Health Care Providers
Diagnosis, Treatment and Testing
- Feeling Worse After Treatment? Maybe It’s Not Lyme Disease
- Two-tier testing explained
- Tests that are NOT recommended (including CD57, urine antigen testing, etc.)
- Tickborne Diseases of the United States: A Reference Manual for Health Care Providers, Fifth Edition (2018).
- Print or save the Tickborne Diseases of the US: A Reference Manual for Health Care Providers, Fifth Edition (2018) Print only version[PDF – 52 pages]
- Order hard copies for your office.
- Online version (replaces the app)
Two-tier testing for Lyme disease
About this Figure
The Two-tier Testing Decision Tree describes the steps recommended by CDC to test for Lyme disease. The first required test is the Enzyme Immunoassay (EIA) or Immunofluorescence Assay (IFA). If this test yields negative results, the provider should consider an alternative diagnosis. Or in cases where the patient has had symptoms for less than or equal to 30 days, the provider may presumptively treat the patient and follow up with a convalescent serum. If the first test yields positive or equivocal results, two options are available: 1) if the patient has had symptoms for less than or equal to 30 days, an IgM Western Blot is performed; 2) if the patient has had symptoms for more than 30 days, the IgG Western Blot is performed. The IgM should not be used if the patient has been ill for more than 30 days.
Understanding laboratory test results
About This Figure
Understanding Test Results for Infectious Diseases
The illustration depicts the likelihood of false positive and false negative test results based on the prior probability of a disease occurring in a given population. Clinicians should consider the likelihood of disease before performing laboratory testing. The likelihood that a patient has a disease depends on many factors:
- Has a patient been in an area where the disease is found?
- Does the patient have signs and symptoms typical of the disease?
- Does the patient have risk factors for contracting or developing the disease?
In populations where disease is rare or unlikely, testing is likely to lead to false positives more frequently than true positives.
Continuing Medical Education for Clinicians
- A free, CDC-sponsored Clinician Outreach and Communication Activity (COCA) course helps providers learn to properly identify and treat tickborne diseases (CME/CNE/CECH available): Little Bite, Big Disease: Recognizing and Managing Tickborne Illnesses.
- As a service to clinicians, CDC has supported the development of an online CME Case Study Course on the Clinical Assessment, Treatment, and Prevention of Lyme Disease. This free, interactive course consists of a series of case studies designed to educate providers regarding the proper diagnosis and treatment of Lyme disease. Each case is accredited for 0.25 CME credits, for a maximum of 1.5 CME. There is no cost for these credits.
- The National Association of School Nurses presents an online course titled “Tick-borne Illness: Prevention, Assessment and Care” that focuses on clinical care of tickborne diseases in school and camp settings. CNE is available.
Case Definition and Report Forms
- Lyme Disease Surveillance Case Definition (revised Jan 2017)
- Lyme Disease Surveillance Case Report Form [PDF – 2 pages] (for public health officials’ use)
Note: Surveillance case definitions establish uniform criteria for disease reporting and should not be used as the sole criteria for establishing clinical diagnoses, determining the standard of care necessary for a particular patient, setting guidelines for quality assurance, or providing standards for reimbursement.
Halperin JJ, Baker P, Wormser GP. Common misconceptions about Lyme disease. Am J Med 2013;126(3):264.
Hu LT. Lyme disease. Ann Intern Med. 2016 May 3;164(9).
Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet 2012;379(9814):461-73.
Forrester JD, Mead P. Third-degree heart block associated with lyme carditis: Review of published cases. Clin Infect Dis 2014 May 30. pii: ciu411.
Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013. MMWR Dec 13;62(49):993-6.
Pediatrics and Pregnancy
American Academy of Pediatrics. Lyme disease (Lyme borreliosis, Borrelia burgdorferi infection). In: Pickering LK, Red Book: 2012
Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am 2008 Jun;22(2):315-26, vii.
Walsh CA, Mayer EW, Baxi LV. Treatment of Lyme disease. Lyme disease in pregnancy: case report and review of the literature. Obstet Gynecol Surv 2007 Jan;62(1):41-50.
Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of Lyme borreliosis. Clin Microbiol Rev 2005 Jul;18(3):484-509.
Branda JA, Strle F, Strle K, Sikand N, Ferraro MJ, Steere AC. Performance of United States serologic assays in the diagnosis of Lyme borreliosis acquired in Europe. Clin Infect Dis 2013 Aug;57(3):333-40.
Hinckley AF, Connally NP, Meek JI, Johnson BJ, Kemperman MM, Feldman KA, White JL, Mead PS. Lyme disease testing by large commercial laboratories in the United States. Clin Infect Dis 2014 May 30. pii: ciu397.
Johnson BJ, Pilgard MA, Russell TM. Assessment of new culture method for detection of Borrelia species from serum of Lyme disease patients. J Clin Microbiol 2014;52:721–4.
Johnson, B.J. “Chapter 4: Laboratory diagnostic testing for Borrelia burgdorferi infection” in Lyme disease: An Evidence-based Approach, J.J. Halperin, Ed. (CAB International, 2011). Complete Article Reproduced with Permission[PDF – 16 pages].
Moore A, Nelson C, Molins C, Mead P, Schriefer M. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United States. Emerg Infect Dis. 2016 Jul;22(7).
Notice to readers: caution regarding testing for Lyme disease. MMWR, CDC Surveillance Summary 2005;54:125.
Swanson SJ, Neitzel D, Reed KD, Belongia EA. Coinfections acquired from Ixodes ticks. Clin Microbiol Rev 2006 Oct;19(4):708-27.
ClinicalTrials.gov Studies of Lyme disease / “Borrelia Infections”.
Search the Biomedical Literature
PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950’s. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.
- Page last reviewed: December 1, 2017
- Page last updated: June 26, 2018
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