Recommended tests in different stages of infection
| Stage of illness | Clinical features | Primary testing recommended | Additional testing |
|---|---|---|---|
| Stage 1 | Early localized disease (< 4 weeks) Erythema migrans | No serologic testing | |
| Stage 2 | Early disseminated disease Lymphocytic meningitis Facial palsy Radiculoneuropathy or carditis | Two-tiered testing If initial test is negative, useacute and convalescent phase serology | |
| Stage 3 | Late Lyme disease (> 4 weeks) Lyme arthritis | Two-tiered testing | Synovial fluid polymerase chain reaction (PCR) if no improvement after 2 months of oral antibiotics |
| Lyme neuroborreliosis | Cerebrospinal fluid (CSF) anti-bodies and 2-tiered testing | CSF PCR or CSF culture |