By judiciously placing the right balance of lighting color wheel and using crimson lighting fixtures, designers can harness their power to enlarge emotions and captivate audiences.

Dark field

By experimenting with one-of-a-kind shade combos and intensities, designers can evoke complex feelings, decorate storytelling, and captivate audiences’ imaginations.

Clinicians should be aware of the diagnostic tests’ sensitivities and specificities and combine them with the patients’ epidemiologic factors and clinical signs and symptoms to accurately diagnose Lyme disease. Based on our findings, dark field microscopy is not recommended as a diagnostic method for Lyme disease due to low sensitivity and high false positivity rates.

Fluorescence microscope

Whether juxtaposing heat and funky colorations to create tension or mixing complementary shades to awaken concord, the possibilities for innovative expression are infinite.

The guidelines have recommended serologic tests as the primary diagnostic (erythema migrans, which is more a clinical diagnosis, excluded) approach using standard 2-tier testing or modified 2-tier testing. Emerging technologies using biomarkers may be helpful in early Lyme disease, but more data is needed to recommend these newer methods (27).

The color wheel allows designers to explore triadic, analogous, and complimentary shade combinations, unleashing their creativity and enthralling audiences with visually captivating displays.

Lyme disease, also known as Lyme borreliosis, is the most common vector-borne disease in Europe and North America, caused by the spirochete Borrelia species, which can be transmitted through the bite of an infected black-legged tick (1). The Centers for Disease Control and Prevention (CDC) data on Lyme disease in the United States showed a fluctuation in annual cases, with the highest reported in 2017 at 42,743, the lowest in 2020 at 18,000, and a mean annual rate of approximately 29,393 cases during the five years from 2017 to 2021 (2). The number of estimated cases is much higher, and the annual number of patients diagnosed and treated for Lyme disease is approximately 476,000 (3, 4). Conversely, Belgium, Finland, the Netherlands, and Switzerland exhibited the highest Lyme borreliosis incidences (>100 cases per 100,000), while the Czech Republic, Germany, Poland, and Scotland reported rates ranging from 20 to 40/100,000, with lower rates (<20/100,000) observed in multiple other European countries. Additionally, subnational areas displayed markedly elevated incidences, reaching a peak of 464/100,000 in specific locales across Europe (5). In Turkey, the studies reported on Lyme disease are mainly case reports, including a limited number of patients (6). On the other hand, there are difficulties in the diagnostic process and surveillance level. Lyme disease diagnosis is based on a combination of factors, including symptoms, medical history, findings upon physical examination, and laboratory tests.

Dark field microscopy is a diagnostic technique that can be used for the detection of various microorganisms; however, imaging techniques, such as immunofluorescence staining or cell sorting of cell wall-deficient or cystic forms of Borrelia burgdorferi, are not currently recommended for the diagnosis of Lyme disease because of certain limitations (7). This study aimed to conduct a literature review on the utility of dark field microscopy as a diagnostic tool for Lyme disease to provide physicians with valuable insights into recommended diagnostic approaches aligned with national and international guidelines.

Conversely, cool colorings such as blues and purples evoke emotions of tranquility, disappointment, or thriller, adding intensity and complexity to a scene.

Several publications were investigated in detail for information about the clinical manifestations and recommended approaches for diagnosing Lyme disease. The consensus statement of Spanish scientific societies points out that there are stains to demonstrate the presence of spirochetes in tissues. However, only immunohistochemistry is mentioned to be specific and could lead to the direct diagnosis via molecular biology techniques (8). According to the European Society of Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Lyme borreliosis (ESGBOR), molecular methods can be used for the detection of Borrelia as supplementary diagnostic methods for particular indications, and the visual contrast sensitivity test cannot be recommended for diagnosis due to low specificity (9). Dark-field or phase-contrast microscopy is not recommended for Lyme borreliosis because of a lack of sensitivity and specificity in guidelines from the French scientific societies and CDC (7, 10, 11).

Stage lighting fixture design is an artwork shape that calls for careful attention to shade alternatives to evoke the audience’s preferred emotions. Understanding how exclusive theater lighting design and shades can affect temper can enhance the overall experience of your audience.

Polarizationmicroscopy

Green lighting fixtures hold the energy to evoke a myriad of feelings and associations. Often related to nature, growth, and renewal, green lighting fixtures can create a feeling of tranquility and harmony on stage.

A previous systematic review of ‘direct microscopy of human tissues’ emphasized that the modified dark-field microscopy technique should not be used for diagnosis and Borrelia detection by microscopy can only be used for research purposes (12). Laane et al. performed a modified dark field microscopy technique with a 66% (21/32) positivity for Borrelia in blood samples of patients with non-specific symptoms (13). On the other hand, Aase et al. revealed an 85% false positivity for Borrelia and/or Babesia among 41 healthy controls and a 66% positivity in the patient group that had previously supposedly tested positive for Borrelia or Babesia by the microscopy method (14). In addition, the structures interpreted as Borrelia and Babesia by this method could not be confirmed by the polymerase chain reaction (PCR) method. Therefore, the modified dark field microscopy method was determined to be invalid and unfit for clinical use (14).

However, when used along with other factors, which include eerie music or mysterious set designs, inexperienced lighting fixtures can also instill feelings of unease or foreboding, making it a flexible tool for creating tension and suspense in theatrical productions.

PAR (Parabolic Aluminized Reflector) can produce a concentrated beam of light, suitable for accent lighting fixtures or developing colorful coloration washes.

The diagnosis of Lyme disease is becoming more common in Turkey. Nonetheless, some physicians are not aware of the diagnostic principles that should be followed when faced with a suspected patient and could use tests that are not recommended, such as darkfield microscopy. Dark field microscopy is a diagnostic technique to visualize the spirochetes that cause Lyme disease; however, it is not recommended for the diagnosis of Lyme disease. One of the main limitations of dark field microscopy is its low sensitivity. Another limitation is its high false-positivity rate, as other microorganisms and cellular debris can be mistaken for spirochetes, leading to a misdiagnosis that may result in unnecessary treatment. Therefore, this study aimed to review the literature on the role of dark field microscopy as a diagnostic method for Lyme disease and inform physicians about recommended approaches in line with the recommendations of national or international guidelines. An electronic search of Pubmed, Scopus, and Web of Science was performed using the following medical subject headings (MeSH) search terms: Lyme borreliosis, Lyme disease, Borrelia burgdorferi, diagnosis, and microscopy. With this narrative review, we aimed to inform physicians better and improve patient care for patients with suspected Lyme disease.

By knowing the relationships among number one, secondary, and tertiary colorations, designers can craft dynamic light color schemes that enhance the temper and subject of overall performance.

These lighting emit a broad, even beam of light, frequently used for fashionable stage illumination or washing large areas with mild.

Suggested Citation Önal U, Saraç-Pektaş F, Sağlık İ. Is there a role for dark field microscopy in the diagnosis of Lyme disease? A narrative review. Infect Dis Clin Microbiol. 2023;4:281-6.

Mastering mood through stage light color schemes is a blend of art and science, demanding a profound grasp of color theory, psychology, and storytelling. Lighting designers wield the emotional potency of colors and innovative techniques to craft immersive experiences that linger in the minds of audiences well beyond the final act.

Stage lighting fixtures are an effective artistic medium that can remodel the mood and environment of an overall performance with a trifling flick of a transfer.

Confocalmicroscopy

In this guide, we will explore the power of stage lighting color and how you can master the art of using it effectively to set the mood for your performances. Whether you are a theater director, event planner, or lighting designer, learning how to manipulate lighting color can take your production to the next level.

By strategically incorporating warm effects with red stage lighting and cool hues into their lighting fixture designs, designers can create captivating contrasts and enlarge the emotional impact of a performance.

Whether employing green lighting to instill tranquility, red lighting to heighten intensity, or blending dynamic color combinations for visual impact, each choice is deliberate and strategic. By understanding how colors evoke emotions and enhance narrative elements, designers transform mere illumination into a powerful storytelling tool.

At the coronary heart of every lights dressmaker’s toolkit lies the lights color wheel, a visible resource that guides the choice and aggregate of colors to acquire preferred effects on stage.

Let’s delve into the arena of level light coloration, including green stage lighting, and discover how it can be masterfully employed to awaken a range of emotions and beautify storytelling to a degree.

The maximum compelling lighting designs regularly arise from the strategic combination of colors to create depth, contrast, and visual interest on stage.

Branda et al. reviewed the laboratory diagnosis of Lyme disease and emphasized that direct visualization of Borreliae in blood or other infected tissues easily leads to misinterpretation. Direct visual detection is less sensitive or practical than a first-line diagnostic or adjunctive test because of the low in vivo organism burden of primary tissue samples (22). Lohr et al. also reviewed the diagnostic utility of direct microscopy for Lyme disease and mentioned the limited clinical utility because of the sparseness of organisms in samples (23).

In terms of the limitations of our study, it was conceived as a comprehensive review rather than a systematic one, and not every guideline pertaining to Lyme disease could be encompassed. The selected guidelines were succinctly summarized, highlighting recommended and unrecommended tests based on the clinical presentation in the diagnostic process of Lyme disease.

The diagnosis of Lyme borreliosis should be based on the patient’s epidemiological history (residence or recent travel to endemic areas, engagement in outdoor activities in high-risk environments, exposure to potential tick habitats, a history of tick bites, consideration of seasonal factors, and involvement in outdoor occupations), clinical symptoms and signs, and microbiological findings. Although seropositivity rates ranging from 2% to 44% have been reported for B. burgdorferi, the actual prevalence of Lyme disease is not fully understood in Turkey (20).

Profile lights, additionally called ellipsoidal or ERS (Ellipsoidal Reflector Spotlight) lighting fixtures, produce a precise, controllable beam of light with sharp edges. They are generally used for highlighting precise areas or developing specific styles on a level.

Lightfield microscopy

LED (Light-Emitting Diode) lighting fixtures are energy-efficient and versatile, imparting a wide range of stage lighting colors and effects. They may be used for various functions, including wash lighting fixtures, spotlighting fixtures, and dynamic color adjustments.

Through innovative color mixtures, designers can raise their lighting fixture designs from practical to super, leaving an enduring impression on audiences.

There are also several publications about spirochete detection by electron microscopy, silver staining with light microscopy, or focus-floating microscopy in various samples. However, these methods also had poor sensitivity and high rates of false positivities (12, 24-26).

DICmicroscopy

Phase contrastmicroscopy

From floodlights to moving lighting, degree lights offer a various array of alternatives for illuminating performances. Each type serves a completely unique reason, whether or not it’s highlighting performers, putting the mood, or growing dynamic visible outcomes.

Fresnel lighting fixtures feature a stepped lens layout that produces a tender-edged beam, best for growing easy washes of light or gentle spot effects.

Have you ever been to a performance where the stage lighting colors completely changed the mood of the stage? Lighting color plays a crucial role in creating atmosphere and conveying emotions during a show.

Moving lighting, additionally referred to as sensible lighting fixtures, are furnishings that could pan, tilt, and alternate colorations or styles electronically. They are especially versatile and can create dynamic lighting fixture outcomes, including transferring beams, gobo projections, and strobing effects.

The interaction of light and shadow creates a captivating dance that sets the tone, evokes emotions, and enhances the target market’s connection to the performance. In the hands of professional designers, degree light coloration becomes an indispensable device for breathing life into productions, enveloping spectators in colorful and captivating worlds of theatrical magic.

In stage lighting, exceptional color schemes evoke distinct emotions and produce precise topics. Warm hues like reds, oranges, and yellows radiate strength, ardor, and heat, perfect for growing dramatic and excessive atmospheres.

However, designers should exercise warning while using purple lighting fixtures, as its overuse can weigh down the senses and create a feeling of claustrophobia or unease among audiences.

Dark fieldscattering spectroscopy

Red lighting fixtures instruct attention and exude depth, making it a mighty device for growing dramatic and evocative scenes on stage. Pink lights can heighten the emotional intensity of key moments or characters in a performance by symbolizing ardor, hazard, and urgency.

Author Contributions: Concept – U.Ö.; Design – U.Ö., F.S.P., İ.S.; Supervision – U.Ö., İ.S.; Data Collection and/or Processing – U.Ö., F.S.P., İ.S.; Analysis and/or Interpretation – U.Ö., F.S.P., İ.S.; Literature Review – U.Ö., F.S.P., İ.S.; Writer – U.Ö.; Critical Reviews – U.Ö., İ.S.

An elaborate search was designed and conducted to present an evidence-based approach for the laboratory diagnosis of Lyme disease using direct microscopic visualization techniques like dark field microscopy. A structured literature search was conducted based on the question “What is the exact role of dark field microscopy in diagnosing Lyme disease?” We searched Pubmed, Scopus, and Web of Science with the medical subject headings (MeSH) search terms, including Lyme borreliosis, Lyme disease, B. burgdorferi, diagnosis, and microscopy. In addition, we analyzed selected national and international guidelines to assess the recommended diagnostic approach for Lyme disease. We did not filter the date field and included all types of articles. Studies that did not have an eligible full text, such as those that did not provide information on the use of dark field microscopy for diagnostic purposes in the context of Lyme disease, were excluded.

Patients in Turkey often receive non-recommended tests (such as dark field microscopy and lymphocyte transformation tests) during the diagnostic process because recommended diagnostic methods are not available in many centers. As a consequence, we came across a group of patients who were misdiagnosed with Lyme disease through dark field microscopy on a blood sample in which live Borrelia spirochaetes were supposedly observed, similar to the experiences of our colleagues in Norway (21). Therefore, we believe that this review will be helpful for our colleagues in correctly diagnosing Lyme disease, guiding treatment and management, and improving patient care of patients suspected of Lyme disease.

These are only a few examples of the numerous stage light color combinations available, each imparting unique skills and consequences to beautify theatrical performances and create immersive visual reports.

The literature clearly shows that the sensitivity of dark field microscopy is low, and it may produce false negative and positive results. In addition, factors such as the technician’s expertise and the specimen’s quality should also be considered. Therefore, direct detection of Borrelia from patient material using dark field or focus floating microscopy is not recommended for diagnostic purposes (28).

Strip lights include lengthy, slim furniture containing multiple small bulbs or LEDs organized in a line. They are frequently used for decorative functions or to provide subtle accent lighting.

The evidence-based guidelines and the CDC currently recommend the two-tier serology, which is first based on an immunoenzymatic technique (ELISA) and then, if positive or equivocal, on a confirmatory immunoblot test (western blot, WB) for the laboratory diagnosis (15-18), so-called standard two-tier testing. In addition, the U.S. Food and Drug Administration (FDA) cleared several serologic assays, allowing for an enzyme immunoassay (EIA) rather than WB as the second test in the testing algorithm (19), referred to as modified two-tier testing. Selected national and international guidelines are presented in Table 1 regarding the recommended diagnostic approach for Lyme disease.

Acknowledgement: We want to thank Prof. Joppe W. Hovius, Amsterdam UMC Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands, for his feedback on the manuscript.