Physician's Reference Manual
Reporting Diagnosed Cases of Tick-borne Disease
Medical care providers are required (105 CMR 300.100) to report each patient they have diagnosed with the following tick-borne diseases:
- Babesiosis
- Borrelia miyamotoi
- Human granulocytic anaplasmosis (HGA)
- Human monocytic ehrlichiosis (HME)
- Lyme disease
- Powassan virus
- Rocky Mountain spotted fever
- Tularemia
For questions on disease reporting or to obtain a specific case report form, please contact the MDPH Office of Integrated Surveillance and Informatics Services at (617) 983-6801.
Laboratory Testing for Lyme Disease
While a diagnosis of Lyme disease may be based solely on clinical signs and symptoms (such as a patient presenting with an EM rash), laboratory tests are available to assist physicians in making a diagnosis.
Laboratory confirmation of infection with B. burgdorferi, the bacteria responsible for causing Lyme disease, is established when a laboratory isolates the spirochete from tissue or body fluid, detects diagnostic levels of IgM or IgG antibodies to the bacteria in serum or cerebrospinal fluid (CSF), or detects a significant change in antibody levels in paired acute and convalescent serum samples.
Serological assays remain the most common and practical method of laboratory testing for Lyme disease. The Centers for Disease Control and Prevention (CDC) recommend that, initially, specimens be tested by a sensitive test such as an enzyme immunoassay (EIA) or immunofluorescent assay (IFA). Samples with positive or equivocal results from these tests should be re-tested using a standardized Western blot procedure. The two-step algorithm, as opposed to using a single test, increases the specificity of laboratory testing. It is important to remember that serological assays will be negative early in disease and this type of testing is not recommended at that time.
Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established. These tests include urine antigen tests, immunofluorescent staining for cell wall-deficient forms of Borrelia burgdorferi, and lymphocyte transformation tests. In general, these tests are not recommended.