Skip to main content
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems
  • Log in
  • My alerts
  • My Cart

Main menu

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems

User menu

  • Log in
  • My alerts
  • My Cart

Search

  • Advanced search
Journal of Clinical Microbiology
publisher-logosite-logo

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
Commentary

Expanding Access to Biospecimens for Lyme Disease Test Development

John L. Schmitz
Brad Fenwick, Editor
John L. Schmitz
aDepartment of Pathology & Laboratory Medicine, McLendon Clinical Laboratories, UNC Health, Chapel Hill, North Carolina, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Brad Fenwick
University of Tennessee at Knoxville
Roles: Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOI: 10.1128/JCM.00449-20
  • Article
  • Info & Metrics
  • PDF
Loading

ABSTRACT

The laboratory diagnosis of Lyme disease relies upon serologic testing. A standard or modified two-tiered testing algorithm is used to enhance the accuracy of antibody detection. However, this approach suffers from a lack of sensitivity in early Lyme disease. Ongoing efforts to develop more sensitive antibody detection technologies and other diagnostic approaches are dependent upon the availability of quality-assured biospecimens linked to reliable clinical data. In this issue of the Journal of Clinical Microbiology, Horn et al. (E. J. Horn, G. Dempsey, A. M. Schotthoefer, U. L. Prisco, et al., J Clin Microbiol 58:e00032-20, 2020, https://doi.org/10.1128/JCM.00032-20) described the development of the Lyme Disease Biobank. Clinically categorized case patients with early Lyme disease and healthy controls were identified (without laboratory diagnostic testing) from three sites where Lyme disease is endemic. Subjects provided whole blood and urine, which were processed and stored at a central biorepository. Whole blood, serum, and urine aliquots were prepared and are available to investigators developing laboratory diagnostics for Lyme disease. After obtaining samples, extensive laboratory testing was performed, including serologic and nucleic acid amplification testing for B. burgdorferi and other tick-borne pathogens. Direct detection methods yielded few positive results. Relative to the findings for another commonly used biorepository cohort, the results of this testing demonstrated a low seropositive rate, as determined by standard two-tiered testing. Additionally, relatively few subjects demonstrated seroconversion with testing of convalescent-phase samples. This clinical and serologically defined cohort of samples from Lyme disease and control cases from areas of Lyme disease endemicity offers an additional valuable resource for novel test development that includes alternate specimen types.

The views expressed in this article do not necessarily reflect the views of the journal or of ASM.

TEXT

Lyme disease (LD), caused by Borrelia burgdorferi sensu stricto, is the most frequently reported tick-borne illness in the United States. Recent analyses estimate over 300,000 cases annually in the United States (1). Most cases occur in the Northeast and Upper Midwest; however, the range of B. burgdorferi-infected ticks may be expanding, resulting in transmission in areas where they were previously considered nonendemic (2). LD occurs in stages, including the early localized (erythema migrans [EM]), early disseminated, and late disseminated stages. EM is a pathognomonic sign that is, however, not universally present and that may be atypical (3, 4). As such, laboratory-based diagnostics are often used to confirm clinical suspicion.

Direct detection of B. burgdorferi, including culture and nucleic acid amplification tests (NAT), are possible but are not practical or sufficiently effective (reviewed in reference 5). Culture is technically challenging due to the slow replicative rate of the B. burgdorferi and thus are neither useful nor practical. NAT can be used for the detection of B. burgdorferi DNA in cerebrospinal fluid (CSF), synovial fluid (SF), and EM lesions. However, the sensitivity of CSF and SF testing by NAT is poor. NAT of EM lesions is more sensitive than NAT of CSF and SF but is usually unnecessary due to the characteristic nature of the EM lesion. Given these limitations, serologic tests are the mainstay of LD diagnostics.

People infected with B. burgdorferi mount robust antibody responses. Patients with disseminated stages typically have levels of antibody readily detectable with current antibody tests and algorithms (6). However, antibody testing in patients with early, localized disease is challenging due to the relatively slow developing antibody response (7). The majority of cases presenting with EM are clinically diagnosed and treated without laboratory confirmation of infection. In addition to sensitivity, specificity concerns with LD antibody tests are well-known. There are cross-reactions in LD assays due to other bacterial infections. In addition, viral infections, such as infections with Epstein-Barr virus, have been associated with false reactivity. A number of approaches have been adopted and are being investigated to improve upon the suboptimal sensitivity and specificity of antibody detection in LD.

The current standard approach for the serologic diagnosis of early disseminated and late disseminated infection with B. burgdorferi is the standard two-tier testing algorithm (STTTA), adopted in 1994 (8). The algorithm relies on the use of a relatively sensitive enzyme immunoassay (EIA) as a screening test. A negative result is reported as such. If the result is equivocal or positive, the sample is then reflexively tested by Western immunoblotting (WB). WB enhances the specificity of testing by requiring IgM and/or IgG reactivity with multiple spirochetal proteins. Unfortunately, the enhanced specificity achieved with this reflexive testing approach is at the cost of sensitivity. The WB assay has lower sensitivity than the screening tests (9). This is particularly problematic for the detection of antibodies during early localized infection, when antibody levels are low. Specificity has been improved with the adoption of the two-tiered testing algorithm (8) as well as with tests using conserved proteins from B. burgdorferi (10, 11).

Among the improvements to testing for LD is the recent adoption of a modified two-tiered testing algorithm (MTTTA) (12). This algorithm replaces WB with a second EIA that uses spirochetal antigens different from those used in the screening EIA. This change addresses, in part, the sensitivity concerns with the WB. Studies have documented this improvement (13–15) and have led the U.S. Centers for Disease Control and Prevention (CDC) to endorse this algorithm as an alternative to the standard two-tiered testing algorithm. A second approach to increase the sensitivity of antibody detection is the use of novel technologies. Arumugam et al. (16) described the use of a multiplexed assay on a microfluidic platform as a more sensitive alternative. In their study, a sensitivity of 80 to 85% was achieved in early LD patients. In comparison, the two-tiered testing algorithm achieved sensitivities of 48.5 to 75%. As expected, the sensitivity was 100% in Lyme arthritis patients, as was the case for the two-tiered testing algorithm.

Given the effectiveness of early treatment (17) and the diagnostic challenges, a significant research effort is under way to develop more sensitive methods for diagnosing early LD. Advances in understanding the biology of B. burgdorferi and the host response to infection and technological advances are paving the way for improvements in laboratory diagnostics (5, 9). As additional novel methods for the detection of B. burgdorferi antibody or other direct detection methods are developed and evaluated, there is a major need for reliable sources of well-documented, quality-assured biospecimens. In particular, biospecimens from early LD patients are particularly desirable.

To this point, Horn et al. (18) describe the development of the Lyme Disease Biobank (LDB). The purpose of LDB is to be a resource for biospecimens from early LD patients and healthy controls from areas of endemicity for use in test development and evaluation. In their publication, the authors describe the identification and assessment of LDB samples. Case patients included subjects from an area of endemicity with EM (lesion size, >5 cm) or annular skin lesions (lesion size, ≤5 cm) or subjects with one or more signs/symptoms of early LD (headache, fatigue, fever, chills, joint or muscular pain) but lacking skin lesions. Cases were enrolled within 30 days of onset and could have been treated with antibiotics for less than 48 h. Controls included healthy subjects from areas of endemicity with no history of LD or other tick-borne infection. LD test results were not used in the selection process for case patients or controls.

Biospecimens were collected from consenting case patients and controls (greater than 10 years of age) identified in 3 areas of endemicity: Martha’s Vineyard, MA; East Hampton, NY, and north central Wisconsin (5 clinic sites). In this initial report, 550 subjects (298 case patients and 252 controls) were enrolled. Whole blood and urine were collected from the case patients and controls and shipped to a central biorepository (Precision for Medicine, Frederick, MD). At the repository, samples were processed and stored as serum, plasma, whole-blood, and whole-urine aliquots. The biorepository is College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified. In addition to biospecimens, a case report form was completed to gather demographic information, information on the signs and symptoms of LD, treatment history, other medical history, relevant epidemiological information, tick exposure, and a photograph of any skin lesions.

All blood samples were tested in a blinded manner by real-time PCR (RT-PCR) for B. burgdorferi, Anaplasma phagocytophilum, Babesia microti, and Borrelia miyamotoi. Samples obtained from Wisconsin were also tested by RT-PCR for Borrelia mayonii and Ehrlichia muris subsp. eauclairensis. Some samples were cultured for B. burgdorferi. A subset of these had the culture fluid tested by RT-PCR for B. burgdorferi. All samples were tested by both a screening EIA and WB. Laboratory testing was performed at multiple sites and included 3 different screening EIAs, depending on the laboratory and time period. Both in-house-developed and commercial WB assays were used, with interpretations being performed according to CDC criteria (8). Many samples were also tested by 2 EIAs, allowing classification according to the MTTTA. The testing laboratories were CAP accredited and CLIA certified.

Based on signs/symptoms and serologic test results, case patients were classified as having laboratory-confirmed LD (positive results by use of the STTTA, RT-PCR, or culture or positive results by two EIAs and an EM lesion size of >5 cm; 35% of cases), probable LD (an EM lesion size of >5 cm and a negative result by use of the STTTA), suspected LD (am EM/annular lesion size of <5 cm and a negative result by use of the STTT), or symptomatic with no lesions. A negative STTTA result could have a positive individual test (EIA or WB) result in the algorithm.

Laboratory testing with direct methods confirmed the poor sensitivity of these approaches: two EM cases were culture positive, nine case patients and one control were positive by RT-PCR-augmented culture, and four cases were RT-PCR positive. B. microti and A. phagocytophilum were also detected in 9% and <1% of samples, respectively.

The STTTA was positive for 29% of cases with EM lesion sizes of >5 cm and for 10 to 12% of cases with EM lesion sizes of <5 cm and cases without lesions. Two percent of controls from regions of endemicity had a positive STTTA result. Just over half of the subjects provided a convalescent-phase blood sample, which was collected from 2 to 3 months after the acute-phase sample was obtained. Interestingly, only 4% of convalescent-phase samples from EM-positive patients demonstrated seroconversion (seronegative in the acute-phase sample and seropositive in the convalescent-phase sample) by STTTA. In total, 35% of patients in the group classified as type 1 (those with EM) had laboratory-confirmed LD, 44% had probable LD, and 21% had suspected LD. In the type 2 category (patients who did not have EM but who were symptomatic), 14% had laboratory-confirmed LD and 86% were seronegative. Eighty-three percent of controls from areas of endemicity were negative by all serologic tests.

This LDB is a source for biospecimens from well-characterized donors that is available to test developers and evaluators. Potential users can access application forms online (info{at}lymebiobank.org). This biorepository is focused on early LD samples. This includes samples from patients with potentially nonclassical or absent EM. While this presents some degree of uncertainty in their use as standards to judge the performance of novel assays, they do represent the patient group for which novel tests are most needed. This study did not enroll subjects with early or late disseminated disease, as these are not priority areas for test development since robust IgG antibody responses will be detected in most patients. However, the bank has more recently enrolled samples from subjects with disseminated disease.

Of concern is the relatively low seropositivity rates of EM-positive cases. This may present a challenge for test development, as the classification of cases with atypical lesions or cases with symptoms of early LD but no lesions could be questioned. While a significant number of donors provided convalescent-phase samples, the STTTA seroconversion rate was <5%, which is concerning (7, 19) and which is lower than that reported for the CDC Lyme Serum Repository (LSR) (20). A close look at the data shows a seroconversion rate of only 7% for IgG blots but a rate of 33% for IgM blots. Applying the STTTA criteria of not using the IgM WB result after 30 days postonset reduces the seroconversion rate significantly. The lack of IgG seroconversion might be due to the use of antibiotics and the 2- to 3-month time frame for collection of the convalescent-phase samples. However, 82% of cases were antibiotic naive. For now, the low seropositivity rate remains unexplained.

Overall, the Lyme Disease Biobank provides another useful biospecimen resource for individuals involved in LD test development and evaluation. It is unique in the variety of biospecimens available (whole blood, serum, urine). It can also be of use for other tick-borne diseases as well, given the laboratory testing conducted. An often-cited resource for serum specimens from Lyme disease patients is the CDC LSR (20), which contains serum samples from EM-positive patients (acute- and convalescent-phase samples) as well as patients with early disseminated infection (carditis, neuroborreliosis) and late disseminated infection (Lyme arthritis). In contrast to the LDB, the LSR samples from patients with early Lyme disease excluded samples from subjects that had received antibiotic therapy (patients who provided convalescent-phase samples had not received antibiotic therapy). In addition, more samples in LSR than in LDB were culture and/or PCR positive. Forty percent of acute-phase samples were STTTA positive, while 61% of convalescent-phase samples were positive, as defined by strict STTTA application (i.e., disregarding the IgM WB result for samples collected >30 days after symptom onset). These results for samples from patients with early disease are noticeably different from those for samples from LDB.

There is a growing appreciation for the value of carefully created, curated, and managed biorepositories to support basic, translational, and clinical research (21). Preanalytic variables can significantly affect testing results; as such, standardization of practices is highly desirable. In fact, there are organizations that accredit biorepositories. Accreditation, such as that provided by the College of American Pathologists, offers a mechanism to ensure best practices in the acquisition, storage, and distribution of biospecimens for research (22). It is worthwhile noting the parent organization of the LDB is accredited by CAP and has CLIA certification. This should provide additional confidence in the quality of the associated biospecimens provided.

  • Copyright © 2020 American Society for Microbiology.

All Rights Reserved.

REFERENCES

  1. 1.↵
    1. Nelson CA,
    2. Saha S,
    3. Kugeler KJ,
    4. Delorey MJ,
    5. Shankar MB,
    6. Hinckley AF,
    7. Mead PS
    . 2015. Incidence of clinician-diagnosed Lyme disease, United States, 2005–2010. Emerg Infect Dis 21:1625–1631. doi:10.3201/eid2109.150417.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Barbarin AM,
    2. Seagle SW,
    3. Creede S
    . 2020. Notes from the field: four cases of Lyme disease at an outdoor wilderness camp—North Carolina, 2017 and 2019. MMWR Morb Mortal Wkly Rep 69:114–115. doi:10.15585/mmwr.mm6904a5.
    OpenUrlCrossRef
  3. 3.↵
    1. Schutzer SE,
    2. Berger BW,
    3. Krueger JG,
    4. Eshoo MW,
    5. Ecker DJ,
    6. Aucott JN
    . 2013. Atypical erythema migrans in patients with PCR-positive Lyme disease. Emerg Infect Dis 19:815–817. doi:10.3201/eid1905.120796.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Tibbles CD,
    2. Edlow JA
    . 2007. Does this patient have erythema migrans? JAMA 297:2617–2627. doi:10.1001/jama.297.23.2617.
    OpenUrlCrossRefPubMedWeb of Science
  5. 5.↵
    1. Schutzer SE,
    2. Body BA,
    3. Boyle J,
    4. Branson BM,
    5. Dattwyler RJ,
    6. Fikrig E,
    7. Gerald NJ,
    8. Gomes-Solecki M,
    9. Kintrup M,
    10. Ledizet M,
    11. Levin AE,
    12. Lewinski M,
    13. Liotta LA,
    14. Marques A,
    15. Mead PS,
    16. Mongodin EF,
    17. Pillai S,
    18. Rao P,
    19. Robinson WH,
    20. Roth KM,
    21. Schriefer ME,
    22. Slezak T,
    23. Snyder JL,
    24. Steere AC,
    25. Witkowski J,
    26. Wong SJ,
    27. Branda JA
    . 2019. Direct diagnostic tests for Lyme disease. Clin Infect Dis 68:1052–1057. doi:10.1093/cid/ciy614.
    OpenUrlCrossRef
  6. 6.↵
    1. Steere AC,
    2. McHugh G,
    3. Damle N,
    4. Sikand VK
    . 2008. Prospective study of serologic tests for Lyme disease. Clin Infect Dis 47:188–195. doi:10.1086/589242.
    OpenUrlCrossRefPubMedWeb of Science
  7. 7.↵
    1. Aguero-Rosenfeld ME,
    2. Nowakowski J,
    3. Bittker S,
    4. Cooper D,
    5. Nadelman RB,
    6. Wormser GP
    . 1996. Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans. J Clin Microbiol 34:1–9. doi:10.1128/JCM.34.1.1-9.1996.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    Centers for Disease Control and Prevention (CDC). 1995. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep 44:590–591.
    OpenUrlPubMed
  9. 9.↵
    1. Branda JA,
    2. Body BA,
    3. Boyle J,
    4. Branson BM,
    5. Dattwyler RJ,
    6. Fikrig E,
    7. Gerald NJ,
    8. Gomes-Solecki M,
    9. Kintrup M,
    10. Ledizet M,
    11. Levin AE,
    12. Lewinski M,
    13. Liotta LA,
    14. Marques A,
    15. Mead PS,
    16. Mongodin EF,
    17. Pillai S,
    18. Rao P,
    19. Robinson WH,
    20. Roth KM,
    21. Schriefer ME,
    22. Slezak T,
    23. Snyder J,
    24. Steere AC,
    25. Witkowski J,
    26. Wong SJ,
    27. Schutzer SE
    . 2018. Advances in serodiagnostic testing for Lyme disease are at hand. Clin Infect Dis 66:1133–1139. doi:10.1093/cid/cix943.
    OpenUrlCrossRef
  10. 10.↵
    1. Wormser GP,
    2. Schriefer M,
    3. Aguero-Rosenfeld ME,
    4. Levin A,
    5. Steere AC,
    6. Nadelman RB,
    7. Nowakowski J,
    8. Marques A,
    9. Johnson BJ,
    10. Dumler JS
    . 2013. Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease. Diagn Microbiol Infect Dis 75:9–15. doi:10.1016/j.diagmicrobio.2012.09.003.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Bacon RM,
    2. Biggerstaff BJ,
    3. Schriefer ME,
    4. Gilmore RD,
    5. Philipp MT,
    6. Steere AC,
    7. Wormser GP,
    8. Marques AR,
    9. Johnson BJB
    . 2003. Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole-cell lysates. J Infect Dis 187:1187–1199. doi:10.1086/374395.
    OpenUrlCrossRefPubMedWeb of Science
  12. 12.↵
    1. Mead P,
    2. Petersen J,
    3. Hinckley A
    . 2019. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep 68:703. doi:10.15585/mmwr.mm6832a4.
    OpenUrlCrossRef
  13. 13.↵
    1. Branda JA,
    2. Strle K,
    3. Nigrovic LE,
    4. Lantos PM,
    5. Lepore TJ,
    6. Damle NS,
    7. Ferraro MJ,
    8. Steere AC
    . 2017. Evaluation of modified 2-tiered serodiagnostic testing algorithms for early Lyme disease. Clin Infect Dis 64:1074–1080. doi:10.1093/cid/cix043.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Pegalajar-Jurado A,
    2. Schriefer ME,
    3. Welch RJ,
    4. Couturier MR,
    5. MacKenzie T,
    6. Clark RJ,
    7. Ashton LV,
    8. Delorey MJ,
    9. Molins CR
    . 2018. Evaluation of modified two-tiered testing algorithms for Lyme disease laboratory diagnosis using well-characterized serum samples. J Clin Microbiol 56:e01943-17. doi:10.1128/JCM.01943-17.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Lipsett SC,
    2. Branda JA,
    3. Nigrovic LE
    . 2019. Evaluation of the modified two-tiered testing method for diagnosis of Lyme disease in children. J Clin Microbiol 57:e00547-19. doi:10.1128/JCM.00547-19.
    OpenUrlAbstract/FREE Full Text
  16. 16.↵
    1. Arumugam S,
    2. Nayak S,
    3. Williams T,
    4. di Santa Maria FS,
    5. Guedes MS,
    6. Chaves RC,
    7. Linder V,
    8. Marques AR,
    9. Horn EJ,
    10. Wong SJ,
    11. Sia SK,
    12. Gomes-Solecki M
    . 2019. A multiplexed serologic test for diagnosis of Lyme disease for point-of-care use. J Clin Microbiol 57:e01142-19. doi:10.1128/JCM.01142-19.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Wormser GP,
    2. Dattwyler RJ,
    3. Shapiro ED,
    4. Halperin JJ,
    5. Steere AC,
    6. Klempner MS,
    7. Krause PJ,
    8. Bakken JS,
    9. Strle F,
    10. Stanek G,
    11. Bockenstedt L,
    12. Fish D,
    13. Dumler JS,
    14. Nadelman RB
    . 2006. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43:1089–1134. doi:10.1086/508667.
    OpenUrlCrossRefPubMedWeb of Science
  18. 18.↵
    1. Horn EJ,
    2. Dempsey G,
    3. Schotthoefer AM,
    4. Prisco UL,
    5. McArdle M,
    6. Gervasi SS,
    7. Golightly M,
    8. De Luca C,
    9. Evans M,
    10. Pritt BS,
    11. Theel ES,
    12. Iyer R,
    13. Liveris D,
    14. Wang G,
    15. Goldstein D,
    16. Schwartz I
    . 2020. The Lyme Disease Biobank: characterization of 550 patient and control samples from the East Coast and Upper Midwest of the United States. J Clin Microbiol: 58:e00032-20. doi:10.1128/JCM.00032-20.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. Rebman AW,
    2. Crowder LA,
    3. Kirkpatrick A,
    4. Aucott JN
    . 2015. Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients. Clin Rheumatol 34:585–589. doi:10.1007/s10067-014-2706-z.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Molins CR,
    2. Sexton C,
    3. Young JW,
    4. Ashton LV,
    5. Pappert R,
    6. Beard CB,
    7. Schriefer ME
    . 2014. Collection and characterization of samples for establishment of a serum repository for lyme disease diagnostic test development and evaluation. J Clin Microbiol 52:3755–3762. doi:10.1128/JCM.01409-14.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    1. De Souza YG,
    2. Greenspan JS
    . 2013. Biobanking past, present and future: responsibilities and benefits. AIDS 27:303–312. doi:10.1097/QAD.0b013e32835c1244.
    OpenUrlCrossRef
  22. 22.↵
    1. McCall SJ,
    2. Branton PA,
    3. Blanc VM,
    4. Dry SM,
    5. Gastier-Foster JM,
    6. Harrison JH,
    7. Jewell SD,
    8. Dash RC,
    9. Obeng RC,
    10. Rose J,
    11. Mateski DL,
    12. Liubinskas A,
    13. Robb JA,
    14. Ramirez NC,
    15. Shea K
    . 2018. The College of American Pathologists Biorepository Accreditation Program: results from the first 5 years. Biopreserv Biobank 16:16–22. doi:10.1089/bio.2017.0108.
    OpenUrlCrossRef
PreviousNext
Back to top
Download PDF
Citation Tools
Expanding Access to Biospecimens for Lyme Disease Test Development
John L. Schmitz
Journal of Clinical Microbiology May 2020, 58 (6) e00449-20; DOI: 10.1128/JCM.00449-20

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Print

Alerts
Sign In to Email Alerts with your Email Address
Email

Thank you for sharing this Journal of Clinical Microbiology article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Expanding Access to Biospecimens for Lyme Disease Test Development
(Your Name) has forwarded a page to you from Journal of Clinical Microbiology
(Your Name) thought you would be interested in this article in Journal of Clinical Microbiology.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
Expanding Access to Biospecimens for Lyme Disease Test Development
John L. Schmitz
Journal of Clinical Microbiology May 2020, 58 (6) e00449-20; DOI: 10.1128/JCM.00449-20
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Top
  • Article
    • ABSTRACT
    • TEXT
    • REFERENCES
  • Info & Metrics
  • PDF

KEYWORDS

biospecimen
Borrelia burgdorferi
diagnosis
Lyme disease
immunoserology

Related Articles

Cited By...

About

  • About JCM
  • Editor in Chief
  • Board of Editors
  • Editor Conflicts of Interest
  • For Reviewers
  • For the Media
  • For Librarians
  • For Advertisers
  • Alerts
  • RSS
  • FAQ
  • Permissions
  • Journal Announcements

Authors

  • ASM Author Center
  • Submit a Manuscript
  • Article Types
  • Resources for Clinical Microbiologists
  • Ethics
  • Contact Us

Follow #JClinMicro

@ASMicrobiology

       

ASM Journals

ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology.

About ASM | Contact Us | Press Room

 

ASM is a member of

Scientific Society Publisher Alliance

 

American Society for Microbiology
1752 N St. NW
Washington, DC 20036
Phone: (202) 737-3600

 

Copyright © 2021 American Society for Microbiology | Privacy Policy | Website feedback

Print ISSN: 0095-1137; Online ISSN: 1098-660X