What is the diagnostic test for Lyme disease if the diagnosis is uncertain?

The diagnostic approach for Lyme disease, particularly when uncertainty exists, typically involves initially performing an enzyme-linked immunosorbent assay (ELISA) followed by confirmation with a Western blot test if the ELISA result is positive or uncertain. This two-step process is crucial because the ELISA test screens for antibodies against Borrelia burgdorferi, the bacterium responsible for Lyme disease. If the ELISA is positive, the Western blot serves as a more specific confirmatory test, enhancing the accuracy of the diagnosis by detecting specific antibody patterns associated with the disease.

PCR testing is less commonly used in routine clinical practice for Lyme disease diagnosis due to its limitations, such as false negatives, particularly in early stages of disease. Culturing the pathogen is also quite rare because Borrelia burgdorferi is difficult to culture and can take significant time, making it impractical for routine diagnostics. A skin biopsy is not a standard diagnostic test for Lyme disease, as the characteristic skin lesion (erythema migrans) may be diagnosed clinically based on history and examination rather than requiring invasive procedures.

Thus, in cases where the diagnosis of Lyme disease is uncertain, the combination of ELISA followed by Western blot is the most effective and accepted method for confirming the presence