Diagnosing Lyme Disease: A Simple Point System

Many of the clinical manifestations of Lyme disease are non-specific, constantly shifting, and shared with many other conditions.

In addition to tell-tale skin manifestations like Erythema migrans and Acrodermatitis chronica atrophicans, the key features include: Fatigue; exercise intolerance; loss of stamina; cognitive dysfunction (often severe); musculoskeletal pain; headache; light and sound sensitivity; sleep disturbances; sexual dysfunction; gastrointestinal disturbances; low-grade fevers and sweats.

Dr. Joseph Burrascano, Jr, one of the nation's leading clinicians focused on Lyme disease, recommends this simple point-based system for making sense of the history, physical exam and symptom patterns.

For each feature, assign the indicated number of points, then simply tally the total:

• Tick exposure in an endemic region = 1 point

• History consistent with Lyme = 2

• Systemic signs & symptoms consistent with Borrelia infection, involving a single organ system (e.g., monoarthritis) = 1

• Involving two or more organ systems = 2

• Erythema migrans (physician confirmed) = 7

• Acrodermatitis chronica atrophicans (biopsy confirmed) =  7

• Seropositivity for Borrelia bergdorferi = 3

• Seroconversion on paired sera = 4

• Tissue microscopy, silver stain = 3

• Tissue microscopy, monoclonal IFA = 4

• Culture positivity = 4

B. burgdorferi antigen recovery = 4

B. burgdorferi DNA/RNA recovery = 4

If a patient’s total score is 7 or above, Lyme Borreliosis is highly likely.

A score of 5-6 suggests a strong possibility.

If the score is 4 or less, Lyme disease is unlikely.