Lyme Disease Testing Limitations: Emerging Infections Without Reliable Tests
Lyme disease testing limitations are becoming increasingly apparent as new Borrelia species are discovered. While diagnostic tools remain limited for standard Lyme disease, there are currently no widely available commercial tests for many emerging tick-borne infections. :contentReference[oaicite:0]{index=0}
The Discovery of New Borrelia Species
Researchers at Mayo Clinic identified a new Borrelia species, Borrelia mayonii, in six patients. Symptoms overlapped significantly with Lyme disease, including fever, rash, and neurologic involvement.
However, diagnosis required PCR testing, as standard Lyme testing could not distinguish this infection.
Borrelia bissettii in the Southern United States
Investigators also identified Borrelia bissettii-like organisms in patients from Georgia and Florida—regions not traditionally considered Lyme-endemic.
Symptoms were indistinguishable from Lyme disease, including fatigue, neurologic complaints, and musculoskeletal pain.
Standard two-tier testing designed for B. burgdorferi may fail to detect these infections.
Borrelia miyamotoi: A Different Type of Infection
Borrelia miyamotoi is a relapsing fever organism transmitted by the same ticks that carry Lyme disease.
It causes fever, low platelets, and low white blood cell counts—features uncommon in Lyme disease.
Standard Lyme serology does not detect B. miyamotoi, requiring specialized testing.
The Diagnostic Gap: No Commercial Tests Available
Most of these infections can only be detected using laboratory-developed tests at specialized institutions.
As noted by infectious disease physician John Aucott, access is limited because samples must be sent to specific research laboratories.
This creates a major barrier to diagnosis in routine clinical practice.
Two-Tier Testing Limitations
Even for B. burgdorferi, current testing performs poorly in early infection.
CDC researchers report sensitivities of only 29–40%, meaning most early Lyme disease cases are missed.
The two-tier system was designed for surveillance, not for clinical diagnosis.
Clinical Diagnosis Becomes Essential
Given these Lyme disease testing limitations, diagnosis often must rely on clinical judgment.
This includes:
- Compatible symptoms
- Geographic exposure
- Tick exposure risk
- Exclusion of alternative diagnoses
- Response to treatment
Waiting for laboratory confirmation in these cases may delay diagnosis and treatment.
Clinical Takeaway
The discovery of emerging Borrelia species highlights a growing gap between pathogen identification and diagnostic capability.
Lyme disease testing limitations—combined with the absence of commercial tests for newer organisms—mean that many patients will remain undiagnosed without clinical evaluation.
Clinicians must recognize that testing alone is insufficient and that clinical judgment remains essential in diagnosing tick-borne disease.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
