Diagnosis

The diagnosis of LD is made on the basis of history, clinical presentation, and supportive serology. In the appropriate clinical context, erythema chronicum migrans is diagnostic. However, interpreting serologic data is problematic because of the lack of standardization of the values by which a positive test result is defined—the degree of cross-reactivity with other spirochetes—thus leading to frequent false-positive and false-negative test results. For the diagnosis of active disease or previous infection, the CDC recommends ELISA testing for IgM and IgG, followed by Western immunoblot testing. Assays based on PCR have been used successfully to amplify both genomic and plasmid B burgdorferi DNA from a variety of tissues, including ocular fluids, with the highest yields obtained from the skin.

• Schwartz AM, Hinckley AF, Mead PS, Hook SA, Kugeler KJ. Surveillance for Lyme disease—United States, 2008–2015. MMWR Surveill Summ. 2017;66(22):1–12.

Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.