Health Care Providers

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.

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.

Download this figure in high resolution pdf icon[PDF – 1 page]

Continuing Medical Education for Clinicians

Case Definition and Report Forms

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.

Additional Reading


Halperin JJ, Baker P, Wormser GP. Common misconceptions about Lyme disease.external icon Am J Med 2013;126(3):264.

Hu LT. Lyme diseaseexternal icon. Ann Intern Med. 2016 May 3;164(9).

Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis.external icon Lancet 2012;379(9814):461-73.

Lyme Carditis

Forrester JD, Mead P. Third-degree heart block associated with lyme carditis: Review of published cases.external icon 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).external icon In: Pickering LK, Red Book: 2012

Feder HM Jr. Lyme disease in children.external icon 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.external icon Obstet Gynecol Surv 2007 Jan;62(1):41-50.


Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of Lyme borreliosis.external icon 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.external icon Clin Infect Dis 2013 Aug;57(3):333-40.

Concerns regarding a new culture method for Borrelia burgdorferi not approved for the diagnosis of Lyme disease. MMWR 2014;63:333.

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.external icon 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.external icon 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 Permissionpdf icon[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.

Recommendations for test performance and interpretation from the second national conference on serologic diagnosis of Lyme disease. MMWR 1995;44:590–591.

Swanson SJ, Neitzel D, Reed KD, Belongia EA. Coinfections acquired from Ixodes ticks.external icon Clin Microbiol Rev 2006 Oct;19(4):708-27.

Ongoing Research

ClinicalTrials.govexternal icon Studies of Lyme disease / “Borrelia Infections”.

Biomedical Literature
Search the biomedical literature at PubMedexternal icon.