Lyme Disease Serologic Testing Guidelines

Testing Algorithm Based on Symptom Duration

The Infectious Diseases Society of America recommends that if initial serologic testing is negative in a patient with suspected Lyme disease and symptoms for less than 4 weeks, repeat testing should be performed 2-4 weeks after symptom onset to allow for antibody development 1, 2, 3
Initial testing may be falsely negative due to delayed antibody response, as antibodies are often not detectable in the primary stage of infection using currently available test methods 4
The Centers for Disease Control and Prevention suggests performing both IgM and IgG Western blot during the first 4 weeks of illness if the initial EIA/ELISA is positive 1, 2, 3
Repeat testing 2-4 weeks after symptom onset is recommended if initial testing is negative but clinical suspicion remains high 5

Specific antibodies develop approximately 2 weeks after symptom onset 1
Antibodies reach maximum titers after 3-4 weeks from onset of clinical manifestations 5
IgG antibodies are frequently present in the second stage of disease 4
Patients with stage III illness typically have high IgG titers 4

Clinical diagnosis alone is sufficient without laboratory confirmation in the United States for patients with erythema migrans 2, 3
The American Academy of Pediatrics and the Infectious Diseases Society of America recommend that patients with erythema migrans can be reasonably diagnosed and treated based on history and clinical signs alone 1, 8
Most cases of neuroborreliosis show intrathecally produced antibodies in CSF, which is the most important microbiological diagnostic criterion 4
Early antibiotic treatment can blunt or abrogate the antibody response 6
Antibiotic treatment may diminish the development of convalescent antibodies 1