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LTT Test for Lyme Disease: Does It Really Work and Is It Reliable?

Is the LTT Test for Lyme Disease Reliable? Accuracy and Limitations

Is the LTT Test for Lyme Disease Reliable? Accuracy and Limitations
Discover whether the LTT test for Lyme disease is a reliable diagnostic tool. Learn about its accuracy, how it works, and the potential benefits and limitations of using it to detect Lyme infection.

The Lymphocyte Transformation Test (LTT) has emerged as a promising diagnostic tool in the battle against Lyme disease, a condition notorious for its diagnostic challenges. While traditional tests such as ELISA and Western Blot remain the standard, they often fall short, especially in detecting chronic or late-stage Lyme disease. This has led many to seek alternatives like the LTT, which aims to measure the body's immune response to Borrelia bacteria. However, questions about the accuracy and reliability of the LTT test remain. Can it provide a clear diagnosis where other tests fail? Is it a reliable option for patients dealing with persistent symptoms? In this article, we delve into the science behind the LTT test, how it works, its advantages, and limitations, to help you determine whether it's a reliable method for diagnosing Lyme disease.

How Reliable Is the LTT Test for Lyme Disease Diagnosis?

Before we assess the reliability of the LTT test for diagnosing Lyme disease and highlight the reported negative cases and proven weaknesses, let's first examine the test's methodology.

Although the LTT test for Borrelia is not without its limitations, we would also like to highlight what seems to be a deliberate effort to undermine the test’s credibility, which further complicates the situation for individuals suspected of having Lyme disease. Our main criticisms are that the test has been shown to occasionally yield inconsistent results and that it is offered at a price that, in some European countries, is three times higher than the Western Blot test. This places an undue financial burden on patients in desperate need of a diagnosis due to their deteriorating condition, as exemplified by the real case discussed below.

Lyme borreliosis, caused by the Borrelia burgdorferi species complex, is the most common tick-borne disease in the Northern Hemisphere. Early diagnosis and appropriate treatment of Lyme borreliosis are crucial to prevent long-term complications, yet the traditional methods of diagnosis, such as Borrelia-specific antibody detection, present significant limitations. Antibodies against Borrelia are often undetectable during the early stages of infection, and their presence alone does not confirm active disease. To address these challenges, the lymphocyte transformation test (LTT) for Borrelia was developed as a diagnostic tool capable of detecting active infection and monitoring treatment efficacy. In their comprehensive study, von Baehr et al. (2012) aimed to validate the effectiveness of Borrelia-LTT, exploring its sensitivity, specificity, and potential application in clinical practice.

Challenges in Diagnosing Lyme Borreliosis

Lyme borreliosis often presents with ambiguous symptoms, ranging from localized skin manifestations to systemic involvement affecting joints, the nervous system, and the heart. Traditional serological methods, such as IgG and IgM antibody detection, are limited in several ways. For instance, Borrelia-specific antibodies may take several weeks to develop after infection, leading to false-negative results in early disease. Additionally, these antibodies may persist long after the infection has resolved, making it difficult to differentiate between past exposure and active infection. Even the use of recombinant Borrelia antigens in modern assays, while improving accuracy, still cannot conclusively prove active infection in all cases.

Moreover, the direct detection of Borrelia through culture or polymerase chain reaction (PCR) methods is highly specific but suffers from low sensitivity, often yielding false-negative results. Thus, there remains a need for a diagnostic method capable of identifying active infections, particularly in patients with ambiguous clinical presentations or negative serology.

Development and Validation of the Borrelia-LTT

The Borrelia-LTT was designed to fill the gap left by traditional diagnostic methods by detecting active cellular immune responses to Borrelia antigens. The LTT measures the proliferation of T cells in response to Borrelia-specific antigens, providing evidence of an ongoing immune response against the pathogen. In their study, von Baehr et al. (2012) utilized lysate antigens from Borrelia burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, and recombinant OspC in the LTT to assess the test’s diagnostic accuracy.

The authors conducted validation studies on various cohorts, including seronegative healthy individuals, seropositive clinically healthy individuals, and patients with clinically confirmed borreliosis. The results demonstrated a sensitivity of 89.4% for detecting active borreliosis and a specificity of 98.7%, making Borrelia-LTT a highly reliable tool for diagnosing active Lyme borreliosis, particularly in seronegative patients.

Correlation Between Borrelia Serology and Borrelia-LTT

In their analysis of 1,480 patients with suspected borreliosis, von Baehr et al. found a strong correlation between Borrelia serology and Borrelia-LTT in 79.8% of cases. The results were positive in both tests in 37.8% of patients, while both tests were negative in 42% of patients. Interestingly, 18% of patients exhibited positive serology with negative LTT results, predominantly following antibiotic treatment. These cases likely represent individuals with resolved infections but persistent antibodies. Conversely, 2.2% of patients were seronegative yet LTT-positive, with half of these patients showing early erythema migrans, suggesting that LTT may detect early immune responses not yet reflected in serological tests.

Impact of Antibiotic Treatment on Borrelia-LTT Results

The Borrelia-LTT has proven particularly useful in monitoring the effectiveness of antibiotic therapy. In a study involving 230 patients with confirmed Lyme borreliosis, follow-up LTT testing performed four to six weeks after antibiotic treatment showed significant declines in LTT reactivity. Among patients with early-stage disease, 92% exhibited negative or borderline LTT results following treatment, suggesting successful elimination of the infection. However, among patients with late-stage disease, only 53 achieved similar outcomes, indicating that Borrelia-specific T cells may persist longer in cases of disseminated infection. These findings underscore the value of LTT in evaluating treatment success, particularly when serology remains unchanged.

Optimizing Borrelia-LTT for Diagnostic Use

The authors highlight several methodological improvements that contributed to the success of the Borrelia-LTT in their study. These include the addition of interferon-α to the cell culture medium, which inhibits nonspecific lymphocyte proliferation and enhances the function of antigen-presenting cells. The use of polymyxin B further reduced nonspecific activation by removing lipid groups from the Borrelia lysates. Additionally, careful selection and dosing of Borrelia antigens were critical in minimizing false-positive results while ensuring sufficient sensitivity to detect Borrelia-specific T cells.

One notable finding from the study was the cross-reactivity observed between lysate antigens of the three Borrelia species and recombinant OspC. While this cross-reactivity limits the ability to identify the specific Borrelia species responsible for infection, it enhances the overall sensitivity of the test for detecting active Lyme borreliosis.

Borrelia-LTT in Long-Term Monitoring and Disease Management

In follow-up studies conducted over one year, von Baehr et al. evaluated patients with both early and late-stage Lyme borreliosis to assess the long-term utility of the Borrelia-LTT. Among patients with early-stage disease, the LTT remained stable and negative in most cases after successful treatment. However, in patients with late-stage disease, intermittent reactivation of Borrelia-specific T cells was observed, correlating with clinical symptom recurrence. These findings suggest that Borrelia-specific T cells may remain dormant in lymphoid organs following treatment and can be mobilized during reactivation of the infection.

The persistence of Borrelia-specific T cells despite negative LTT results following antibiotic treatment raises questions about the complete elimination of the pathogen. In some cases, latent or persistent infections may result in phases of reactivation, further complicating the management of late-stage Lyme borreliosis. These observations align with other studies indicating that Borrelia can persist despite antibiotic treatment, and the authors suggest that a single course of antibiotics may not always suffice for complete eradication of the pathogen.

Evaluating the Use of Borrelia-LTT in Diagnostic Decision-Making

The study by von Baehr et al. (2012) offers valuable insights into the practical applications of Borrelia-LTT in clinical decision-making. Although serology remains a fundamental tool for diagnosing borreliosis, the LTT can play a crucial role in specific scenarios where the clinical picture is unclear or serological results are inconclusive. For example, in patients with early manifestations of borreliosis, where antibodies have yet to develop, the LTT can serve as a more immediate indicator of active infection. In cases where serology results are borderline or where past exposure to Borrelia is suspected but clinical symptoms persist, the LTT can help determine if an active infection is ongoing, thus guiding the decision to initiate antibiotic therapy.

The authors emphasize that while the LTT is a useful diagnostic tool, it should not be used in isolation. Rather, it should complement other clinical findings, such as the patient’s medical history and symptom presentation. This holistic approach ensures a more accurate diagnosis and better-informed treatment decisions, particularly in cases where the infection may have occurred in the more remote past or when clinical symptoms are ambiguous.

Monitoring Treatment Success with Borrelia-LTT

The Borrelia-LTT is also effective in assessing the success of antibiotic treatment, offering a way to track the decline in immune response to Borrelia antigens. However, as noted by von Baehr et al., clinical symptoms may persist for some time even after the infection has been successfully treated. This phenomenon is particularly true in cases of disseminated borreliosis, where the immune system may continue to react to residual antigenic material despite the absence of live Borrelia. Therefore, LTT follow-up testing is best performed four to six weeks after the completion of therapy, allowing sufficient time for any surviving Borrelia to become active and for Borrelia-specific T cells to clear from the bloodstream.

Additionally, the authors caution against performing LTT during antibiotic therapy itself, as the test will likely yield negative results due to the suppressive effects of antibiotics on bacterial activity and the immune response. However, after discontinuation of treatment, the test may again show positive results if the infection persists or reactivates, highlighting its utility in post-therapy monitoring.

Addressing Criticisms of Borrelia-LTT

Despite its strengths, the Borrelia-LTT has faced criticism regarding its specificity, particularly concerns over false-positive results. Von Baehr et al. acknowledge that while some studies have reported a lower specificity for the LTT, these discrepancies are likely due to methodological differences. By optimizing the test’s antigen concentrations and incorporating mechanisms such as the use of interferon-α and polymyxin B to reduce nonspecific activation, the authors were able to achieve a high specificity of 98.7% in their study.

However, the authors also recognize that there is no single "gold standard" for diagnosing borreliosis, and as such, the LTT must be evaluated in conjunction with clinical and serological findings. The study points to a need for further validation, particularly in testing cross-reactivity with other bacterial species, such as syphilis or leptospirosis, which could potentially lead to false-positive results. In their limited testing, von Baehr et al. did not find cross-reactivity with these pathogens, nor did they observe any false positives due to autoimmune diseases, allergies, or persistent viral infections, such as HIV or Epstein-Barr virus.

The Future of Cellular Immunological Testing in Lyme Disease

The Borrelia-LTT is not the only cellular immunological method under investigation for diagnosing Lyme borreliosis. Other tests, such as those based on cytokine stimulation, offer the potential for quicker results, requiring only 24 hours of incubation compared to the six days needed for the LTT. Tests like the QuantiFERON or ELISPOT assays measure cytokine production, such as interferon-γ, by T cells in response to antigen exposure. However, these tests face their own challenges, particularly in distinguishing between latent and active infections, as they may detect cytokine production from non-T helper cells or monocytes in addition to memory T cells.

Von Baehr et al. argue that while cytokine stimulation assays may offer faster results, the LTT remains more reliable for detecting ongoing active infections due to its focus on memory T helper cell proliferation over a longer incubation period. This longer period minimizes the risk of nonspecific activation, which can be a concern in short-term assays. Additionally, the absence of a gold standard for diagnosing active Borrelia infections makes it essential to validate new methods, such as cytokine stimulation tests, against well-established techniques like the LTT.

Conclusion

The lymphocyte transformation test (LTT) for Borrelia represents a significant advancement in the diagnosis and management of Lyme borreliosis. Its high sensitivity and specificity make it a valuable tool for detecting active infections, particularly in cases where serology is inconclusive or where early-stage disease is suspected. Furthermore, the Borrelia-LTT offers clinicians a method for monitoring the success of antibiotic treatment, providing insight into the patient’s immune response and helping guide decisions regarding further therapy.

While challenges remain, such as addressing the potential for false positives and improving cross-reactivity testing, the results of von Baehr et al. (2012) suggest that the Borrelia-LTT is a reliable and informative addition to the diagnostic toolkit for Lyme borreliosis. As newer cellular immunological methods continue to emerge, the Borrelia-LTT provides a solid foundation for future comparative studies and advances in the diagnosis and treatment of this complex disease.

Case Report: Diagnostic Challenges with LTT for Lyme Disease at Synevo Laboratories

Background

In 2023, a middle-aged patient experienced a significant worsening of symptoms suggestive of neuroborreliosis. Seeking medical intervention, the patient consulted a renowned infectious disease specialist. After a comprehensive evaluation, the specialist strongly suspected Lyme disease, particularly its neurological manifestation known as neuroborreliosis. The specialist recommended the lymphocyte transformation test (LTT) at Synevo Laboratories as a diagnostic tool. However, despite clinical suspicion, the LTT results were negative. As a consequence, the patient was not provided with treatment, resulting in ongoing uncertainty, anxiety, and severe physical discomfort.

Progression of Undiagnosed Lyme Disease

Over the following year, the patient’s condition deteriorated significantly. The symptoms worsened to such an extent that the patient became severely debilitated. In light of this rapid decline, alternative diagnostic and therapeutic methods were sought. Blood samples were sent to an overseas laboratory, where the presence of the bacterium Ehrlichia was identified. Immediate antibiotic therapy was initiated and continued for one month.

Immune System Support

In addition to antibiotic treatment, the patient sought to enhance immune function through the use of various supplements. These included colostrum and herbal supplements known for their immunostimulatory properties. This approach was intended to support the body's defense mechanisms and promote recovery from infection.

Further Investigations and Discoveries

Upon the recommendation of a physician, additional testing was conducted to identify other potential infections that could be contributing to the patient's worsening condition. During this process, the patient decided to repeat the Western blot test for Borrelia, despite prior negative results. Surprisingly, the test returned a positive result this time, confirming the presence of Borrelia bacteria. However, despite this new evidence, the patient continued to encounter difficulty in securing treatment. Physicians in Bulgaria remained reluctant to treat the patient, often dismissing the diagnosis of Lyme disease, either due to a lack of awareness or, in some cases, misinformation.

Second LTT Test at Synevo Laboratories

With the positive Western blot result in hand, the patient elected to undergo a second LTT at Synevo Laboratories. This time, the LTT result was positive, highlighting a discrepancy with the earlier test result. Further research into this discrepancy suggested that the immune system's suppression during the initial LTT may have been responsible for the false-negative result. The LTT is designed to detect an active immune response to Borrelia, and it is only effective when the immune system is actively responding to the bacteria at the time of testing.

It is well-documented that Borrelia bacteria can evade detection by suppressing the immune system through specific proteins. This phenomenon, while scientifically established, remains insufficiently recognized or discussed by many healthcare professionals. The lack of widespread knowledge or acknowledgment of these mechanisms likely contributes to the misdiagnosis and delayed treatment of Lyme disease in some cases.

Conclusion

This case illustrates the diagnostic challenges associated with the lymphocyte transformation test (LTT), particularly in patients with a suppressed immune system. The patient's experience underscores the complexities of diagnosing infectious diseases such as Lyme disease, where test results may be influenced by factors like immune status. In this case, the initial negative LTT result delayed appropriate treatment, but a combination of further investigations, including a repeat LTT and Western blot test, ultimately led to an accurate diagnosis.

This report highlights the importance of considering the timing and immune context when interpreting LTT results. It also emphasizes the need for greater awareness among healthcare providers about the immune-evasive properties of Borrelia. The case serves as a reminder that persistence in seeking a diagnosis is crucial in the management of complex infectious diseases like Lyme disease.

Critical Review of the Lymphocyte Transformation Test (LTT) for Diagnosing Lyme Borreliosis

The lymphocyte transformation test (LTT) has been proposed as a method for diagnosing active Lyme borreliosis caused by Borrelia burgdorferi sensu lato. However, in a review by Dessau et al., the utility of LTT for clinical diagnostics is critically evaluated, revealing significant methodological concerns and shortcomings in the existing studies on LTT’s effectiveness. Specifically, a study conducted by von Baehr et al. on the use of LTT in Lyme disease diagnosis raises questions about its reliability, selection criteria, and overall clinical relevance.

Study Overview and Shortcomings

The von Baehr et al. study aimed to validate the LTT for diagnosing active Lyme borreliosis, investigating 120 seronegative blood donors, 40 seronegative patients with autoimmune diseases, 48 healthy seropositive individuals, and 94 seropositive patients with clinical signs of Lyme borreliosis. Additionally, 1,480 samples were tested using both LTT and serological methods, including IgG and IgM ELISA and Western blot.

However, Dessau et al. point out several major issues with the study's design and methodology. For instance, the criteria for diagnosing Lyme borreliosis in the 94 patients with clinical symptoms were not clearly defined. There was no clarification on whether critical diagnostic measures, such as spinal pleocytosis and a positive antibody index, were applied in cases of Bannwarth’s syndrome, as required by European Lyme disease case definitions. Similarly, the diagnosis of patients with migratory arthromyalgias lacked sufficient detail, leaving it unclear how these cases were confirmed as Lyme borreliosis.

Furthermore, the inclusion of 160 seronegative individuals as controls may have introduced selection bias, as serology and LTT results tend to correlate. This could have led to an overestimation of LTT’s specificity. The study also fails to adequately explain the criteria for selecting the 1,480 patients classified as having "suspected Lyme borreliosis," leaving the clinical spectrum of these cases ambiguous.

Confusion in Methodology and Inconsistent Data

The methodology of the von Baehr et al. study also presents several confusing aspects. For instance, the threshold for a positive stimulation index (SI) in the LTT varied between >3 and >5, leading to uncertainty in how positive results were determined. Moreover, the results presented in the tables do not consistently add up. Of the 1,480 patients tested, 592 were reportedly LTT-positive, but only 340 reappear in the subsequent analysis, with no explanation provided for this discrepancy. Dessau et al. argue that a flow diagram or clearer explanation would have been necessary to clarify how subsets of patients were selected for analysis.

Additionally, the study found that 40% of the 1,480 patients suspected of having Lyme borreliosis were LTT-positive, while 63% were serology-positive. These high rates of positive results contrast sharply with findings from similar studies in Denmark, where only 9.2% of suspected Lyme patients were IgM-positive, and 3.3% were IgG-positive. This disparity suggests potential issues with selection bias or problems with the specificity of both LTT and serology in the von Baehr et al. study.

Lack of Evidence for Active Infection Detection and Treatment Monitoring

One of the primary claims of the von Baehr et al. study was that LTT could detect active Lyme borreliosis and monitor the effect of antibiotic treatment. However, Dessau et al. argue that this claim is unsupported due to the lack of follow-up clinical features, such as organism detection via culture or PCR. The study design did not include a prospective trial with a control group, making it difficult to draw any valid conclusions about LTT's ability to detect active infection or monitor treatment effectiveness. Dessau et al. note that rigorous study design, including controlled trials, would be necessary to substantiate these claims.

Concerns About Ethical Standards and Conflicts of Interest

The review also highlights concerns about the ethical standards and potential conflicts of interest in the von Baehr et al. study. An ethics statement was notably absent from the publication. Moreover, the authors of the study were associated with a commercial laboratory that offers the LTT as a diagnostic service, potentially leading to bias. The laboratory’s website suggests that a positive LTT result could indicate persistent infection, even though this is not supported by European neurological or microbiological guidelines, which discourage the use of LTT due to insufficient validation and low specificity.

Challenges in Developing Reliable Diagnostic Biomarkers

While LTT has been proposed as a tool for diagnosing active Lyme borreliosis, the challenges in developing reliable biomarkers for active Borrelia infections remain significant. Antibody detection is currently unable to distinguish between active infection and past exposure or asymptomatic infection, and T-cell recognition, such as that employed in LTT, may lack the necessary specificity to avoid false positives.

Dessau et al. reference a recent Swedish study that explored the use of the ELISPOT technique for supplementary diagnosis of Lyme borreliosis. This study found that ELISPOT had a specificity of only 82%, raising concerns about the reliability of cellular immune response assays like LTT for clinical diagnostics.

Concluding Remarks on LTT’s Clinical Utility

The review concludes that the clinical value of LTT for diagnosing active Lyme borreliosis, as proposed by von Baehr et al., is not supported by the available evidence. The methodological issues, lack of clarity in patient selection, and absence of strong evidence for detecting active infection or monitoring treatment effects undermine the study's conclusions. Additionally, the association with a commercial laboratory raises concerns about conflicts of interest.

Dessau et al. emphasize the importance of critically reading scientific literature and ensuring that adequate peer review standards are met, particularly in the growing number of open-access journals. The issues with LTT highlight the need for cautious interpretation of studies that lack rigorous validation, as unsupported conclusions may lead to misdiagnosis and inappropriate treatment strategies for Lyme disease.

A case of conversion of a positive LTT to a negative one

The lymphocyte transformation test (LTT) is frequently used to diagnose drug reactions by assessing the proliferation of T cells when exposed to a suspected drug antigen. Although the test is simple and low-risk, it carries the possibility of false positives due to various factors influencing immune cell responses. T-cell proliferation in LTT does not always directly correlate with in vivo allergic reactions, and patient conditions such as infections can alter test outcomes. Influenza infection, which typically induces a Th1 immune response, may interfere with results by converting an existing Th2 response.

In an article, based on the work by Kondo et al. (2021), a patient with a history of drug-induced skin eruptions showed multiple positive LTT results for suspected drugs. However, during an influenza infection, the results of the LTT turned negative, raising questions about the test’s reliability during infection. This case emphasizes the importance of understanding immune system modulation when interpreting LTT results, particularly in the context of concurrent infections.

Case Presentation

A 37-year-old woman, with no significant past medical history, experienced recurrent, asymptomatic eruptions consisting of diffuse and fused purpura across her body for six months. At her initial visit to Mie University Hospital, the eruptions had resolved, but her medical history raised suspicions of drug-related eruptions. She had been taking non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, alprazolam, and other medications. Blood tests, including a full blood count, inflammatory markers, and IgE-RAST for common allergens, were within normal ranges. A whole-body computed tomography (CT) scan revealed no abnormalities, ruling out other causes such as infections, allergic reactions, or malignancies.

To further investigate the cause of her eruptions, an LTT was performed for the suspected drugs. The results were all positive, and the patient was advised to discontinue all the tested drugs except alprazolam, after which the eruptions did not recur. One year later, she returned to the hospital seeking advice on which drugs she could safely take. A repeat LTT was performed for the same drugs, and once again, all results were positive. Due to the continued positive results, she was admitted for a drug challenge test (DCT), and a blood sample for the LTT was taken upon admission.

Shortly after hospitalization, the patient developed a high fever and was diagnosed with influenza. Surprisingly, all LTT results taken at the time of admission turned negative for the suspected drugs. Eleven days after recovering from influenza, the LTT was repeated, and some of the results had reverted to positive. A patch test with dilutions of the same drugs tested in the LTT yielded negative results. Drug challenge tests for tiaramide and loxoprofen were performed, but no skin eruptions occurred. However, due to the high stimulation index (SI) for acetaminophen, the DCT for this drug was not performed, and the patient was advised to avoid acetaminophen. After this intervention, no recurrence of skin rashes was observed.

The detailed LTT data, including stimulation indices across various time points, can be found in the original article by Kondo et al. (2021).

Discussion

This case highlights a unique scenario in which previously positive LTT results turned negative during an influenza infection. The LTT is generally useful for diagnosing drug-induced reactions, as it measures T-cell proliferation following stimulation with the targeted drug. The test is especially valuable in diagnosing severe drug eruptions, with positive rates as high as 60-70% for certain drug classes like β-lactams. However, the test is not without limitations, particularly when multiple drugs yield positive results.

It is known that the immune system responds differently depending on the nature of the trigger. Th1 immune responses are typically induced during infections, such as influenza, while drug reactions often provoke a Th2 response. In this case, the shift from Th2 to Th1 induced by the influenza infection may explain the temporary disappearance of positive LTT results. Despite the patient’s persistent lymphocyte count, the immune response to the drugs was altered during the infection, leading to false-negative LTT results.

Moreover, the discrepancy between the patch test and LTT results may be due to the limited penetration of drugs through the epidermis during patch testing. In cases where Th2 cells are abundant, such as in pseudo-lymphoma or erythroderma papulosum drug eruptions, LTT results are more likely to be positive, whereas patch tests may yield negative results due to insufficient drug penetration.

The current case, reported by Kondo et al. (2021), underscores the need for careful timing when performing LTT, particularly in patients with concurrent infections. While LTT remains a valuable tool in diagnosing drug reactions, its results can be influenced by underlying immune shifts, such as those caused by infections. It is important to take the clinical context into account, as well as the immune status of the patient, when interpreting LTT results.

Conclusion

In this case, the immune response to suspected drugs changed from positive to negative during an influenza infection, likely due to a shift from a Th2 to a Th1 immune response. This highlights the importance of considering the timing of LTT in patients with concurrent infections, as immune modulation may affect the reliability of the test results. Clinicians should be cautious in interpreting LTT outcomes and consider repeating the test after recovery from an infection to ensure accurate diagnosis and appropriate management of drug allergies.

References

  1. The Lymphocyte Transformation Test for Borrelia Detects Active Lyme Borreliosis and Verifies Effective Antibiotic Treatment
    Author: Volker von Baehr
    Publisher: Bentham Open
    URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC3474945/
  2. Lymphocyte transformation test: The multiple positive results turned to all negative after influenza infection
    Author: Makoto Kondo
    Publisher: Wiley
    URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC8443438/
  3. The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful
    Author: R.B. Dessau
    Publisher: Clinical Microbiology and Infection
    URL: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65422-7/fulltext

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