Lab result explainedInflammationLast updated November 11, 2026

Lyme disease test: what positive, negative and equivocal results, western blot bands and timing mean

Lyme disease test · Lyme disease antibody panel: screening EIA/ELISA with reflex to western blot (IgM and IgG) or a second EIA · reported in Screening EIA: index value or signal-to-cutoff ratio (negative, equivocal, positive); western blot: number and identity of bands (kDa)

A Lyme disease test looks for antibodies your immune system makes against Borrelia burgdorferi, the spiral-shaped bacterium that deer ticks (black-legged ticks) transmit. It does not detect the bacterium itself, which is scarce in blood, and that single fact explains most of the confusion about Lyme testing. Antibodies take time to appear, typically 2 to 6 weeks after infection, so the test is often negative in the first weeks when the classic expanding rash is present, and antibodies then persist for years after successful treatment, so a positive test cannot tell you whether an infection is active or long gone.

Testing in the United States is done in two tiers. The first tier is a sensitive screening enzyme immunoassay (EIA or ELISA), reported as negative, equivocal or positive, often with an index value. Anything equivocal or positive moves to the second tier: either an IgM and IgG western blot, which is scored by counting specific bands (2 of 3 for IgM, 5 of 10 for IgG), or, since 2019, a second, different EIA. Only a positive on both tiers counts as a positive Lyme test; a positive screen with a negative second tier is reported as negative. The two-tier approach is about 99 percent specific, but it is only around 30 to 50 percent sensitive during the rash stage, 80 to 90 percent in early disseminated disease and nearly 100 percent in late Lyme arthritis.

Roughly 476,000 people a year in the United States are diagnosed and treated for Lyme disease, mostly in the Northeast, mid-Atlantic and upper Midwest. The most useful things to know about your result are when you were tested relative to the tick bite or the start of symptoms, whether you had the erythema migrans rash (which is diagnosed by looking, not by a blood test), whether both tiers were positive, and whether your symptoms fit the stage the antibodies suggest. A test from a laboratory that uses its own band criteria or unvalidated methods, rather than the CDC two-tier standard, does not carry the same meaning.

Lyme disease test at a glance

What it is: a two-step blood test for antibodies to Borrelia burgdorferi: a screening ELISA, then a western blot (IgM 2 of 3 bands; IgG 5 of 10 bands) or a second ELISA.
Timing: antibodies appear 2–6 weeks after infection. Testing in the first 1–2 weeks after a tick bite is not useful; an expanding rash over 2 inches (5 cm) across is Lyme disease and is treated without testing.
Positive on both tiers: you have been infected with Lyme at some point. With compatible symptoms and exposure it is treated; antibodies persist for years, so a positive test cannot show whether treatment worked.
Positive screen, negative western blot or second ELISA: reported as negative. In people with a low chance of Lyme, most isolated positive screens are false positives.
Negative: either no infection, or too early. If symptoms began within the last 30 days and the picture fits, a repeat test 2–4 weeks later catches seroconversion. Months of symptoms with a negative test make Lyme very unlikely.
False positives come from mononucleosis, syphilis and other spirochetes, autoimmune disease and some other infections; an IgM result is only interpreted in the first 30 days of illness.

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What Lyme disease test measures

After Borrelia enters the skin from a tick's mouthparts it multiplies locally, producing the erythema migrans rash in 70 to 80 percent of people, then spreads through the blood to joints, the nervous system, the heart and other skin sites. The immune system responds first with IgM antibodies, usually detectable 2 to 4 weeks after the bite, then IgG antibodies from about 4 to 6 weeks, which persist for years or decades. The screening EIA measures total antibodies against whole bacterial extracts or, in newer assays, against the C6 peptide or VlsE protein, which cross-react less with other organisms.

The western blot separates Borrelia proteins by size and shows which ones your antibodies recognize, each appearing as a band labeled by its molecular weight in kilodaltons (kDa). CDC criteria call an IgM blot positive when at least 2 of 3 bands are present (23 or 24 kDa OspC, 39 kDa BmpA, 41 kDa flagellin), and an IgG blot positive when at least 5 of 10 are present (18, 21/23/24, 28, 30, 39, 41, 45, 58, 66 and 93 kDa). The 41 kDa flagellin band is shared with many other bacteria, including mouth and gut organisms, so it alone means nothing; the 23, 39 and 93 kDa bands are much more specific. The modified two-tier test replaces the blot with a second EIA of a different design and performs as well, with better sensitivity in early disease.

Several things the test does not do are worth knowing. It cannot measure how active or severe the infection is. It cannot confirm that treatment worked, because antibody levels, especially IgG, stay positive for years and are not retested after treatment. Blood PCR and culture are too insensitive for routine use, although PCR of joint fluid is useful in Lyme arthritis and spinal fluid antibody testing in neurologic Lyme. Urine antigen tests, lymphocyte transformation tests, CD57 counts, live-blood microscopy and testing the tick itself are not validated for diagnosing Lyme disease and are not recommended by the CDC or infectious disease societies.

Normal range for Lyme disease test

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

Group	Typical range (Screening EIA: index value or signal-to-cutoff ratio (negative, equivocal, positive); western blot: number and identity of bands (kDa))	Notes
Screening EIA, negative	Index below about 0.90 (varies by assay)	No second-tier test is run. If symptoms began less than 30 days ago and the picture fits early Lyme, a convalescent sample 2 to 4 weeks later may seroconvert.
Screening EIA, equivocal	Index about 0.91–1.09	Treated like a positive screen: reflexed to the second tier. Most equivocal screens in people without a compatible illness are negative on the blot.
Screening EIA, positive	Index 1.10 or above (varies by assay)	Not a diagnosis on its own. Reflexed to western blot (IgM and IgG) or a second EIA. A high index makes a true positive more likely but does not replace the second tier.
IgM western blot, positive	At least 2 of 3 bands: 23/24 kDa, 39 kDa, 41 kDa	Interpreted only when symptoms have been present for 30 days or less. Beyond that, an isolated positive IgM is most likely a false positive and IgG should be positive if Lyme is the cause.
IgG western blot, positive	At least 5 of 10 bands: 18, 21/23/24, 28, 30, 39, 41, 45, 58, 66, 93 kDa	Expected in disease of more than 4 to 6 weeks' duration, in Lyme arthritis and late neurologic Lyme. Stays positive for years after treatment.
Modified two-tier test (two EIAs)	Both EIAs positive = positive; either negative = negative	FDA-cleared since 2019 and endorsed by the CDC; more sensitive than the blot in early disease and easier to standardize.
Sensitivity by stage (standard two-tier)	Erythema migrans: roughly 30–50%; early disseminated (facial palsy, meningitis, carditis): 80–90%; Lyme arthritis: about 99%	Specificity about 99% in all stages. In the rash stage the diagnosis is clinical; a negative test does not rule it out.
Timeline after a tick bite	Under 2 weeks: test usually negative even if infected; 2–6 weeks: antibodies appear; months to years: IgG persists	Treatment given early, during the rash, can prevent antibodies from ever developing, which is harmless and expected.
Spinal fluid and joint fluid	CSF antibody index above 1.0 supports neurologic Lyme; synovial fluid PCR positive in about 70–85% of untreated Lyme arthritis	Used by specialists in specific situations; not part of routine testing.

Positive Lyme disease test

A positive Lyme test, meaning both the screening EIA and the second tier are positive, shows that your immune system has met Borrelia burgdorferi. Whether that reflects an infection that needs treatment depends on the rest of the picture. If you live in or have visited an area where Lyme is common, had a tick exposure in the right season, and have symptoms that fit a stage of Lyme disease (an expanding rash, summer flu-like illness, facial droop, severe headache with a stiff neck, palpitations or fainting, a swollen knee), the test confirms the diagnosis and a 10 to 28 day course of antibiotics is given depending on the stage. Doxycycline, amoxicillin and cefuroxime are the usual choices, and most people recover fully.

Which antibodies are positive helps date the infection. A positive IgM with a negative IgG in someone whose symptoms began within the last 30 days fits early infection. A positive IgG, with or without IgM, fits an infection of more than a month's duration, including Lyme arthritis, which typically appears months after the bite as a swollen, not very painful knee. An isolated positive IgM in someone who has been unwell for more than 30 days is treated as a false positive, because by then a true infection would have produced IgG; this pattern is one of the commonest reasons people are incorrectly told they have Lyme.

A positive test does not mean an active infection if you were treated for Lyme in the past. IgG antibodies persist for years, sometimes for life, so retesting after treatment is not useful and a persisting positive is not a reason for more antibiotics. In high-incidence areas a few percent of healthy people are seropositive from a past infection they never noticed. Finally, a positive screen with a negative second tier is a negative result, and tests from laboratories that use their own band criteria, count the 41 kDa band alone, or offer unvalidated methods should not be read as positive Lyme tests.

Common causes

Current early disseminated Lyme disease
Weeks to a few months after the bite: multiple rashes, facial nerve palsy (sometimes both sides), meningitis with severe headache, nerve root pain, or carditis with palpitations, fainting and heart block. IgM and often IgG are positive at this stage.
Late Lyme disease (Lyme arthritis, late neurologic Lyme)
Months after infection: intermittent swelling of one or a few large joints, usually a knee, in about 60 percent of untreated people; less often a chronic nerve or brain involvement. IgG is positive in essentially all cases, which is why a negative IgG argues strongly against late Lyme.
Past Lyme disease, treated or unnoticed
Antibodies, especially IgG, persist for years after infection, so people treated for Lyme in the past, and some who never knew they were infected, stay positive. A positive test in someone with new, unrelated symptoms can mislead.
Cross-reacting antibodies from other infections
Infectious mononucleosis (Epstein-Barr virus), syphilis, leptospirosis, relapsing fever, periodontal spirochetes, Helicobacter pylori, bacterial endocarditis and some viral infections can produce a positive screen and occasionally a positive IgM blot, usually with only the non-specific 41 kDa band plus one other.
Autoimmune and inflammatory conditions
Rheumatoid arthritis, lupus, rheumatoid factor and other autoantibodies can trigger false-positive screening EIAs and IgM blots. These are the people most likely to be told they have Lyme when they have a different inflammatory disease.
Isolated positive IgM after 30 days of illness
IgM assays are the least specific part of the panel. When symptoms have lasted more than a month and IgG is negative, the IgM result is regarded as a false positive by CDC criteria.
Other tick-borne infections at the same time
Anaplasmosis, babesiosis and Borrelia miyamotoi are carried by the same ticks and can occur with Lyme. They do not themselves produce a positive Lyme test (B. miyamotoi can cross-react), but a positive Lyme test with high fever, low white cells or platelets, or anemia prompts testing for them.
Non-standard laboratories and interpretation
Some laboratories report in-house band criteria, count bands the CDC excludes, or use unvalidated methods, producing 'positive' reports in people without Lyme. Results should be interpreted by CDC two-tier criteria.

Symptoms that can go with it

An expanding red or bull's-eye rash at the bite site, over 2 inches (5 cm) across, appearing 3 to 30 days after the bite, usually not itchy or painful
Fever, chills, fatigue, headache, muscle and joint aches in summer or early fall
Multiple smaller rashes elsewhere on the body (early disseminated disease)
Drooping of one or both sides of the face (facial nerve palsy), severe headache with neck stiffness, or shooting nerve pains
Palpitations, light-headedness, fainting, chest pain or breathlessness (Lyme carditis with heart block, which can be dangerous)
A swollen, warm, mildly painful knee or other large joint months after exposure, sometimes coming and going
Persisting fatigue, aches and difficulty concentrating for weeks to months after treatment in about 10 percent of people, which usually improves with time

Negative Lyme disease test

A negative Lyme test means no antibodies to Borrelia burgdorferi were detected, or that a positive screen was not confirmed by the second tier. What it means depends almost entirely on timing. In the first 2 to 4 weeks after a tick bite, including the stage when the erythema migrans rash is visible, more than half of infected people have not yet made detectable antibodies, so a negative test does not rule Lyme out. The rash itself is the diagnosis: an expanding red patch over 5 cm across appearing days to a month after exposure in a Lyme area is treated without any blood test, and testing at that point mostly produces falsely reassuring negatives.

If you have had symptoms for more than 4 to 6 weeks and your two-tier test is negative, Lyme disease is unlikely to be the cause. Late Lyme arthritis and late neurologic Lyme produce a positive IgG in essentially everyone, so months of fatigue, aches or brain fog with a negative test point to another explanation, and repeat Lyme testing or testing at specialty laboratories with non-standard criteria does not help. The exception is a person who received antibiotics early in the illness for another reason, which can blunt the antibody response.

A negative Lyme test after a tick bite also does not exclude the other infections the same ticks carry. Anaplasmosis (high fever, low white cells and platelets, raised liver enzymes), babesiosis (fever and hemolytic anemia, dangerous in older people and those without a spleen), Borrelia miyamotoi, Powassan virus and ehrlichiosis each have their own tests. In the southern United States, a Lyme-like rash after a lone star tick bite (STARI) tests negative for Lyme, and the same tick can trigger alpha-gal allergy to red meat. A fever within a few weeks of a tick bite deserves evaluation whatever the Lyme test says.

Common causes

Tested too early
Antibodies take 2 to 6 weeks to appear. A test in the first 1 to 2 weeks after a bite, or during the rash, is negative in about half of truly infected people. A repeat 2 to 4 weeks later, if symptoms persist and the picture fits, detects seroconversion.
No Lyme infection
Most tick bites, even by deer ticks in Lyme areas, do not transmit Borrelia: in prophylaxis trials about 3 percent of recognized bites led to Lyme disease overall, and transmission essentially requires more than 36 hours of attachment. Symptoms after a bite are often unrelated or due to another infection.
Early antibiotic treatment
People treated during the rash stage frequently never develop a positive test, because the bacteria were cleared before a full antibody response formed. This is expected and does not mean treatment failed.
A different tick-borne infection
Anaplasmosis, babesiosis, ehrlichiosis, Borrelia miyamotoi, Powassan virus, Rocky Mountain spotted fever and STARI are not detected by a Lyme test and need their own tests.
Symptoms from another condition
Fatigue, joint pain, numbness and cognitive symptoms lasting months with a negative two-tier test are far more likely to be fibromyalgia, depression, sleep disorders, thyroid disease, autoimmune disease, vitamin deficiencies or other causes than Lyme.
Immunosuppression or European Borrelia species
Strong immunosuppression can blunt antibody production. Infections acquired in Europe (Borrelia afzelii, B. garinii) are sometimes under-detected by US whole-cell assays; C6 and VlsE-based tests perform better, so mention foreign travel.

Symptoms that can go with it

An expanding rash at a tick-bite site: treat as Lyme regardless of a negative test
Fever, chills and severe headache within 1 to 3 weeks of a tick bite, with low white cells or platelets (anaplasmosis or ehrlichiosis)
Fever with dark urine, jaundice or marked fatigue (babesiosis), especially in older adults or after splenectomy
A Lyme-like rash after a lone star tick bite in the southern or central United States (STARI)
Long-standing fatigue, widespread pain and poor concentration with a negative test, which need a broader evaluation rather than repeat Lyme testing
No symptoms at all after a tick bite, which is the most common outcome

Read it alongside

Complete blood count — low white cells and platelets with fever after a tick bite suggest anaplasmosis or ehrlichiosis; anemia with high LDH and bilirubin suggests babesiosis.
ALT and AST — mildly raised in early Lyme and more so in anaplasmosis and babesiosis.
CRP and ESR — modestly raised in early Lyme and Lyme arthritis; a normal CRP with months of symptoms argues against active inflammation.
ECG — for anyone with a positive test and palpitations, dizziness, fainting or chest pain, to look for heart block from Lyme carditis.
Blood smear and PCR for Babesia and Anaplasma — when fever accompanies a tick bite, whatever the Lyme result.
Spinal fluid analysis and CSF Lyme antibody index — for suspected Lyme meningitis or other neurologic Lyme, interpreted by a specialist.
Synovial fluid cell count and Borrelia PCR — for a swollen joint with a positive IgG, to confirm Lyme arthritis and exclude septic or crystal arthritis.
Mono test, RPR for syphilis, ANA and rheumatoid factor — when a positive Lyme test does not fit the clinical picture, to look for a cross-reacting cause.

What usually happens next

If you removed an attached deer tick within the last 72 hours in a high-incidence area and it was attached for 36 hours or more (engorged), ask your clinician about a single preventive dose of doxycycline; it lowers the risk of Lyme from about 3 percent to under 1 percent. Testing at this point is not useful.
If you have an expanding rash, expect treatment without a blood test, or with a test drawn for the record that may well be negative. Photograph the rash with a ruler for scale.
If a first test is negative but symptoms began within the last 30 days and fit early Lyme, a repeat two-tier test 2 to 4 weeks later (a convalescent sample) is the standard next step.
If your screen was positive and the second tier negative, the result is negative; ask what else could explain your symptoms rather than seeking a laboratory that will report it positive.
After a confirmed diagnosis and treatment, do not retest: antibodies persist and a positive follow-up test is expected. Lingering fatigue or aches for weeks to months are common and usually resolve; prolonged or repeated antibiotic courses have not helped in randomized trials and carry real harms.
Fever, low blood counts or anemia after a tick bite should prompt testing for anaplasmosis and babesiosis, which are treated differently.

Diet, lifestyle and natural levers with evidence

What can move Lyme disease test once the cause is known. Nothing here replaces finding the cause.

Daily tick checks and prompt removal

Strong evidence

Borrelia transmission essentially requires the tick to feed for more than 36 hours, so removing ticks within a day prevents nearly all infections. In the placebo arm of the single-dose doxycycline trial, Lyme developed after about 3 percent of recognized deer-tick bites overall but after roughly 10 percent of bites by nymphs that had fed long enough to become partially engorged, and after none that were removed early. Check the scalp, behind the ears, armpits, groin, waistband and behind the knees after time outdoors, and remove any tick with fine tweezers, pulling steadily at the skin.

Do not burn, smother or twist the tick; this does not help and may increase regurgitation of bacteria. Sending the tick for testing is not recommended to guide treatment.

Permethrin-treated clothing and EPA-registered repellents

Moderate evidence

In a randomized trial of outdoor workers in North Carolina, clothing factory-treated with permethrin reduced tick bites by about 80 percent in the first year of use, and the effect persisted, reduced, into the second year. Repellents containing 20 to 30 percent DEET, 20 percent picaridin, IR3535 or oil of lemon eucalyptus applied to exposed skin reduce tick attachment in field studies. Treated clothing plus a skin repellent is the combination public-health agencies recommend for people working or hiking in tick habitat.

Permethrin is applied to clothing and gear, never to skin. Oil of lemon eucalyptus is not recommended for children under 3.

Shower within two hours and tumble-dry clothes on high heat

Preliminary evidence

In a case-control study in Connecticut, bathing or showering within two hours of coming indoors was associated with about 58 percent lower odds of Lyme disease, presumably by washing off unattached ticks and prompting a body check. Ten minutes in a hot dryer kills ticks on clothing; washing alone, even in warm water, does not. Keeping lawns mowed, leaf litter cleared and a wood-chip barrier between lawn and woodland reduces tick numbers near the house.

Herbal antimicrobials (Japanese knotweed, cryptolepis, cat's claw and others)

Preliminary evidence

Laboratory studies have shown that extracts of several plants, including Japanese knotweed and cryptolepis, kill Borrelia in test tubes, and they are widely promoted for 'chronic Lyme'. There are no randomized human trials showing that any herbal product treats Lyme disease, prevents it after a tick bite, or changes the antibody test, and persisting antibodies after treatment are not an indication for them. Antibiotics remain the only treatment with evidence of benefit.

Cryptolepis and high-dose herbal protocols have caused liver injury and interact with blood thinners and other medicines; discuss anything you plan to take with your clinician.

When to see a clinician promptly

Palpitations, fainting, light-headedness, chest pain or breathlessness in anyone with possible Lyme disease: Lyme carditis can cause complete heart block within days and is an emergency.
Severe headache with a stiff neck, fever, or new weakness or drooping on one side of the face within weeks to months of a tick bite or rash.
An expanding red rash more than 2 inches (5 cm) across at a tick-bite site, or multiple new rashes, with or without flu-like symptoms: treatment should start without waiting for a test.
Fever, chills or severe fatigue within 1 to 3 weeks of a tick bite, particularly if you are over 60, pregnant, immunosuppressed or without a spleen, because anaplasmosis and babesiosis can be severe.
A swollen, warm knee or other large joint, especially if you live in or have visited a Lyme area in the past year.
A tick attached for 36 hours or more removed within the last 72 hours in a high-incidence area, to discuss a single preventive dose of doxycycline.

Frequently asked questions

How long after a tick bite should I get tested for Lyme disease?

Not right away. Antibodies take 2 to 6 weeks to appear, so a test in the first 1 to 2 weeks is negative in most infected people and tells you nothing. If you develop an expanding rash you are treated on the appearance of the rash alone. If you develop fever, aches, facial weakness or joint swelling without a rash, test at that point, and if the first test is negative within 30 days of symptom onset, repeat it 2 to 4 weeks later. There is no reason to test after an uneventful bite with no symptoms.

What does a positive Lyme ELISA with a negative western blot mean?

By CDC criteria it is a negative result. The screening ELISA is designed to catch everyone, so it also picks up antibodies from mono, syphilis, autoimmune disease and other infections. The western blot (or second ELISA) is the specific step, and when it is negative the screen is regarded as a false positive. The only exception is very early infection, when the blot may lag the screen by a week or two; if symptoms are recent and fit Lyme, a repeat in 2 to 4 weeks settles it.

What do the western blot bands (23, 39, 41 kDa) mean?

Each band is a Borrelia protein your antibodies recognize, named by its size in kilodaltons. For IgM, 2 of 3 bands (23/24, 39, 41) are needed; for IgG, 5 of 10 (18, 21/23/24, 28, 30, 39, 41, 45, 58, 66, 93). The 41 kDa band is a flagellar protein shared with many bacteria and is present in a large share of healthy people, so on its own it is meaningless. The 23 kDa (OspC), 39 kDa and 93 kDa bands are far more specific. A report listing one or two IgG bands is negative, not 'weakly positive'.

Can a Lyme test be a false positive?

Yes, mainly at the screening stage, which is why two tiers are required. Infectious mononucleosis, syphilis, leptospirosis, periodontal disease, bacterial endocarditis, rheumatoid arthritis, lupus and other autoantibody conditions can all produce a positive ELISA and sometimes a positive IgM blot. An isolated positive IgM more than 30 days into an illness is treated as a false positive. Even with 99 percent specificity, in someone with little exposure risk and vague symptoms, a positive test is more likely to be false than true, which is why testing is not recommended as a screen for fatigue alone.

Can a Lyme test be negative and I still have Lyme?

Yes, in the first few weeks. During the erythema migrans rash only about 30 to 50 percent of people test positive, so early Lyme is diagnosed by the rash and exposure, not by blood. By 4 to 6 weeks most untreated people are positive, and in late Lyme (arthritis, late neurologic disease) essentially everyone has IgG antibodies. A negative two-tier test after months of symptoms therefore makes Lyme very unlikely, and the symptoms deserve a different explanation.

Will my Lyme test stay positive after treatment?

Usually, yes. IgG antibodies persist for years and sometimes decades after successful treatment, and IgM can linger for months. A positive test after treatment does not mean the infection is still active and is not a reason for more antibiotics; guidelines specifically advise against retesting for this reason. If you develop new symptoms years later, a positive test cannot distinguish old antibodies from a new infection, so the clinical picture decides.

Should I get the tick tested for Lyme?

The CDC does not recommend it for medical decisions. A tick that tests positive often did not transmit infection (especially if attached under 36 hours), a tick that tests negative does not exclude bites from other ticks you did not notice, and results arrive after the window for preventive treatment. Identifying the tick type and how engorged it is, which your clinician or a photograph can do, is what guides the decision about a preventive doxycycline dose.

What is the difference between IgM and IgG Lyme antibodies?

IgM is the first antibody made, appearing 2 to 4 weeks after infection and fading over months; IgG appears from about 4 to 6 weeks and persists for years. A positive IgM with negative IgG fits an infection less than a month or two old. Because IgM tests are prone to false positives, the CDC only counts an IgM result when symptoms have lasted 30 days or less; after that, Lyme should show up as IgG, and a lone IgM positive is disregarded.

References

Lyme disease tests. MedlinePlus, US National Library of Medicine (2023)View source
Clinical testing and diagnosis for Lyme disease. Centers for Disease Control and Prevention (2024)View source
Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morbidity and Mortality Weekly Report (2019)
Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morbidity and Mortality Weekly Report (1995)
Lantos PM, Rumbaugh J, Bockenstedt LK, et al.. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clinical Infectious Diseases (2021)
Waddell LA, Greig J, Mascarenhas M, Harding S, Lindsay R, Ogden N. The accuracy of diagnostic tests for Lyme disease in humans, a systematic review and meta-analysis of North American research. PLoS ONE (2016)
Branda JA, Steere AC. Laboratory diagnosis of Lyme borreliosis. Clinical Microbiology Reviews (2021)
Steere AC, Strle F, Wormser GP, et al.. Lyme borreliosis. Nature Reviews Disease Primers (2016)
Nadelman RB, Nowakowski J, Fish D, et al.. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. New England Journal of Medicine (2001)
Kugeler KJ, Schwartz AM, Delorey MJ, Mead PS, Hinckley AF. Estimating the frequency of Lyme disease diagnoses, United States, 2010–2018. Emerging Infectious Diseases (2021)
Vaughn MF, Funkhouser SW, Lin FC, et al.. Long-lasting permethrin impregnated uniforms: a randomized-controlled trial for tick bite prevention. American Journal of Preventive Medicine (2014)
Connally NP, Durante AJ, Yousey-Hindes KM, Meek JI, Nelson RS, Heimer R. Peridomestic Lyme disease prevention: results of a population-based case-control study. American Journal of Preventive Medicine (2009)

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