{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T21:14:56Z","timestamp":1768770896210,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Boston Children\u2019s Hospital Research Faculty Council"},{"name":"Bay Area Lyme Disease Foundation"},{"name":"Boston Children\u2019s Hospital Research Faculty Council"},{"name":"Bay Area Lyme Disease Foundation"},{"DOI":"10.13039\/100014731","name":"Global Lyme Alliance","doi-asserted-by":"publisher","award":["K23-HD082368"],"award-info":[{"award-number":["K23-HD082368"]}],"id":[{"id":"10.13039\/100014731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Variability in 2-tier Lyme disease test results according to the specific first-tier enzyme immunoassay (EIA) in children has not been examined rigorously. In this study, we compared paired results of clinical 2-tier Lyme disease tests to those of the C6 peptide EIA followed by supplemental immunoblotting (C6 2-tier test).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a prospective cohort study of children aged \u22651 to \u226421 years who were undergoing evaluation for Lyme disease in the emergency department at 1 of 6 centers located in regions in which Lyme disease is endemic. The clinical first-tier test and a C6 EIA were performed on the same serum sample with supplemental immunoblotting if the first-tier test result was either positive or equivocal. We compared the results of the paired clinical and C6 2-tier Lyme disease test results using the McNemar test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 1714 children enrolled, we collected a research serum sample from 1584 (92.4%). The clinical 2-tier EIA result was positive in 316 (19.9%) children, and the C6 2-tier test result was positive or equivocal in 295 (18.6%) children. The clinical and C6 2-tier test results disagreed more often than they would have by chance alone (P = .002). Of the 39 children with either a positive clinical or C6 2-tier test result alone, 2 children had an erythema migrans (EM) lesion, and 29 had symptoms compatible with early disseminated Lyme disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Two-tier Lyme disease test results differed for a substantial number of children on the basis of the specific first-tier test used. In children for whom there is a high clinical suspicion for Lyme disease and who have an initially negative test result, clinicians should consider retesting for Lyme disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piy133","type":"journal-article","created":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T20:16:44Z","timestamp":1543522604000},"page":"128-133","source":"Crossref","is-referenced-by-count":12,"title":["Two-Tier Lyme Disease Serology Test Results Can Vary According to the Specific First-Tier Test Used"],"prefix":"10.1093","volume":"9","author":[{"given":"Alexandra B","family":"Maulden","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aris C","family":"Garro","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran","family":"Balamuth","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael N","family":"Levas","sequence":"first","affiliation":[{"name":"Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E","family":"Bennett","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, A. 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Dupont Hospital for Children, Sidney Kimmel Medical College Thomas Jefferson University, Wilmington, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desiree N","family":"Neville","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A","family":"Branda","sequence":"first","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lise E","family":"Nigrovic","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"2020043013161299300_CIT0001","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1128\/CMR.18.3.484-509.2005","article-title":"Diagnosis of Lyme borreliosis","volume":"18","author":"Aguero-Rosenfeld","year":"2005","journal-title":"Clin Microbiol Rev"},{"key":"2020043013161299300_CIT0002","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s11908-014-0450-9","article-title":"A concise critical analysis of serologic testing for the diagnosis of Lyme disease","volume":"16","author":"DeBiasi","year":"2014","journal-title":"Curr Infect Dis Rep"},{"key":"2020043013161299300_CIT0003","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/cid\/cir464","article-title":"Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide 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