Diagnosing Lyme Disease: Clinical vs Laboratory Criteria

Robert Bransfield, MD, DLFAPA, Associate Clinical Professor, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, examines the clinical and laboratory definitions of Lyme disease.

Interview Transcript (slightly modified for readability)

“Chronic Lyme is not just Borrelia burgdorferi sensu stricto, it’s also other tick-borne diseases. Now, people have two definitions of Lyme disease that adds to the confusion. Some people define Lyme disease in a very restrictive way, other people define it in a broader way. The most restrictive definition is defined by the surveillance criteria, which is Borrelia burgdorferi sensu stricto based on the laboratory strain of B31 from Shelter island, and being able to replicate that with two-tier testing with the deer-borne criteria. That’s the most restrictive definition and that’s what’s used by the CDC [Centers for Disease Control and prevention] for surveillance purposes.

Broader definitions of different degrees recognize that there [are] different strains of Borrelia that may be causative and different ways of interpreting these indirect antibody testing. There’s other reliance on culture or PCR testing rather than the highly controversial two-tier testing that journal articles have demonstrated to be 56% reliable, which is very poor reliability. [These tests] were never standardized for late-stage disease, and actually, they’ve never been standardized, they were just replicated and never quite validated.

Part of the debate is, what do you rely on in identifying a patient with Lyme disease? Do they have it based on clinical criteria? Or do they have it based, instead, on laboratory criteria? Or a combination of both?”