Manifest is a Batch-23 scaffold — atoms / phenotypes / regimen drug list not yet authored. Regimen axis intentionally empty — doxycycline / amoxicillin / cefuroxime / ceftriaxone require manifest backing. Pediatric pregnancy phenotype + co-infection (Anaplasma, Babesia) handling will need a dedicated phenotype split when the manifest is authored. Deepened 2026-05-15 (shard-5-obped-id depth-pass-1, solo wave-7): added co-located _briefs/id.lyme-disease.core.v1.md + _research-bundles/id.lyme-disease.core.v1.md. Repointed design_brief from the tier3 package path (src/lib/tier3/problem-package/packages/lyme-disease/_design-brief.md) to the in-scope _briefs/ convention. Added 4 severity triggers: lyme_carditis_with_av_block (life_threatening — PR > 0.3 s or symptomatic high-grade AV → admit + cardiology + IV ceftriaxone OR PO doxy + temporary pacing if symptomatic), lyme_meningitis_or_encephalitis (severe — IV ceftriaxone 14-28 d + LP with intrathecal Ab index), coinfection_suspected_with_severe_features (severe — co-test babesiosis/anaplasmosis/Powassan/hard-tick relapsing fever if severe atypical / hemolysis / profound cytopenias), single_dose_doxycycline_prophylaxis_eligible (mild — within 72 h tick attachment ≥ 36 h in endemic area, NNT ~50 per Nadelman NEJM 2001). Severity triggers: 6 → 10. Removed 2 misattributed PMIDs (25776532 ProMISe sepsis-EGDT, 29766750 POINT minor-stroke) from evidence.pmids — they were inherited copy-paste errors flagged in the shard QUARANTINE (same SUSPECTED_FABRICATION cluster as cellulitis 213e6134; 23900119 REDUCE was not in this dossier). Added Klempner PTLDS NEJM 2001 (11450676) as the keystone trial driving the IDSA strong recommendation against chronic-antibiotic re-treatment for post-treatment Lyme disease syndrome. Branda 2018 modified 2-tier serology, Mead MMWR 2019, Nadelman NEJM 2001 single-dose prophylaxis, and Halperin DECID-IT are referenced via primary_guideline text + research bundle, pending PMID verification in next research:pubmed loop. Refined outpatient setting_playbook: PTLDS surveillance schedule at 1-3-6 mo + preventive counseling for next tick exposure + chemoprophylaxis eligibility discussion + VLA15 Phase 3 vaccine surveillance note added. Non-drug actions expanded from 3 → 6; monitoring 2 → 4; escalation_triggers 3 → 4; disposition_criteria 1 → 2. Phenotype matrix (stage × organ × severity × host × coinfection × PTLDS × treatment-history × prophylaxis-eligibility) and Bayesian linkage (EM-rash clinical-diagnostic LR ~100; modified 2-tier serology LRs by stage with low-prevalence-area caveat; PCR LRs synovial fluid + CSF; T_treat = clinical EM at presentation; T_test = atypical rash or neuro/cardiac/articular features + endemic exposure; T_post_exposure_prophylaxis = 4-criterion eligibility; cross-dossier routing edges to AV-block / bacterial-meningitis / babesiosis / anaplasmosis / Bell-palsy / refractory-Lyme-arthritis) documented in the co-located brief + research bundle; first-class TS fields remain schema-blocked.