Lyme Disease Questionnaire

Diagnosing Lyme Disease: A Simple Point System

Record your points for each bullet in the spaces provided below:

1.  Tick exposure in an endemic region = 1 point

2.  History consistent with Lyme Disease = 2 points

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

4.  Systemic signs and symptoms involving two or more organ systems = 2 points

5.  Erythema migrans (physician confirmed) = 7 points

6.  Acrodermatitis chronica atrophicans (biopsy confirmed) = 7 points

7.  Seropositivity for Borrelia burgdorferi = 3 points

8.  Seroconversion on paired sera = 4 points

9.  Tissue microscopy, silver stain = 3 points

10.  Tissue microscopy, monoclonal IFA = 4 points

11.  Culture positivity = 4 points

12.  B. burgdorferi antigen recovery = 4 points

13.  B. burgdorferi DNA/RNA recovery = 4 points

If your 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.