Hey Pete,
I sent you a bunch of information from a pay to use site called "UP to DATE" we use it in the medical field all the time, it is something like 8 or 900/year to subscribe. Anyhow, they essentially look at all the recommendations from all the literature and summarize the points of the day. Below is a snipet of what I sent you. Essentially I will tell you I completely agree with all the guys above, go in, send off some blood for confirmatory testing, BUT, get treated after the blood is sent. Do not wait. too many things can go wrong. I know they are saying to wait on treatment, but I personally don't feel like playing those games. Your buddy typically will not see any local symptoms for a few days and it will take 7-10 days minimum to develop an antibody response which is what is picked up by the testing.
Put it this way, when I picked one up last year and my kids dug it out of my back, I treated myself right away. My infectious disease doc I talked with gave me the "you should test, wait blah blah speach" but then when I asked him if he would have treated his wife or kid right away his line changed to "hell yah, would in a heartbeat"!!
so to me that answered that pretty well.
SUMMARY AND RECOMMENDATIONS
The diagnosis of early Lyme disease can be made solely on clinical grounds if the characteristic erythema migrans (EM) lesion is present in a patient who lives in or has recently traveled to an area that is endemic for Lyme disease (
picture 1 and
picture 2). The patient with a characteristic EM lesion will likely be seronegative, since the lesion appears prior to development of a diagnostic, adaptive immune response. Laboratory testing is neither required nor recommended. (See
'Approach to diagnosis' above.)
In contrast to the negative serology at the time of the appearance of the EM lesion, by the time the patient has findings of early disseminated extracutaneous disease (eg, lymphocytic meningitis, facial palsy, radiculoneuropathy, carditis with heart block), serologic tests are positive, as they are in patients with late Lyme disease. (See
'Approach to diagnosis' above.)
Serologic testing should be performed in patients who meet
all of the following criteria:
A recent history of having resided in or traveled to an area endemic for Lyme disease
and
A risk factor for exposure to ticks
and
Symptoms consistent with early disseminated disease or late Lyme disease (eg, meningitis, radiculopathy, mononeuritis, cranial nerve palsy, arthritis, carditis) (See
'Indications for serologic testing' above.)
Serologic testing for Lyme disease should
not be performed in the following settings:
In patients with an EM rash. Patients with skin rashes consistent with EM who reside in or have recently traveled to an endemic area should be treated for Lyme disease. (See
"Clinical manifestations of Lyme disease in adults", section on 'Erythema migrans' and
"Lyme disease: Clinical manifestations in children", section on 'Erythema migrans' and
"Treatment of Lyme disease", section on 'Early disease (erythema migrans)'.)
For screening of asymptomatic patients living in endemic areas
For patients with non-specific symptoms only (eg, fatigue, myalgias/arthralgias). The use of serologic testing in populations with a low pre-test probability of Lyme disease results in a greater likelihood of false positive test results than true positive test results. (See
'Indications for serologic testing' above.)
A skin lesion similar to EM can be seen in Southern tick-associated rash illness (STARI); however, the geographic distribution of Lyme disease and STARI are usually different (exceptions are Maryland, Delaware, and New Jersey). (See
'Distinction from STARI' above.)
When serologic testing is indicated, two-tier testing is recommended. This approach uses an ELISA followed by a Western blot as the tests of choice. (See
'Serologic tests' above.)
Routine follow-up serologic testing is
not recommended in assessing the patient who is cured or slowly improving. (See
'Persistence of antibodies' above.)
The diagnosis of neurologic Lyme disease and Lyme arthritis are discussed separately. (See
"Nervous system Lyme disease", section on 'Diagnosis' and
"Musculoskeletal manifestations of Lyme disease", section on 'Laboratory testing'.)
PCR testing of specimens of CSF or synovial fluid for B. burgdorferi DNA in a reliable laboratory can add confirmatory information in seropositive patients. However, a positive PCR result by itself is likely to be a false-positive result, and a positive result does not prove that the patient has active infection, since spirochetal DNA may persist long after spirochetal killing has occurred. (See
'Polymerase chain reaction' above.)
Use of laboratory tests other than these to support a diagnosis of Lyme disease is
not recommended. (See
'Special considerations' above.)
