TY - JOUR AU - Moore, Andrew AU - Nelson, Christina AU - Molins, Claudia AU - Mead, Paul AU - Schriefer, Martin T1 - Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States T2 - Emerging Infectious Disease journal PY - 2016 VL - 22 IS - 7 SP - 1169 SN - 1080-6059 AB - In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%–40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%–100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. KW - Lyme disease KW - Borrelia burgdorferi KW - bacteria KW - serologic analysis KW - PCR KW - guidelines KW - laboratory diagnosis KW - public health KW - United States KW - vector-borne infections DO - 10.3201/eid2207.151694 UR - https://wwwnc.cdc.gov/eid/article/22/7/15-1694_article ER - End of Reference