Lyme disease laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2],Ilan Dock, B.S.


Laboratory blood tests are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease. The Centers for Disease Control recommends a two-tier testing protocol for Lyme disease. Polymerase chain reaction (PCR) tests for Lyme disease have also been developed to detect the genetic material (DNA) of the Lyme disease spirochete. Currently, PCR is the only means to detect the presence of organism. Identification and testing of the individual tick after removal is generally not useful.

Laboratory Findings

  1. Signs and symptoms
  2. A history of possible exposure to infected blacklegged ticks
  • Laboratory blood tests are helpful if used correctly and performed with validated methods.
  • Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease.
  • Just as it is important to correctly diagnose Lyme disease when a patient has it, it is important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else.


Two-step Laboratory Testing Process[1]

The Two-tier Testing Decision Tree describes the steps required to properly 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 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. - Source:

Polymerase chain reaction

Other Types of Laboratory Testing

Testing Ticks

  • Patients who have removed a tick often wonder if they should have it tested.
  • In general, the identification and testing of individual ticks is not useful in deciding if a person should get antibiotics following a tick bite because:[15]
    • If the test shows that the tick contained disease-causing organisms, that does not necessarily mean that the patient was infected.
    • If the patient has been infected, symptoms will probably develop before results of the tick test are available, so appropriate treatment should not be withheld for availability of tick testing results.
    • Negative results can lead to false assurance. For example, the patient may have been unknowingly bitten by a different tick that was infected.


  1. "Two-step Laboratory Testing Process| Lyme Disease | CDC".
  2. Engstrom SM, Shoop E, Johnson RC (1995). "Immunoblot interpretation criteria for serodiagnosis of early Lyme disease" (PDF). J Clin Microbiol. 33 (2): 419–27. PMID 7714202.
  3. Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP (1996). "Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease". Arch Intern Med. 156 (18): 2105–9. PMID 8862103.
  4. 4.0 4.1 Goossens HA, Nohlmans MK, van den Bogaard AE (1999). "Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis". Infection. 27 (3): 231. PMID 10378140.
  5. 5.0 5.1 5.2 Berardi VP, Weeks KE, Steere AC (1988). "Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay". J Infect Dis. 158 (4): 754–60. PMID 3049839.
  6. Feder HM, Gerber MA, Luger SW, Ryan RW (1991). "False positive serologic tests for Lyme disease after varicella infection". N Engl J Med. 325 (26): 1886–7. PMID 1961232.
  7. Woelfle J, Wilske B, Haverkamp F, Bialek R (1998). "False-positive serological tests for Lyme disease in facial palsy and varicella zoster meningo-encephalitis". Eur J Pediatr. 157 (11): 953–4. PMID 9835449.
  8. Strasfeld L, Romanzi L, Seder RH, Berardi VP (2005). "False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection". Clin Infect Dis. 41 (12): 1826–7. PMID 16288417.
  9. Burdash N, Fernandes J (1991). "Lyme borreliosis: detecting the great imitator". The Journal of the American Osteopathic Association. 91 (6): 573–4, 577–8. PMID 1874654.
  10. Coyle PK, Schutzer SE, Deng Z; et al. (1995). "Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease". Neurology. 45 (11): 2010–5. PMID 7501150.
  11. Valentine-Thon E, Ilsemann K, Sandkamp M (2007). "A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis". Diagn. Microbiol. Infect. Dis. 57 (1): 27–34. doi:10.1016/j.diagmicrobio.2006.06.008. PMID 16876371.
  12. Eisendle K, Grabner T, Zelger B (2007). "Focus floating microscopy: "gold standard" for cutaneous borreliosis?". Am. J. Clin. Pathol. 127 (2): 213–22. doi:10.1309/3369XXFPEQUNEP5C. PMID 17210530.
  13. Cadavid D (2006). "The mammalian host response to borrelia infection". Wien. Klin. Wochenschr. 118 (21–22): 653–8. doi:10.1007/s00508-006-0692-0. PMID 17160603.
  14. "Laboratory tests that are not recommended| Lyme Disease | CDC".
  15. "Tick removal and testing | Lyme Disease | CDC".