Faculty Collaboration Database

Diagnostic Performance of C6 Enzyme Immunoassay for Lyme Arthritis. Pediatrics 2020 Jan;145(1)

Date

12/15/2019

Pubmed ID

31836615

DOI

10.1542/peds.2019-0593

Scopus ID

2-s2.0-85077403221 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

OBJECTIVES: In Lyme disease endemic areas, initial management of children with arthritis can be challenging because diagnostic tests take several days to return results, leading to potentially unnecessary invasive procedures. Our objective was to examine the role of the C6 peptide enzyme immunoassay (EIA) test to guide initial management.

METHODS: We enrolled children with acute arthritis undergoing evaluation for Lyme disease presenting to a participating Pedi Lyme Net emergency department (2015-2019) and performed a C6 EIA test. We defined Lyme arthritis with a positive or equivocal C6 EIA test result followed by a positive supplemental immunoblot result and defined septic arthritis as a positive synovial fluid culture result or a positive blood culture result with synovial fluid pleocytosis. Otherwise, children were considered to have inflammatory arthritis. We report the sensitivity and specificity of the C6 EIA for the diagnosis of Lyme arthritis.

RESULTS: Of the 911 study patients, 211 children (23.2%) had Lyme arthritis, 11 (1.2%) had septic arthritis, and 689 (75.6%) had other inflammatory arthritis. A positive or equivocal C6 EIA result had a sensitivity of 100% (211 out of 211; 95% confidence interval [CI]: 98.2%-100%) and specificity of 94.2% (661 out of 700; 95% CI: 92.5%-95.9%) for Lyme arthritis. None of the 250 children with a positive or equivocal C6 EIA result had septic arthritis (0%; 95% CI: 0%-1.5%), although 75 children underwent diagnostic arthrocentesis and 27 underwent operative joint washout.

CONCLUSIONS: In Lyme disease endemic areas, a C6 EIA result could be used to guide initial clinical decision-making, without misclassifying children with septic arthritis.

Author List

Nigrovic LE, Bennett JE, Balamuth F, Levas MN, Neville D, Lyons TW, Branda JA, Maulden AB, Lewander D, Garro A, PEDI LYME NET

Author

Michael Levas MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Arthritis, Infectious
Arthrocentesis
Blood Sedimentation
Borrelia burgdorferi
C-Reactive Protein
Child
Child, Preschool
Clinical Enzyme Tests
Diagnosis, Differential
Female
Humans
Immunoblotting
Immunoglobulin G
Immunoglobulin M
Infant
Lyme Disease
Male
Prospective Studies
Sensitivity and Specificity