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Equine veterinary journal2020; 53(1); 71-77; doi: 10.1111/evj.13277

Modelling the probability and impact of false-positive serology for Borrelia burgdorferi sensu lato: A case study.

Abstract: Serological screening tests for Lyme borreliosis have poor specificity, with potential for misdiagnosis and unnecessary antimicrobial treatment. Objective: To evaluate the impact of Lyme borreliosis seroprevalence and serologic test characteristics on the probability of obtaining a false-positive result and impact on antimicrobial use. Methods: Cross-sectional serological survey and modelling. Methods: Sera from 303 horses in southern Belgium were analysed by enzyme-linked immunosorbent assay (ELISA). Apparent seroprevalence was derived from serological data and a Bayesian estimate of true seroprevalence was computed. These were a starting point to model the impact of test and population characteristics on the probability of obtaining false-positive results and consequently unnecessary treatments and complications. Results: Apparent and true seroprevalence were 22% (95% CI 18%-27%) and 11% (credible interval with 95% probability 0.6%-21%) respectively. We estimate that two-thirds of positive samples are false positive in southern Belgium, with one in five of tested horses potentially misdiagnosed as infected. Around 5% of antimicrobial use in equine veterinary practice in Belgium may be attributable to treatment of a false-positive result. Conclusions: There was uncertainty regarding the ELISA's sensitivity and specificity. Conclusions: This study highlights the importance of appreciating the poor diagnostic value of ELISA screening for Lyme borreliosis as demonstrated by this case study of seroprevalence in southern Belgium where we demonstrate that a nontrivial number of horses is estimated to receive unwarranted treatment due to poor appreciation of screening test characteristics by practitioners, contributing substantially to unnecessary use of antimicrobials.
© 2020 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2020-06-23 PubMed ID: 32385952PubMed Central: PMC7818418DOI: 10.1111/evj.13277Google Scholar: Lookup
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  • Journal Article

Summary

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The research analyzes the likelihood and impact of incorrect positive results in serological tests for Lyme borreliosis in horses in Belgium. It indicates that there is a significant possibility of these tests resulting in misdiagnosis, leading to unnecessary treatments and antimicrobial use.

Objective and Methodology

  • The objective of this research was to evaluate the impact of Lyme borreliosis seroprevalence, the occurrence of the disease in a specific population, and the characteristics of the serological tests on the probability of getting a false-positive result, leading to unnecessary applications of antimicrobial treatment.
  • Using a cross-sectional serological survey and modelling, the research investigated sera from 303 horses from southern Belgium using enzyme-linked immunosorbent assay (ELISA), a common laboratory test used for detecting and measuring antibodies in blood.
  • The researchers analyzed the apparent seroprevalence derived from the serological data and computed a Bayesian estimate of true seroprevalence as a starting point for their model.
  • The model was designed to study the impact of test and population characteristics on the likelihood of obtaining false-positive results and consequently unnecessary treatments and complications.

Results

  • The results indicated that both apparent and true seroprevalence were 22% (95% CI 18%-27%) and 11% (credible interval with 95% probability 0.6%-21%) respectively.
  • The research suggested that two-thirds of the positive sample results in southern Belgium were false positives, leading to one in five of the tested horses potentially being misdiagnosed as infected.
  • About 5% of antimicrobial use in Belgian equine veterinary practice was likely a result of treatment based on false-positive findings.

Conclusions

  • Despite the study pointing out that uncertainty exists regarding the ELISA’s sensitivity and specificity, it highlighted the crucial need to recognize the poor diagnostic value of ELISA screening for Lyme borreliosis.
  • Through the case study of seroprevalence in southern Belgium, the research illustrates that a considerable amount of horses likely receive unneeded treatment due to a lack of understanding of screening test characteristics by practitioners.
  • The misguided treatments were contributing substantially to the unnecessary use of antimicrobials in the population, not only raising concerns about possible antibacterial resistance but also about the well-being of horses that receive unneeded treatment.

Cite This Article

APA
Houben RMAC, Meersschaert C, Hendrickx G, Pitel PH, Amory H. (2020). Modelling the probability and impact of false-positive serology for Borrelia burgdorferi sensu lato: A case study. Equine Vet J, 53(1), 71-77. https://doi.org/10.1111/evj.13277

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 53
Issue: 1
Pages: 71-77

Researcher Affiliations

Houben, Rosa M A C
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
Meersschaert, Carole
  • Laboratoires Réunis, Junglinster, Luxembourg.
Hendrickx, Guy
  • Avia-GIS, Zoersel, Belgium.
Pitel, Pierre-Hugues
  • LABEO Frank Duncombe, Caen, France.
Amory, Hélène
  • FARAH, Faculty of Veterinary Medicine, Liège University, Liège, Belgium.

MeSH Terms

  • Animals
  • Antibodies, Bacterial
  • Bayes Theorem
  • Belgium / epidemiology
  • Borrelia burgdorferi
  • Borrelia burgdorferi Group
  • Cross-Sectional Studies
  • Enzyme-Linked Immunosorbent Assay / veterinary
  • Horse Diseases / diagnosis
  • Horse Diseases / epidemiology
  • Horses
  • Lyme Disease / diagnosis
  • Lyme Disease / epidemiology
  • Lyme Disease / veterinary
  • Seroepidemiologic Studies

Grant Funding

  • Equine Focus Point Belgium

Conflict of Interest Statement

C. Meersschaert and P. Pitel are employed by commercial laboratories which offer diagnostics. Neither laboratory had influence on the content or the submission of this manuscript.

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Citations

This article has been cited 1 times.
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