QUOTE- "Here at Johns Hopkins, for example, our laboratory does not report Western blot bands with its Lyme disease testing results. The report is a simple yes or no; you have a positive result or a negative result, so there is less tendency for misinterpretation." Paul Auwaerter, for Medscape Infectious Diseases.
Auwaerter was co-author on the Hopkins blood test study- 2005- where it showed 75% of the people with Lyme were missed.
"Among acute-phase samples, 21 (25%) were seropositive, including 8 with IgG and 17 with IgM by immunoblotting. "
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1248466/pdf/0742-05.pdf
He was also the editor for the 2006 IDSA Lyme disease guidelines which stated:
"Therefore, the presence of seropositivity does not guarantee that a given medical condition is due to B. burgdorferi infection."
"For the small proportion of patients who have neurologic Lyme disease but are found to be seronegative by 2-tier testing, a convalescent-phase serum sample obtained ∼2 weeks after the acute-phase sample will usually yield positive results."
"In the absence of erythema migrans, neurologic manifestations are too nonspecific to warrant a purely clinical diagnosis; laboratory support for the diagnosis is required." "In the vast majority of patients, the clinical manifestations are too nonspecific to warrant a purely clinical diagnosis of Lyme arthritis. Confirmation of the diagnosis requires serologic testing. All patients should be determined to be seropositive by 2-tier testing that includes an ELISA and IgG immunoblot [162, 206]"
Unfortunately, the findings of this meta-analysis cannot be considered reliable, because the majority of the studies that were analyzed included “Lyme disease” cases that were poorly characterized or were diagnosed on the basis of less reliable serologic testing methods than are currently recommended [278, 279]."
"If serologic testing for Lyme disease is done for chronically ill patients who only have fatigue or musculoskeletal complaints without any objective manifestation of Lyme disease, the test results have a poor positive predictive value [98, 99, 101, 102, 104, 270]. Regardless of the nature of the symptom(s), a low positive predictive value can also be anticipated if serologic testing is done for patients who do not reside in or travel to a geographic area where Lyme disease is endemic. Under these circumstances, the majority of patients with a positive test result will not have active B. burgdorferi infection and, accordingly, would be unlikely to obtain a durable response from antibiotic treatment directed at this
infection."
"Moreover, many of these studies did not follow currently recommended standards for serologic testing for Lyme disease [117] and were likely to have included patients who had never been infected with B. burgdorferi."
"The most sensitive diagnostic method is acute-phase and convalescent-phase serologic testing using an indirect fluorescent antibody assay (acute-phase testing alone is not sufficiently sensitive) [348–350]."
"Diagnostic testing performed in laboratories with excellent quality-control procedures is required for confirmation of extracutaneous Lyme disease, HGA, and babesiosis."
IDSA 2006 Lyme Guidelines
http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
CDC states:
"The two steps of Lyme disease testing are designed to be done together. CDC does not recommend skipping the first test and just doing the Western blot. Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment."
CDC Criteria Lyme testing
http://www.cdc.gov/lyme/diagnosistesting/LabTest/TwoStep/index.html
CDC Report
http://www.cdc.gov/mmwr/preview/mmwrhtml/00038469.htm