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New! APHL Guidance and Interpretation of Lyme Disease Serologic Test Results

This report describes the proper interpretation of serologic testing for B. burgdorferi and identifies best practices for reporting results to clinicians, public health agencies, and patients.

Videos

Understanding pre-test probability

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]

Additional Reading

General

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).

Kugeler KJ, Schwartz AM, Delorey MJ, et al. Estimating the frequency of Lyme disease diagnoses, United States, 2010-2018. Emerg Infect Dis. 2021 Feb;27(2):616-619.

Schwartz AM, Kugeler KJ, Nelson CA, et al. Use of commercial claims data for evaluating trends in Lyme disease diagnoses, United States, 2010-2018. Emerg Infect Dis. 2021;27(2):499-507.

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

Lyme Carditis

Marx GE, Leikauskas J, Lindstrom K, et al. Fatal Lyme Carditis in New England: Two Case Reportsexternal icon  Annals of Internal Medicine 2020;172(3): 222-224.

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.

Pediatrics and Pregnancy

American Academy of Pediatrics. Lyme disease (Lyme borreliosis, Borrelia burgdorferi infection).external icon In: Pickering LK, Red Book: 2021.

Grant DS, Neville DN, Levas M, et al. Validation of septic knee monoarthritis prediction rule in a Lyme disease endemic areaexternal icon. Pediatr Emerg Care. 2021 May 13.

Sood SK. Lyme disease in childrenexternal icon. Infect Dis Clin North Am. 2015 Jun;29(2):281-94.

Waddell LA, Greig J, Lindsay LR, et al. A systematic review on the impact of gestational Lyme disease in humans on the fetus and newbornexternal icon. PLoS One. 2018 Nov 12;13(11):e0207067.

Testing

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, Steere AC. Laboratory diagnosis of Lyme Borreliosisexternal icon. Clin Microbiol Rev. 2021 Jan 27;34(2):e00018-19.

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, et al. 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 Permission [PDF – 16 pages].pdf icon

Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.

Moore A, Nelson C, Molins C, et al. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United StatesEmerg 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.

Mead PM, Petersen JM, Hinckley AF. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.

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.