Preliminary falsification of EIA screening is cost‐effective in the two‐step serodiagnosis of lyme disease

We read with great interest the article by Trevejo et al. that described a simplified procedure for the laboratory diagnosis of Lyme disease (LD). The authors assumed as “certain” the clinical diagnosis of LD and on this basis calculated the sensitivity of 3 different diagnostic approaches. We suggest that there is some bias in the assumption that 25 EIA-positive serum samples plus 2 more Western immunoblot (WB)–confirmed samples, among equivocal results, sum up to a sensitivity of 41%, by the authors’ simplified method, in the early phase of LD. Similarly, the assumption was made that 39 EIA-positive sera, with no WB confirmation of equivocal results, give a sensitivity of 71% in the convalescent phase. The authors ignore that 6 (22%) of 27 and 23 (59%) of 39 EIA-positive results were disproved by WB. We cannot understand what scientific reasoning allows the omission of the WB-unconfirmed, EIA-equivocal results and the inclusion of WB-unconfirmed but EIApositive cases.