Lyme disease overdiagnosis in a large healthcare system: a population-based, retrospective study
Open accessAbstract
Objectives To evaluate the impact of false-positive IgM immunoblots on Lyme disease treatment and case reporting in a large healthcare system. Methods We obtained the results of all Lyme disease serological tests ordered at U.S. Air Force healthcare facilities in the USA between January 2013 and December 2017. We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria, and we assessed whether these cases were reported to the U.S. Department of Defense surveillance system. Results Of the 18 410 serum tests (17 058 immunoassays and 1352 immunoblots) performed on 15 928 unique individuals, 249/1352 (18.4%) IgM immunoblots were positive. After excluding repeat tests, insufficiently documented cases, and participants with a history of Lyme disease, 212 positive IgM immunoblot cases were assessed. A total of 113/212 (53.3%) were determined to be false positives. Antibiotics were prescribed for Lyme disease for 97/99 (98.0%) participants with a true-positive test and 91/113 (80.5%) participants with a false-positive test. The number of false-positive cases reported to the surveillance system was identical to the number of unreported true-positive cases (n = 44). Conclusions Lyme disease serological tests were overused in a large healthcare system, and positive results were frequently misinterpreted, leading to misdiagnosis and widespread antibiotic misuse. Underreporting of…
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There are cases of incorrect reporting of Lyme disease in clinical practice, resulting in false-positive diagnoses, and incidence rates should be interpreted with caution.
“It should be noted, however, there that are cases of incorrect reporting of Lyme disease in clinical practice, resulting in false-positive diagnoses of Lyme disease, and accordingly, incidence rates should be interpreted with caution [67].”
From What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease? (2025) · cites this paper as [67]
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What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease?
Brutkiewicz, R. R., Cao, W., Morgan, D., Reis, R. S. D., Suryadevara, V., Willette, A. A., Willette, S. A., Wyatt-Johnson, S. K., & Duggan, M. R. (2025) · Trends in Neurosciences · doi:10.1016/j.tins.2025.05.009 · Cited by 3 · see citing works
- Authors
- Webber, B. J., Burganowski, R. P., Colton, L., Escobar, J. D., Pathak, S. R., & Gambino-Shirley, K. J.
- Affiliations
- Wright-Patterson Air Force Base (US)
- Solutions Through Innovative Technologies (United States) (US)
- Corresponding author
- Webber, B.J.
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 25
- Issue
- 10
- Pages
- 1233-1238
- ISSN
- 1198-743X (ISSN-L)
- OpenAlex
- W2917833030
- Cited by
- 57
- References
- 0
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 9 · 2022: 13 · 2021: 2 · 2020: 14 · 2019: 3
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- U.S. Department of Energy
- Oak Ridge Institute for Science and Education
- U.S. Air Force
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- Lyme disease, overdiagnosis, serological testing, antibiotic misuse, misdiagnosis, case notification, surveillance systems, United States Air Force, military health services
- MeSH terms
- Medical Overuse, Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Bacterial, Child, Child, Preschool, False Positive Reactions, Female, Humans, Immunoglobulin M, Infant, Lyme Disease, Male, Middle Aged, Military Personnel, Retrospective Studies, Serologic Tests, United States, Immunoblotting, Incidence, Young Adult
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