Clinician handoff
Lyme
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
I have brain fog, fatigue, and joint pain that moves around. The symptoms started [after a known tick bite / after outdoor activity in an endemic area / gradually with no clear trigger]. I have [had / not had] a bull's eye rash. I would like to discuss Lyme testing and whether co-infection screening is warranted given my history.
What would weaken it
- -No plausible tick exposure, rash, or infection timeline before the cognitive decline.
- -Normal testing plus a story that fits sleep, pain, or medication effects better than infection.
- -No joint pain, nerve symptoms, headaches, or other extra clues that travel with the fog.
Key points to communicate
- •Please document what exposure history actually makes Lyme plausible in my case.
- •If Lyme testing is negative, I want to know which alternative causes move up next.
- •If you think the story fits something more common, tell me exactly what pattern points you there.
- •Can we discuss modified two-tier testing (MTTT) if standard ELISA is equivocal?
- •If neurological Lyme is suspected, should we consider a lumbar puncture for CSF Borrelia antibodies?
Bring this to the visit
- •A timeline of tick exposure, rash, and symptom onset.
- •All prior Lyme testing results: ELISA, Western blot, C6 peptide.
- •Co-infection testing if done: Babesia, Bartonella, Anaplasma, Ehrlichia.
- •Antibiotic treatment history with response and any Herxheimer reactions.
Useful screening structure
- -Two-tier Lyme testing (ELISA + Western blot) as standard CDC approach.
- -Consider specialty lab testing (iSpot Lyme, Galaxy Diagnostics) if standard tests are negative but clinical suspicion remains.
- -Co-infection panel since Lyme rarely travels alone.
Tests and measurements to discuss
Two-tier Lyme serology (ELISA + Western Blot) or modified two-tier testing (MTTT)
What this helps clarify: Lyme confirmatory test - follows positive ELISA
Range context
CDC criteria
How to use the result
Save the result with date and symptoms from the same week.
Co-infection panel: Babesia (PCR + antibodies + blood smear), Bartonella (IFA + ePCR), Anaplasma/Ehrlichia
What this helps clarify: Tests for Babesia, Bartonella, Anaplasma, Ehrlichia
Range context
Negative
How to use the result
Save the result with date and symptoms from the same week.
Inflammatory markers: hs-CRP, C4a (not in IDSA 2020 guidelines - non-specific complement marker)
What this helps clarify: High-sensitivity inflammatory marker relevant to systemic and neuroinflammatory burden.
Range context
<1.0 mg/L
How to use the result
Save the result with date and symptoms from the same week.
CD57 NK cells (not recommended by IDSA 2020 - NIH study found no difference vs controls)
CBC with differential (screen for co-infection cytopenias)
What this helps clarify: Core blood count panel used to review white cell patterns, hemoglobin, and platelet context.
Range context
Lab reference interval
How to use the result
Save the result with date and symptoms from the same week.
Liver function panel (baseline before antibiotic treatment)
Questions to ask directly
- •Given my exposure and symptom timeline, does Lyme with co-infections fit this picture?
- •If standard testing is negative, what's the clinical threshold for empiric treatment?
- •Should treatment be combination therapy, and for how long?
- •How do I distinguish treatment response from ongoing infection vs post-treatment Lyme disease?
Functional impact snapshot
- -Rate cognitive function before and during antibiotic treatment at weekly intervals.
- -Track Herxheimer pattern: does fog worsen temporarily before improving?
- -Note which cognitive domains are most affected: memory, processing speed, word-finding.
Escalate instead of self-managing if
- •Facial palsy, meningitis symptoms, or heart block suggesting Lyme neuroborreliosis or carditis.
- •Progressive weakness, numbness, or radiculopathy.
- •Severe Herxheimer reactions during treatment requiring medical management.
Peer-reviewed references
- 1. IDSA/AAN/ACR 2020 Lyme Guidelines (Lantos PM et al., Clin Infect Dis 2021; PMID 33417672) [DOI]