Diagnostic Testing for Lyme Disease

Abstract This chapter describes the 2-tiered serological approach for the diagnosis of Lyme disease, and provides guidelines for interpreting the results of this approach, with focus on false negative and false positive results. Other diagnostic approaches, such as polymerase chain reaction and culture methods, are also described. The first tier of the standardized 2-tiered serologic test for B. burgdorferi is a screening test by sensitive enzyme immunoassay (EIA) or immunofluorescence methods. Nowadays typically an EIA, this method examines blood for the presence of class-specific IgM and IgG (together or separately) antibodies. If results fall below the threshold, then the first tier is reported as negative, and the test overall is considered negative with no need to perform immunoblotting. If first-tier testing is judged positive or falls in the equivocal range, testing will proceed to separate IgM and IgG western blots, also termed immunoblots.