The Past, Present, and (Possible) Future of Serologic Testing for Lyme Disease

Abstract

Lyme disease prevails as the most commonly transmitted tick-borne infection in the United States, and serologic evaluation for antibodies to Borrelia burgdorferi remains the recommended modality for diagnosis. This review presents a brief historical perspective on the evolution of serologic assays for Lyme disease and provides a summary of the performance characteristics for the currently recommended two-tiered testing algorithm (TTTA). Additionally, a recently proposed alternative to the traditional TTTA is discussed, and novel methodologies, including immuno-PCR and metabolic profiling for Lyme disease, are outlined.

FIG 1

Diagram of the two-tiered testing algorithm including interpretation and IgM/IgG blot positivity criteria for the United States. For individuals with more than 30 days of symptoms, IgM Western blot analysis should not be performed, or, if performed, the results should not be used to guide clinical decisions.