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Diagnostic Tests

Modified Two-Tiered Serodiagnostic Testing Algorithms for Acute Phase or Early Disseminated Lyme Disease

Haroon Samar, MD, MPH, FAAFP

Matthew J. Kenney, DO

American Family Physician. 2024;110(1):85-86.

Author disclosure: No relevant financial relationships.

HAROON SAMAR, MD, MPH, and MATTHEW J. KENNEY, DO, Carl R. Darnall Army Medical Center, Fort Cavazos, Texas.

Author disclosure: No relevant financial relationships.

1.Kugeler KJ, Schwartz AM, Delorey MJ, et al. Estimating the frequency of Lyme disease diagnoses, United States, 2010–2018. Emerg Infect Dis. 2021;27(2):616-619.
2.Centers for Disease Control and Prevention. Lyme disease. Accessed January 9, 2024. https://www.cdc.gov/lyme
3.Branda JA, Strle K, Nigrovic LE, et al. Evaluation of modified 2-tiered serodiagnostic testing algorithms for early Lyme disease. Clin Infect Dis. 2017;64(8):1074-1080.
4.Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019;68(32):703.
5.Kobayashi T, Auwaerter PG. Diagnostic testing for Lyme disease. Infect Dis Clin North Am. 2022;36(3):605-620.
6.Branda JA, Linskey K, Kim YA, et al. Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide enzyme immunoassay. Clin Infect Dis. 2011;53(6):541-547.
7.Wormser GP, Levin A, Soman S, et al. Comparative cost-effectiveness of two-tiered testing strategies for serodiagnosis of Lyme disease with noncutaneous manifestations. J Clin Microbiol. 2013;51(12):4045-4049.
8.Centers for Medicare & Medicaid Services. Clinical laboratory fee schedule. Accessed January 17, 2024. https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs/files/24clabq1
9.National Institute for Health and Care Excellence (NICE). Lyme disease: diagnosis and management. Updated October 17, 2018. Accessed May 29, 2024. https://www.nice.org.uk/guidance/ng95

This series is coordinated by Natasha Pyzocha, DO, contributing editor.

A collection of Diagnostic Tests published in AFP is available at https://www.aafp.org/afp/diagnostic.

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Black Keratotic Papule on the Thigh

Ageism Revisited

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