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Support modification ( editing ) of existing documents. Work in all ... There are other good open source JavaScript PDF libraries available. However, most of them ... the probability of a false-positive test result is greater than that of a true-positive result For these reasons, the American College of Physicians has established guidelines for laboratory evaluation of patients with suspected Lyme disease: 1 The diagnosis of early Lyme disease is clinical (ie, exposure in an endemic area, with physician-documented erythema migrans), and does not require laboratory confirmation (Tests are often negative at this stage) 2 Late disease requires objective evidence of clinical manifestations (recurrent brief attacks of monarticular or oligoarticular arthritis of the large joints; lymphocytic meningitis, cranial neuritis [Bell s palsy], peripheral neuropathy or, rarely, encephalomyelitis but not headache, fatigue, paresthesias, or stiff neck alone; atrioventricular conduction defects with or without myocarditis) and laboratory evidence of disease (twostage testing with ELISA and Western blot, as described above) 3 Patients with nonspecific symptoms without objective signs of Lyme disease should not have serologic testing done It is in this setting that false-positive tests occur more commonly than true-positive tests 4 The role of serologic testing in neuroborreliosis is unclear, as sensitivity and specificity of cerebrospinal fluid serologic tests have not been determined However, it is rare for a patient with neuroborreliosis to have positive serologic tests on cerebrospinal fluid without positive tests on serum (see below) 5 Other tests such as the T cell proliferative assay, PCR testing, and urinary antigen detection have not yet been studied well enough to be routinely used (see discussion below) Cultures for B burgdorferi can be performed but are not routine and are usually reserved for clinical studies Aspiration of erythema migrans lesions has yielded positive cultures in up to 30% of cases, whereas culture of a 2-mm punch biopsy is positive in 50 70% PCR of a skin biopsy is even more sensitive, with positivity rates of 80% In early disease, blood cultures are positive in up to 50% if large volumes (9 mL) are used, but cerebrospinal fluid is rarely culture positive The ability to culture organisms from skin lesions is greatly influenced by antibiotic therapy Even a brief course of several days will result in negative cultures Special silver staining of chronically inflamed synovial tissue demonstrates spirochetes in one-third of patients PCR is very specific for detecting the presence of Borrelia DNA, but sensitivity is variable and depends on which body fluid is tested and the stage of the disease In general, PCR is more sensitive than culture, especially in chronic disease Up to 85% of synovial fluid samples are positive in active arthritis In contrast, 38% of cerebrospinal fluid samples in acute neuroborreliosis are PCR positive, and only 25% are positive in chronic neuroborreliosis The significance of a positive reaction is unclear Whether a positive PCR indicates persistence of viable organisms that will respond to further treatment or is a marker for residual DNA (not active infection) has not been clarified In chronic Lyme arthritis, some have suggested that a positive PCR indicates active infection that requires further therapy, while others have found a positive reaction despite months of therapy, suggesting that the presence of DNA is indicative of an autoimmune arthritis. online pdf javascript editor: About PDFescape - The Free PDF Editor - PDFescape jquery pdf editor plugin Display and manipulate PDF files within your web interface thanks to ...
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