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A blood test for antibodies to the bacteria is the preferred test for the diagnosis of Lyme disease. However, if a person has central nervous system symptoms, such as meningitis, then IgM, IgG, and western blot testing may sometimes be performed on cerebrospinal fluid (CSF).
How Lyme Disease is Diagnosed. Lyme disease is a clinical diagnosis made by a doctor or nurse examining the patient. Early Lyme is not a laboratory diagnosis: a negative Lyme blood test doesnât rule out Lyme in the first few weeks of the illness. Also, 20% of people have no rash, only a âflu likeâ illness.