Lyme Disease Testing and Reporting

When to test for Lyme disease

Consider testing for Lyme disease among patients who:

Demonstrate clinical symptoms, which may include an erythema migrans (EM) rash characteristic of Lyme disease.

AND

Report some geographic connection to areas in which Lyme disease is known to occur (e.g., travel to endemic areas, residing in regions with known incidence) OR has recently reported a tick bite.

Important notes on rashes

Erythema Migrans (EM) Rash: 

• EM rash due to Lyme disease presents in 70-80% of cases.

• The EM rash may develop at the site of the tick bite between 3 and 30 days after exposure (average of 7 days). Over the following days, the rash will expand.

• The EM rash may not always present as a “bullseye.”

• Most often, the rash will not cause pain or itching.

Small bumps from uninfected tick bites are common and are not a sign of Lyme disease.

A bite from a lone star tick resulting in Southern Tick-Associated Rash Illness (STARI) may be misidentified as an EM rash.

How to test for Lyme disease

Note, after infection with an organism that can cause Lyme disease, antibody concentration may be too low to detect for several weeks.

Most cases of Lyme disease are caused by Borrelia burgdorferi (B. burgorferi) infection. In the upper midwest, Borrelia mayonii (B. mayonii) is also known to cause Lyme disease.

Confirmatory laboratory evidence of Borrelia burgdoferi or Borrelia mayonii includes one of the following:

1. Isolation in culture

2. Detection in a clinical specimen by B. burgdorferi group-specific NAAT assay

3. Detection of B. burgdorferi group-specific antigens by immunohistochemical assay on autopsy or biopsy tissue samples.

4. Standard two-tier serological tests:

(1) Tier one:

Positive screening by methods such as enzyme immunoassay or positive immunofluorescence assay for IgM, IgG, or combination immunoglobulin

(2) Tier two:

Positive IgM immunoblot, or

Positive IgG immunoblot

5. Modified two-tier serological tests:

(1) Tier one:

Positive screening

(2) Tier two:

Positive sequential enzyme immunoassay

A positive IgG immunoblot that is not preceded by a positive screening assay is considered presumptive laboratory evidence of Lyme Disease.

Reporting Lyme disease cases

Report clinical presentation and laboratory testing via EPID 200 form via fax to the Northern Kentucky Health Department (Epidemiology fax line: 859-363-2057). Lyme disease requires routine notification within five (5) days.

Please include any of the following on the EPID 200 form:

• Erythema migrans (EM) rash greater than or equal to 5 cm in diameter
  Note: Please include the diameter of the rash in the report
  
  

• Symptoms involving the musculoskeletal system:

  • • Recurrent objective joint swelling in one or more joints lasting weeks or months

• Symptoms involving the cardiovascular system:

  • • Acute onset of high-grade (2nd or 3rd degree) atrioventricular conduction defects resolving in days or weeks.
      
      

• Any of the following symptoms involving the nervous system (unless due to another etiology):

  • • Facial palsy (unilateral or bilateral)

    • Lymphocytic meningitis

    • Radiculoneuropathy

    • Cranial neuritis

    • Encephalomyelitis