Tick Testing Recommendations for Lyme Disease

In the investigation of a tick bite, examination of a removed tick may be useful. Species identification by a qualified expert or laboratory is recommended to inform clinical decisions. However, laboratory detection of Borrelia burgdorferi in the captured tick specimen is not recommended by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR). (Lantos, 2021)

Tick testing recommendations from the IDSA, AAN, and ACR 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease are summarized below.

Detailed information about the recommended laboratory tests for the diagnosis of Lyme disease and other tickborne diseases in patients can be found in the ARUP Consult Lyme Disease, Rocky Mountain Spotted Fever, and Other Tickborne Diseases topic.

Recommendations

Removed ticks should be submitted for species identification.

The identification of tick species and other characteristics (eg, life stage and degree of engorgement) can inform clinical decisions about antibiotic prophylaxis and patient counseling about early signs of tickborne diseases such as Lyme disease. (Lantos, 2021)

If symptoms develop, treatment should not be delayed for the results of species identification. (CDC, 2022)

Removed ticks should not be tested for B. burgdorferi.

Studies show that detection of B. burgdorferi in ticks is a poor predictor of Lyme disease development or asymptomatic seroconversion. (Lantos, 2021; CDC, 2022) Even in areas that are highly endemic for Lyme disease, the probability of an individual developing Lyme disease after being bitten by an infected tick is low (<5%), so treatment decisions should not be based on the presence of B. burgdorferi in a removed tick. (Lantos, 2021)

ARUP Testing

ARUP offers a tick identification test. Please visit the LTD for more information about this test.