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Test Sequence
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Interpretation for Laboratories
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Interpretation for Providers
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Comments / Further Actions
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Tier 1
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Tier 2a
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Tier 2b
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Lyme VlsE IgM/IgG Total Immunoassay
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Lyme IgM Immunoassay
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Lyme IgG Immunoassay
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Negative
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Testing Not
Indicated
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Testing Not
Indicated
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Negative for antibodies to B. burgdorferi (Lyme disease).
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No laboratory evidence of infection with B. burgdorferi (Lyme disease).
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Negative results may occur in patients recently infected (≤14 days) with B. burgdorferi. If recent infection is suspected, repeat testing on a new sample collected in 7–14 days is recommended.
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Positive/ Equivocal
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Negative
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Negative
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Antibodies to B. burgdorferi (Lyme disease) not confirmed.
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No laboratory evidence of infection with B. burgdorferi (Lyme disease).
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Negative results may occur in patients recently infected (≤14 days) with B. burgdorferi. If recent infection is suspected, repeat testing on a new sample collected in 7–14 days is recommended.
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Positive/ Equivocal
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Positive/ Equivocal
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Negative
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IgM-class antibodies to B. burgdorferi (Lyme disease) detected.
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Results are consistent with acute or recent infection with B. burgdorferi (Lyme disease).
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IgM immunoassay results should only be considered as indicative of recent infections in patients presenting within 30 days of symptom onset. Consideration of IgM immunoblot results in patients with symptoms lasting >30 days is discouraged due to the risk of false positive IgM immunoblot results or prolonged IgM seropositivity following disease resolution.
Testing of a new specimen collected in 7–14 days to demonstrate IgG seroconversion may be considered to confirm infection. If both tests are equivocal consider repeat testing in 7-14 days if clinically warranted.
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Positive/ Equivocal
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Negative
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Positive/ Equivocal
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IgG-class antibodies to B. burgdorferi (Lyme disease) detected.
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Results are consistent with B. burgdorferi (Lyme disease) infection in the recent or remote past. IgG-class antibodies may remain detectable for months to years following resolution of
infection.
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Results should not be used to monitor or establish adequate response to therapy. Response to therapy is confirmed through resolution of clinical symptoms; additional laboratory testing should not be performed. If both tests are equivocal consider repeat testing in 7–14 days if clinically warranted.
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Positive/ Equivocal
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Positive/ Equivocal
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Positive/ Equivocal
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IgM and IgG-class antibodies to B. burgdorferi (Lyme disease) detected.
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Results are consistent with B. burgdorferi infection (Lyme disease) in the recent or remote past. Antibodies may remain detectable for months to years following resolution of infection.
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Results should not be used to monitor or establish adequate response to therapy. Response to therapy is confirmed through resolution of clinical symptoms; additional laboratory testing should not be performed. If both tests are equivocal consider repeat testing in 7–14 days if clinically warranted.
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