Practice parameters for the diagnosis of patients with nervous system Lyme borreliosis (Lyme disease)

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Abstract
In endemic Lyme borreliosis areas, significant numbers of asymptomatic individuals may have serologic evidence of exposure to B. burgdorferi. [1] Consequently, coincidentally positive serologic tests may lead to the inappropriate attribution of unrelated disorders to this infection. By contrast, in nonendemic areas, serologic false positives may outnumber true positives, again potentially leading to overdiagnosis. These problems, inherent in any serologic testing, are further compounded by differences in technique among laboratories, often resulting in discordant results. [2,3] These problems may lead to under- or overdiagnosis and inadequate or unnecessary treatment, then to unnecessary morbidity and cost as well as inconvenience. In seropositive individuals, the potential cost and morbidity of leaving a true B. burgdorferi infection untreated must be balanced against the risks and costs of unnecessary treatment. For each patient, the physician's analysis must include: