At a glance
CDC is working to compile the most up to date guidance and information for front-line healthcare professionals to consult when treating and preventing Lyme Disease in patients. Check out the resources below for more information.
Tools for the clinic
Caring for Patients after a Tick Bite [PDF – 2 pages]
Tickborne Diseases of the United States
Wall Poster: The Many Forms of Lyme Disease Rashes (Erythema Migrans)
Lyme disease prophylaxis after tick bite
Lyme Disease Prophylaxis After Tick Bite Poster [PDF – 1 page]
Lyme Disease Prophylaxis After Tick Bite Printable [PDF – 1 page]
Note: In general, CDC does not recommend antibiotics after tick bites to prevent tickborne diseases. However, in certain circumstances, a single dose of doxycycline after a tick bite in an area where Lyme disease is common may lower risk of Lyme disease.
Lyme disease serologic testing and pretest probability
A patient’s pretest probability for Lyme disease helps inform whether they should be tested for Lyme disease.
Pretest Probability of Lyme Disease and Serologic Testing Poster [PDF – 2 pages]
Pretest Probability of Lyme Disease and Serologic Testing Printable Version [PDF – 2 pages]
Evaluation of pediatric knee monoarthritis in areas where Lyme disease occurs
Evaluation of Pediatric Knee Monoarthritis in Areas Where Lyme Disease Occurs Poster [PDF – 1 page]
Note: This tool is intended to support healthcare providers. Providers should use clinical judgement, taking into account the patient's history, diagnostic testing, and prior treatment when making clinical decisions for their patients.
Special thanks to Pedi Lyme Net and Dr. Lise Nigrovic for their research and input on the flow chart.
APHL guidance and interpretation of Lyme disease serologic test results
These tools describe the proper interpretation of serologic testing for B. burgdorferi and identify best practices for reporting results to clinicians, public health agencies, and patients.
Standard Two-Tiered Testing (STTT) Suggested Results Reporting Interpretation
Modified Two-Tiered Testing (MTTT) Suggested Results Reporting Interpretation
Additional reading
General
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).
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. Lancet 2012;379(9814):461-73.
Lyme carditis
Marx GE, Leikauskas J, Lindstrom K, et al. Fatal Lyme Carditis in New England: Two Case Reports 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. Clin Infect Dis 2014 May 30. pii: ciu411.
Lyme disease post-exposure prophylaxis after tick bite
Nadelman RB, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001 Jul 12;345(2):79-84.
Harms MG, et al. A single dose of doxycycline after an Ixodes ricinus tick bite to prevent Lyme borreliosis: An open-label randomized controlled trial. J Infect. 2021 Jan;82(1):98-104.
Pediatrics and pregnancy
American Academy of Pediatrics. Lyme disease (Lyme borreliosis, Borrelia burgdorferi infection). 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 area. Pediatr Emerg Care. 2021 May 13.
Sood SK. Lyme disease in children. 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 newborn. PLoS One. 2018 Nov 12;13(11):e0207067.
Testing
Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of Lyme borreliosis. Clin Microbiol Rev 2005 Jul;18(3):484-509.
Association of Public Health Laboratories. Suggested reporting language, interpretation and guidance regarding Lyme disease serologic test results. [PDF – 17 pages] 2021.
Branda JA, Steere AC. Laboratory diagnosis of Lyme Borreliosis. 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. 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. 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]
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 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. Clin Microbiol Rev 2006 Oct;19(4):708-27.
Ongoing research
Check out ClinicalTrials.gov for studies of Lyme disease and Borrelia Infections.
Biomedical Literature
Search the biomedical literature at PubMed.