Lyme Disease Referral Guidelines

In the U.S., Lyme disease is due to infection with the spirochete Borrelia burgdorferi transmitted by the bite of an Ixodes tick.  The classic presentation is systemic complaints such as fever, malaise arthralgias and myalgias associated with the target like erythema migrans (EM) rash.  Subsequent symptoms of secondary and tertiary disease can be diverse and widespread including articular, neurological, dermatologic and cardiac complaints. The disease responds readily to antibiotic therapy typically with doxycycline and in more advanced cases, brief courses of IV antibiotics.

Unlike many other infectious diseases, Lyme disease is unevenly distributed in the U.S. Maine has an incidence rate of 141 cases per 100,000, while the incidence rate in the state of Washington is 0.2/100,000 and in our experience, mostly acquired elsewhere. As such, non-specific joint, neurologic, skin or cardiac problems without standard positive serologic testing for Lyme disease acquired in the state of Washington are unlikely to be Lyme disease. Further, social media has widely spread misinformation about this disease convincing many people that they have this problem without convincing evidence that this is so.

At VMC, we find evaluating these patients in the infectious disease clinic, typically not helpful, and may delay making an appropriate diagnosis. As such, the UW Medicine | Valley Medical Center Infectious Disease Clinic, has prioritized the below group of patients, that are best served in our clinic:

1. Patients with positive standard serologic testing as defined by Infectious Diseases Society of America, serial serologic testing rather than culture, PCR or antigen testing typically with Western blot confirmation on equivocal tests.

   • Order test 164226: Lyme Disease Total Antibody with Reflex to Immunoassay (serum or plasma)

2. Patients with EM-like rash who have traveled to areas with higher incidence of Lyme disease, typically the Northeast or upper Midwest with or without tick bite.

3. Typical EM rash with clear history of tick bite or exposure to appropriate environment (wild brushy areas) preferably documented by photograph if acquired in the state of Washington.

Our goal is to see patients at most risk of having ongoing sequelae from Lyme disease, and thus be of the greatest service to our patients; we would like to and try to avoid seeing patients with diagnoses unlikely to be due to Lyme including typical amyotrophic lateral sclerosis, relapsing-remitting multiple sclerosis, Parkinson’s disease, dementia or cognitive decline, new-onset seizures, nonspecific magnetic resonance imaging (MRI) white matter abnormalities confined to the brain or persistent or recurring nonspecific symptoms such as fatigue, pain, arthritis or cognitive impairment. 

Please feel free to reach out to the doctors and APPs in our clinic with any questions.