Instructor

Elizabeth Maloney, MD
Education Co-Director, VectorWise CME

Description

Many physicians are unaware that serologic tests for Lyme disease have significant limitations. This course reviews basic principles of diagnostic testing and applies those principles to available serologic tests for Lyme disease. The goal is to help clinicians understand and navigate the nuances of serology and discover how it fits within their evaluation of patients who potentially have Lyme disease.

Note: It may be helpful to view Basic principles of diagnostic testing prior to participating in this activity.

Learning objectives

  1. Understand role of serology in diagnosing Lyme disease
  2. Understand the procedures for ELISA, Western blot and two-tier testing in Lyme disease
  3. Recognize the utility and limitations of serology in Lyme disease


Accreditation Statement

This session, Serologic testing in Lyme disease, is approved for 0.75 enduring AAFP Prescribed credit.

The AAFP has reviewed VectorWise CME, and deemed it acceptable for AAFP credit. Term of approval is from 05/15/2025 to 05/14/2026. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.




Evidence-based bibliography for further study

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  • Tilton RC, Sand MN, Manak M. The western immunoblot for Lyme disease: determination of sensitivity, specificity, and interpretive criteria with use of commercially available performance panels. Clin Infect Dis 1997; 25 Suppl 1:S31-4. 
  • Landry ML, Hassan S, Rottmann BG, et al. Performance of two modified two-tier algorithms for the serologic diagnosis of Lyme disease. J Clin Microbiol. 2024;62(5):e0013924. doi:10.1128/jcm.00139-24
  • Tick-borne Disease Working Group 2022 Report to Congress available at: https://health.gov/sites/oash/files/2025-02/tbdwg-2022-report-to-congress.pdf
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  • Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme disease. New Engl J Med. 1988; 319(22):1441–1446. https://doi.org/10.1056/NEJM198812013192203
  • Tracy KE, Baumgarth N. Borrelia burgdorferi manipulates innate and adaptive immunity to establish persistence in rodent reservoir hosts. Frontiers in Immunology. 2017; 8, 116. https://doi.org/10.3389/fimmu.2017.00116
  • Embers ME, Barthold SW, Borda JT, et al. Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection. PLoS One. 2012; 7(1):e29914. Epub 2012 Jan 11. Erratum in: PLoS One. 2012;7 Embers ME. 
  • Bacon RM, Bickerstaff BJ, Schreifer ME, Gilmore RD, Philipp MT, Steere AC, et al. Serodiagnosis of Lyme Disease by Kinetic Enzyme-Linked Immunosorbent Assay Using Recombinant VlsE1 or Peptide Antigens of Borrelia burgdorferi compared with 2-Tiered Testing Using Whole Cell Lysates. J Infect Dis 2003; 187:1187-99. 
  • Radtke FA, Ramadoss N, Garro A, et al. Serologic Response to Borrelia Antigens Varies with Clinical Phenotype in Children and Young Adults with Lyme Disease. J Clin Microbiol. 2021;59(11):e0134421. doi:10.1128/JCM.01344-21.
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  • Aguero-Rosenfeld ME, Nowakowski J, Bittker S, Cooper D, Nadelman RB, Wormser GP. Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans. J Clin Microbiol. 1996;34(1):1-9. 
  • Branda JA, Body BA, Boyle J, et al. Advances in serodiagnostic testing for Lyme disease are at hand. Clin Infect Dis. 2017;66(7):1133-1139. doi:10.1093/cid/cix943
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About the Instructor

Elizabeth L. Maloney, MD

Education Co-Director, VectorWise CME; Partnership for Tick-borne Diseases Education

Dr. Maloney is a Minnesota family physician whose current focus is on tick-borne diseases education and policy. She began providing comprehensive, evidence-based, continuing medical education courses for physicians in 2007 and subsequently founded Partnership for Tick-borne Diseases Education, a non-profit providing evidence-based continuing medical education programming and materials on tick borne diseases. She has authored several peer-reviewed papers and treatment guidelines on Lyme disease and is currently a member of the federally mandated Tick-Borne Diseases Working Group (TBDWG). She is currently the Education Co-director at VectorWise CME.