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Modified Two-Tiered Testing (MTTT) Study Shows Increased Early Sensitivity for B. Burgdorferi

Arick P. Sabin, et al., published “Clinical evaluation of a Borrelia modified two-tiered testing (MTTT) shows increased early sensitivity for Borrelia burgdorferi but not other endemic Borrelia species in a high incidence region for Lyme disease in Wisconsin” in Diagnostic Microbiology and Infectious Disease on November 9, 2022,* (version of record). Recently, a modified two-tiered testing algorithm (MTTT; ZEUS Scientific) for Borrelia burgdorferi was cleared by the FDA. This led the researchers to assess the algorithm to verify Lyme disease as well as evaluate the results in comparison to those acquired using standard two-tiered testing (STTT).

Modified Two-Tiered Testing (MTTT)
Borrelia burgdorferi, Courtesy Dave Dorward, PhD, NIH

Medical documents from patients who provided sera for laboratory testing for Lyme-like disease were examined. Three hundred twenty sera samples were run by the STTT and MTTT methodologies and the results were assessed. The positive STTT samples were also positive by MTTT (94%). The MTTT corroborated the disease in 116 subjects (36%, P = 0.007), and 30 (26%) were negative by the STTT. Heightened MTTT sensitivity was observed (P = 0.0005) during initial contagion. MTTT was inadequately sensitive in detecting other non-Borrelia spp. illnesses.

Standard implementation of MTTT would enhance sensitivity for early Lyme disease caused by B. burgdorferi but could potentially fail to detect illness originating from B. mayonii and B. miyamotoi.


For more information:

Read the study in Diagnostic Microbiology and Infectious Disease.

Visit the CDC’s Lyme Disease 2022 Case Definition.

Read more about Lyme disease testing.