How Is It Diagnosed?

Lyme disease picture of a boy with a teddy bearHistorically, the diagnosis of Lyme disease has been based upon characteristic clinical findings with laboratory testing playing a supportive role. Until diagnostic testing is perfected, this will remain the most valid approach. The serological tests for anti-Borrelia antibodies can be problematic since the antibody is not detectable in the first 2 to 6 weeks after exposure to a presumed tick bite. A two-tier test employing an enzyme linked immunoassay (ELISA) followed by a confirmatory Western blot affords the best chance of establishing the laboratory diagnosis with certainty. lyme disease picture of a prescription padOther serological studies including measurement of IgM-specific immunoglobulin which generally becomes elevated early in the course of infection, and IgG-specific immunoglobulin which typically arises later can be useful. The application of polymerase chain reaction (PCR) to the detection of Borrelia- specific DNA can be helpful. The challenge to the physician treating a patient with suspected Lyme disease is in interpreting these diverse diagnostic tests. In the final analysis however, most authorities consider it prudent to err on the side of empiric treatment, especially in patients with signs and symptoms of nervous system involvement even when a definite cause and effect relation cannot be established to active Borrelia infection.