Lyme Disease
Reportable by Providers and LaboratoriesAbout this Reportable Disease
Infectious agent: Borrelia burgdorferi
Description of illness: The most common sign of Lyme disease is a circular rash called an erythema migrans (bull's eye rash), usually occurring within 3 to 30 days at the site of the tick bite. Other common symptoms include fatigue, chills, fever, headaches, muscle and joint aches, nausea, vomiting, conjunctivitis, and swollen lymph nodes. Neurologic symptoms can also occur, including facial weakness, headaches, and radicular pain. In the later stages patients may experience paresthesia, pain due to peripheral neuropathy, and personality, cognitive, and sleep disturbances. Irregular heart rhythms and pain and swelling in large joints may also occur.
Interactive Disease Data
Laboratory Reporting for this Disease
Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.
- Manually report results to TDH by faxing or mailing a completed PH-1600 form to your local health department, or faxing to the state health office at (615) 741-3857
- Automatically submit results to TDH via electronic laboratory reporting (ELR), which automates the process of sharing data with TDH using interoperability standards.
- See the ELR Onboarding Handbook for details on the onboarding process, checklist, frequently asked questions, business rules, message format, and vocabulary.
- To initiate the ELR onboarding process with TDH, register in the Trading Partner Registration (TPR) system TPR provides documentation for Promoting Interoperability (PI) attestation and milestone letters to document onboarding progress. Contact MU.Health@tn.gov for assistance.
- Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
- Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for Healthcare Providers
Clinical Summary
- Lyme disease is a tick-borne bacterial infection caused primarily by Borrelia burgdorferi and transmitted by the bite of an infected blacklegged tick (Ixodes scapularis).
- Early localized disease most often presents with erythema migrans (EM) (a circular expanding rash), occurring 3-30 days after the tick bite and nonspecific symptoms (fatigue, fever/chills, headache, myalgias/arthralgias).
- Untreated infection can progress to early disseminated disease (e.g., multiple EM lesions, facial palsy, meningitis, carditis) and late disease (notably arthritis).
- Diagnosis depends on presentation and timing. CDC recommends two-step serologic testing using FDA-cleared assays (standard two-tier or modified two-tier); tests may be falsely negative in the first 4–6 weeks after infection. EM with compatible exposure can be treated clinically without waiting for serology.
- Treatment is antibiotics (commonly doxycycline, amoxicillin, or cefuroxime axetil, depending on age/pregnancy/allergies and clinical manifestation). Early treatment improves outcomes and helps prevent progression. Lyme disease is reportable in Tennessee.
Healthcare Provider Reporting
Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.
Providers must report cases of all diseases and conditions listed through one of these methods:
• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857
• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.
• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for the Public
What It Is
Lyme disease is an illness caused by Borrelia bacteria that spreads to people through the bite of an infected blacklegged tick. In Tennessee, it is associated with the blacklegged (deer) tick.
Signs and Symptoms
A common early sign is an expanding circular rash called erythema migrans (bull’s-eye rash), which may appear within 3–30 days after a tick bite, along with symptoms such as fatigue, fever/chills, headache, and muscle or joint aches. Neurologic symptoms (such as facial weakness) can also occur.
How It Spreads
Lyme disease is spread by tick bites—it does not spread through casual person-to-person contact. Preventing tick bites and removing ticks promptly lowers the chance of infection.
Diagnosis and Treatment
Healthcare providers diagnose Lyme disease based on symptoms, possible tick exposure, and—when appropriate—blood testing using the CDC’s recommended two-step testing process. Lyme disease is treated with antibiotics, and most people recover well when treated early.
Prevention
Reducing risk focuses on avoiding tick bites (repellent, protective clothing, and tick checks) and removing ticks promptly after outdoor activity.
This Page Last Updated: March 25, 2026 at 8:53 PM