Announcing a new article publication for Zoonoses journal. Clinicians’ understanding of prevalence is key in diagnostic test interpretation. In high-prevalence scenarios, the post-test probability of a positive test result can approach 100%, whereas in low-prevalence situations, the post-test probability might only slightly exceed the initial low pre-test probability. In this article an example of this issue is presented in the context of interpreting Lyme disease test results in high- versus low-incidence states.
A thought experiment is presented demonstrating the effects of prevalence on the interpretation of early Lyme disease serologic testing. A positive test result was found to be more than 30 times more likely to be a false positive than a true positive in Arkansas.
In locations with low Lyme disease incidence, efforts might be better spent on thoroughly working up alternative diagnoses before considering testing for Lyme disease. Furthermore, it is suggested that clinicians in low-incidence states in the southern USA consider waiting before treating patients empirically with antibiotics for clinical scenarios consistent with early Lyme disease, because southern tick-associated rash illness in the southern USA commonly mimics the classic erythema migrans rash associated with Lyme disease, but is mild and self-limiting.
Read More: https://www.scienceopen.com/hosted-document?doi=10.15212/ZOONOSES-2025-0016
Zoonoses is fully open access journal for research scientists, physicians, veterinarians, and public health professionals working on diverse disciplinaries of zoonotic diseases. Please visit https://zoonoses-journal.org/ to learn more about the journal.
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eISSN 2737-7474
ISSN 2737-7466
Dirk Haselow and Aaron Wendelboe. How Prevalence Influences the Interpretation of Lyme Disease Test Results in a High-Incidence State (Wisconsin) Versus a Low-Incidence State (Arkansas). Zoonoses. 2025. Vol. 5(1). DOI: 10.15212/ZOONOSES-2025-0016