Lyme Disease Testing and Diagnosis: New Insights from the Lyme Disease Biobank

A new study published online in Frontiers in Medicine provides critical insights into the accuracy of standard two-tier testing (STTT) for diagnosing Lyme disease. Researchers from the Lyme Disease Biobank found that despite presenting with erythema migrans 5 cm, only 34% of patients tested positive for Lyme disease using the CDC's STTT algorithm. Furthermore, among patients experiencing ongoing symptoms, only 35% followed up with a clinician. This study highlights the need for improved diagnostic tools and increased awareness among healthcare providers.

Key Takeaways:

• Only 34% of patients with erythema migrans 5 cm are positive for Lyme disease by standard two-tier testing (STTT) algorithm, as per the U.S. Centers for Disease Control and Prevention (CDC) guidelines.
• Among patients continuing to experience symptoms, only 35% follow up with a clinician, indicating a significant gap in post-infection care.
• Immunoglobulin G seroconversion was rare, seen in only 4% of samples, suggesting limited evidence of a strong immune response.
• 78% of participants showed no Lyme disease symptoms at the second blood draw, highlighting the complex and ambiguous nature of Lyme disease manifestations.
• The majority of ongoing symptoms were reported to be joint pain, fatigue, and muscle pain, underscoring the need for improved diagnostic tools to address these symptoms effectively.
• Dr. Linden Hu, a professor of immunology at Tufts Medical School, praised the Lyme Disease Biobank for its pioneering role in developing a large repository of well-characterized samples from patients with diverse manifestations of Lyme disease.

Statistics:

• 34% of patients with erythema migrans 5 cm tested positive for Lyme disease using the CDC's STTT algorithm (Source: Frontiers in Medicine)
• 35% of participants with ongoing symptoms followed up with a clinician after the second blood draw (Source: Frontiers in Medicine)
• 78% of participants showed no Lyme disease symptoms at the second blood draw (Source: Frontiers in Medicine)
• 22% of participants reported ongoing symptoms after the second blood draw (Source: Frontiers in Medicine)
• 4% of samples showed immunoglobulin G seroconversion, indicating a rare instance of a strong immune response (Source: Frontiers in Medicine)

Sources:

• Frontiers in Medicine, 7/10/2025
• Research team from the Lyme Disease Biobank in Portland, Oregon, led by Dr. Elizabeth J. Horn
• Tufts Medical School in Boston, led by Professor Linden Hu