Screening for Lyme Disease with C6 Peptide at a Veterans Hospital in Long Island, NY

Abstract

BackgroundLyme Disease (LD) is an endemic disease in Long Island, NY caused by Borrelia burgdorferi. The CDC recommends a two tier system for diagnosis of LD, a screening immunoassay followed by confirmatory Western Blot (WB). The C6 peptide (C6P) is a very sensitive screening test for LD and is currently used as the standard method of screening for LD at the Northport Veteran Affairs Hospital.MethodsA retrospective review of all C6P testing was conducted during the periods of 1/1/2010 to 12/31/2016. A total of 2558 C6P tests were performed at the Northport VA Medical Center. Patients with either positive or equivocal assays were then divided into Lyme Positive (LP) or Lyme Negative (LN) groups. Lyme positive was defined as either having an erythema migrans rash, 2 or more IgM bands or 5 or more IgG bands.ResultsOut of the 409 C6P tests which were evaluated with a follow up western blot, 181 patients were considered LP and 228 were LN. These two groups are similar in age, gender and race. Results summarized in Table 1 and frequency of Western Blot bands were plotted in figure 1. Six of the LP patients were coinfected with babesia and 1 patient coinfected with anaplasma.ConclusionA positive tick bite history, headaches, and joint swelling /aches (P < 0.05), were significantly more likely to be present in patients who were considered to be Lyme positive. The most common false positive antibody is the 41kD IgG.Table 1.Clinical CharacteristicsPositive for Lyme (181)%Negative for Lyme (228)%p-valueMale16993.421192.50.75RaceCaucasian17395.621192.50.23Black73.9177.5Other10.631.3Diabetic3418.84720.60.64Recent Tick bite <30d3418.8104.4Old Tick bite >30d2916.0187.9Tick Bite history6334.828.0012.30.00001Signs andSymptomsEM rash3217.700.0Headaches/neck ache2714.9198.30.036Joint Ache/Swelling5832.04720.60.0086Bell’s Palsy52.841.80.49Myalgias3418.8177.50.00057Palpitations21.100.0Disclosures All authors: No reported disclosures.