{
  "slug": "lyme",
  "id": "lyme-biomarkers",
  "condition": {
    "name": "Lyme Disease",
    "shortName": "Lyme Disease",
    "alternateNames": [
      "Lyme borreliosis",
      "Borrelia burgdorferi infection"
    ]
  },
  "page": {
    "title": "Lyme Disease Biomarker Atlas | Serology, CSF & Chronic Lyme Markers",
    "breadcrumbName": "Lyme Disease Biomarkers",
    "description": "Searchable atlas of Lyme disease biomarkers — two-tier serology, C6 peptide ELISA, CSF indices, CXCL13, and inflammatory markers for early, disseminated, and post-treatment Lyme — from peer-reviewed literature.",
    "keywords": [
      "Lyme disease biomarkers",
      "Lyme serology",
      "C6 peptide ELISA",
      "neuroborreliosis CSF",
      "CXCL13 Lyme",
      "chronic Lyme biomarkers",
      "Lyme disease blood test",
      "two-tier Lyme test",
      "Lyme Western blot",
      "VisE C6 Lyme test",
      "neuroborreliosis CSF markers",
      "CXCL13 Lyme CSF",
      "post-treatment Lyme disease syndrome",
      "PTLDS blood tests",
      "Borrelia burgdorferi serology",
      "Lyme co-infection panel",
      "biomarker atlas",
      "biomarker database",
      "peer-reviewed biomarkers",
      "chronic illness biomarkers"
    ],
    "canonical": "https://research.opensourcemed.info/lyme-biomarkers.html",
    "hero": "Serologic, cerebrospinal fluid, molecular, and inflammatory biomarkers in Borrelia burgdorferi infection — from early localized disease through disseminated, neuroborreliosis, and post-treatment persistent symptom phenotypes.",
    "dateModified": "2026-06-29"
  },
  "categories": {
    "serologic": "Serologic",
    "csf": "CSF",
    "inflammatory": "Inflammatory",
    "molecular": "Molecular",
    "coinfection": "Co-infection",
    "chronic": "Chronic/PTLDS",
    "functional": "Functional"
  },
  "filters": [
    "serologic",
    "csf",
    "inflammatory",
    "molecular",
    "coinfection",
    "chronic",
    "functional"
  ],
  "faq": [
    {
      "question": "What is the standard Lyme disease blood test?",
      "answer": "CDC-recommended two-tier testing: an EIA for Borrelia burgdorferi antibodies, followed by IgM and/or IgG immunoblot if the EIA is positive or equivocal. The C6 peptide ELISA is an alternative first-tier test."
    },
    {
      "question": "Are there biomarkers for chronic Lyme or post-treatment Lyme disease?",
      "answer": "No validated chronic Lyme biomarker panel exists. Persistent symptoms after standard antibiotic therapy (PTLDS) overlap clinically with ME/CFS."
    }
  ],
  "markers": [
    {
      "name": "B. burgdorferi EIA (screening)",
      "alternateName": "Enzyme immunoassay — tier 1",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Active or past Lyme infection",
      "reference": {
        "citation": "CDC 2024",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "IgG immunoblot (≥5 of 10 bands)",
      "alternateName": "Tier 2 confirmatory",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Disseminated / late Lyme",
      "reference": {
        "citation": "CDC 2024",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "IgM immunoblot (≥2 of 3 bands)",
      "alternateName": "Tier 2 — early disease",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Early disseminated (<30 days IgM)",
      "reference": {
        "citation": "CDC 2024",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "C6 peptide ELISA (VisE)",
      "alternateName": "VlsE invariant region C6",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "High sensitivity in later stages",
      "reference": {
        "citation": "Bacon et al. 2003",
        "doi": "10.1086/376905"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-VlsE antibodies",
      "alternateName": "Variable lipoprotein E",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Borrelia immune response",
      "reference": {
        "citation": "Bacon et al. 2003",
        "doi": "10.1086/376905"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-OspC antibodies",
      "alternateName": "Outer surface protein C",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Early infection marker",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-OspA antibodies",
      "alternateName": "Outer surface protein A",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Tick-borne transmission phase",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-p41 (flagellin) antibodies",
      "alternateName": "IgG/IgM immunoblot band",
      "direction": "up",
      "category": "serologic",
      "comparison": "Uninfected",
      "symptoms": "Common immunoblot band",
      "reference": {
        "citation": "CDC 2024",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "CSF CXCL13",
      "alternateName": "B-cell chemoattractant",
      "direction": "up",
      "category": "csf",
      "comparison": "Non-NB controls",
      "symptoms": "Neuroborreliosis — high specificity",
      "reference": {
        "citation": "Rupprecht et al. 2005",
        "doi": "10.1212/01.wnl.0000185296.27976.4f"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "CSF anti-Bb antibody index",
      "alternateName": "Intrathecal antibody production",
      "direction": "up",
      "category": "csf",
      "comparison": "Serum/CSF ratio",
      "symptoms": "Neuroborreliosis confirmation",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "CSF lymphocytic pleocytosis",
      "alternateName": "WBC >5/μL",
      "direction": "up",
      "category": "csf",
      "comparison": "Normal CSF",
      "symptoms": "CNS inflammation",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "CSF protein elevation",
      "alternateName": "Blood-CSF barrier dysfunction",
      "direction": "up",
      "category": "csf",
      "comparison": "Normal CSF",
      "symptoms": "Neuroborreliosis, meningitis",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "PathologyTest",
      "loinc": "2880-3"
    },
    {
      "name": "CSF oligoclonal bands",
      "alternateName": "Intrathecal IgG synthesis",
      "direction": "mixed",
      "category": "csf",
      "comparison": "Normal CSF",
      "symptoms": "CNS immune activation subset",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "CSF glucose",
      "alternateName": "CSF chemistry",
      "direction": "mixed",
      "category": "csf",
      "comparison": "Normal CSF",
      "symptoms": "Usually normal in Lyme meningitis",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "PathologyTest",
      "loinc": "2340-8"
    },
    {
      "name": "Interleukin-6 (IL-6)",
      "alternateName": "Pro-inflammatory cytokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Active Borrelia infection",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest",
      "loinc": "26881-5"
    },
    {
      "name": "Interleukin-10 (IL-10)",
      "alternateName": "Anti-inflammatory cytokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Immune regulation during infection",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest",
      "loinc": "26862-5"
    },
    {
      "name": "Interferon-γ (IFN-γ)",
      "alternateName": "Th1 cytokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Cell-mediated immune response",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest",
      "loinc": "14477-8"
    },
    {
      "name": "C-Reactive Protein (CRP)",
      "alternateName": "Acute phase protein",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Variable in Lyme — often normal",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest",
      "loinc": "1988-5"
    },
    {
      "name": "CCL19",
      "alternateName": "CC chemokine ligand 19",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Lymphocyte trafficking — research",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "B. burgdorferi PCR (blood/CSF/tissue)",
      "alternateName": "Molecular detection",
      "direction": "mixed",
      "category": "molecular",
      "comparison": "Uninfected",
      "symptoms": "Low sensitivity in blood; higher in EM biopsy",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "B. burgdorferi culture",
      "alternateName": "Gold standard — rarely used",
      "direction": "mixed",
      "category": "molecular",
      "comparison": "Uninfected",
      "symptoms": "Low yield from blood",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "EM skin biopsy PCR",
      "alternateName": "Primary lesion sampling",
      "direction": "up",
      "category": "molecular",
      "comparison": "Uninfected tissue",
      "symptoms": "Early localized disease",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Anaplasma phagocytophilum serology",
      "alternateName": "Tick co-infection",
      "direction": "up",
      "category": "coinfection",
      "comparison": "Uninfected",
      "symptoms": "Co-infection with Lyme",
      "reference": {
        "citation": "Swanson et al. 2022",
        "doi": "10.1016/j.ttbdis.2022.101987"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Babesia microti serology / PCR",
      "alternateName": "Tick co-infection",
      "direction": "up",
      "category": "coinfection",
      "comparison": "Uninfected",
      "symptoms": "Hemolytic anemia, fever",
      "reference": {
        "citation": "Swanson et al. 2022",
        "doi": "10.1016/j.ttbdis.2022.101987"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Ehrlichia / Ehrlichiosis panel",
      "alternateName": "Tick co-infection",
      "direction": "up",
      "category": "coinfection",
      "comparison": "Uninfected",
      "symptoms": "Fever, leukopenia, thrombocytopenia",
      "reference": {
        "citation": "Swanson et al. 2022",
        "doi": "10.1016/j.ttbdis.2022.101987"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Powassan virus serology",
      "alternateName": "Tick-borne encephalitis virus",
      "direction": "up",
      "category": "coinfection",
      "comparison": "Uninfected",
      "symptoms": "Neurological co-infection",
      "reference": {
        "citation": "Swanson et al. 2022",
        "doi": "10.1016/j.ttbdis.2022.101987"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Serum CXCL13 (PTLDS research)",
      "alternateName": "B-cell chemokine",
      "direction": "mixed",
      "category": "chronic",
      "comparison": "HC, treated Lyme",
      "symptoms": "Persistent symptoms research",
      "reference": {
        "citation": "Aucott et al. 2014",
        "doi": "10.1016/j.amjmed.2014.02.016"
      },
      "testType": "BloodTest"
    },
    {
      "name": "PBMC cytokine profile (PTLDS)",
      "alternateName": "Peripheral immune signature",
      "direction": "mixed",
      "category": "chronic",
      "comparison": "HC, recovered Lyme",
      "symptoms": "Post-treatment persistent symptoms",
      "reference": {
        "citation": "Aucott et al. 2014",
        "doi": "10.1016/j.amjmed.2014.02.016"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-neuronal antibodies (PTLDS)",
      "alternateName": "Autoimmune neurological",
      "direction": "mixed",
      "category": "chronic",
      "comparison": "HC",
      "symptoms": "Cognitive, neuropathic symptoms",
      "reference": {
        "citation": "Aucott et al. 2014",
        "doi": "10.1016/j.amjmed.2014.02.016"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Heart rate variability (PTLDS)",
      "alternateName": "Autonomic function — ME/CFS overlap",
      "direction": "down",
      "category": "chronic",
      "comparison": "HC",
      "symptoms": "Fatigue, dysautonomia",
      "reference": {
        "citation": "Aucott et al. 2014",
        "doi": "10.1016/j.amjmed.2014.02.016"
      },
      "testType": "BloodTest"
    },
    {
      "name": "ESR (erythrocyte sedimentation rate)",
      "alternateName": "Non-specific inflammation",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Often normal in Lyme",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Liver enzymes (ALT/AST)",
      "alternateName": "Hepatic involvement",
      "direction": "mixed",
      "category": "functional",
      "comparison": "HC",
      "symptoms": "Disseminated Lyme subset",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Synovial fluid anti-Bb antibodies",
      "alternateName": "Lyme arthritis",
      "direction": "up",
      "category": "serologic",
      "comparison": "Non-Lyme arthritis",
      "symptoms": "Large joint mono/oligoarthritis",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Anti-Bb IgG (synovial PCR)",
      "alternateName": "Lyme arthritis molecular",
      "direction": "mixed",
      "category": "molecular",
      "comparison": "Non-Lyme joint fluid",
      "symptoms": "Persistent Lyme arthritis",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Facial palsy + CSF pleocytosis",
      "alternateName": "Clinical-laboratory composite",
      "direction": "up",
      "category": "functional",
      "comparison": "Bell's palsy non-Lyme",
      "symptoms": "Lyme neuroborreliosis",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Lyme arthritis RF/anti-CCP",
      "alternateName": "Rheumatoid panel",
      "direction": "down",
      "category": "functional",
      "comparison": "RA patients",
      "symptoms": "Negative — helps distinguish RA",
      "reference": {
        "citation": "Lantos et al. 2021",
        "doi": "10.1016/j.idc.2021.05.001"
      },
      "testType": "MedicalTest"
    }
  ]
}