The spirochete Borrelia burgdorferi may afflict skin, heart, joints, and the central or peripheral nervous system. This agent of Lyme disease, perhaps because of its varied presentations, is often raised as the cause of headache, fatigue, and subjective neurocognitive dysfunction. For clinicians who trained in the 20th century when the spirochete Treponema pallidum was invoked as the "Great Imitator," testingfor Lyme disease now seems as or more common than it had been for syphilis. With a narrower disease spectrum than syphilis, is such frequent testing for Lyme disease justified, and how should results be interpreted?
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