB, a 28.9% increase in the intervention group post-intervention, 59.5% increase in the control group (P = 0.47). The number of CSF-Borrelia-antibody index tests increased 20.8% in the intervention group, 18.0% in the control group (P = 0.68), while ordered serum-B. burgdorferi antibody tests declined 43.1% in the intervention group, 34.5% in the control group (P = 0.30). 25.1% had the presence of serum-B. burgdorferi antibodies. We found no difference in LNB pre-hospital delay before and after intervention or between groups (P = 0.21). The intervention group performed significantly better on a follow-up questionnaire (P = 0.02). Conclusion We found an overall improvement in LB awareness and referrals among general practitioners but could not show any effect of the intervention on clinical outcomes of LNB.
Collapse
Affiliation(s)
- Fredrikke Christie Knudtzen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Thøger Gorm Jensen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Clinical Microbiology, Odense University Hospital and Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Nanna Skaarup Andersen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Joppe W Hovius
- Amsterdam UMC, Location AMC, Center for Experimental and Molecular Medicine, Amsterdam Multidisciplinary Lyme Borreliosis Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sigurdur Skarphédinsson
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Pradelli L, Pinciroli M, Houshmand H, Grassi B, Bonelli F, Calleri M, Ruscio M. Comparative Cost and Effectiveness of a New Algorithm for Early Lyme Disease Diagnosis: Evaluation in US, Germany, and Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:437-451. [PMID: 34079307 PMCID: PMC8165099 DOI: 10.2147/ceor.s306391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This Lyme disease early detection economic model, for patients with suspected Lyme disease without erythema migrans (EM), compares outcomes of standard two-tier testing (sTTT), modified two-tier testing (mTTT) and the DiaSorin Lyme Detection Algorithm (LDA), a combination of both serology tests and Interferon-ɤ Release Assay. Patients and Methods A patient-level simulation model was built to incorporate effectiveness estimation from a structured focused literature review, and health-care cost inputs for the United States, Germany, and Italy. Simulated clinical outcomes were 1) percent of patients with timely and correct diagnosis, 2) patients appropriately treated and exposed to antibiotics therapy, and 3) patients with late Lyme disease manifestations. Expected health outcomes were expressed in terms of differences in quality-adjusted life years (QALYs) due to disseminated Lyme disease and persisting symptoms, and economic outcomes were analyzed from a third-party payer perspective. Results The DiaSorin LDA resulted in a better sensitivity compared to sTTT and mTTT, 84% vs 49% and 45%, respectively, in the base case (13% of infected patients in the tested population). Due to the improved diagnostic performance, the LDA-based strategy is expected to be more effective, providing mean incremental 0.024 QALYs per tested patient, or 0.19 per infected patient. Furthermore, from a third-party payer perspective, the adoption of the LDA-based strategy would reduce the expected health-care cost for suspected and confirmed Lyme disease by roughly 40%, ie about $410, €130, and €170 per tested patient in the United States, Germany, and Italy, respectively, compared to sTTT. The results are most sensitive to the infection rate in the tested population, with LDA maintaining a cost advantage for Lyme disease active infection rates ≥0.8-2.5%. Conclusion LDA early diagnostic testing and subsequent treatment of subjects with early Lyme disease without EM are expected to outperform traditional management strategies both clinically and economically in the US, Germany, and Italy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maurizio Ruscio
- Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASU GI), Trieste, Italy
| |
Collapse
|