Lyme disease is the most common vector-borne disease in the U.S.
Tests generally appear in the order most useful for common clinical situations
| Test name: Borrelia burgdorferi Antibodies, Total by ELISA with Reflex to IgG & IgM by Western Blot (Early Disease) |
| ARUP #: 0050267 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Western Blot |
| Use: Screen for Lyme disease <4 weeks after onset of disease If known tick bite and erythema migrans present, proceed with treatment - no testing necessary |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features, combined with available laboratory tests Diagnosis of Lyme disease should not be made on the basis of positive IgM results alone in patients with symptoms <4 weeks' duration; antibodies are usually undetectable during early localized stage |
| Test name: Borrelia burgdorferi C6 Peptide Antibodies, Total by ELISA with Reflex to IgG & IgM by Western Blot |
| ARUP #: 0051043 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Western Blot |
| Use: Alternative screen for Lyme disease <4 weeks after onset of disease If known tick bite and erythema migrans present, proceed with treatment - no testing necessary |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Test name: Borrelia burgdorferi Antibodies, IgG & IgM by Western Blot |
| ARUP #: 0050254 |
| Methodology: Qualitative Western Blot |
| Use: Confirm an equivocal or positive antibody test performed <4 weeks after appearance of erythema migrans If known tick bite and erythema migrans present, proceed with treatment - no testing necessary For IgG, positive result reported when greater than or equal to 5 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, or 93kDA; all other bandings reported as negative For IgM, positive result reported when greater than or equal to 2 bands are present: 23, 39, or 41kDa; all others reported as negative |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Follow-up: Retesting in 10-14 days may be helpful when serology test results are equivocal |
| Test name: Borrelia burgdorferi Antibody, IgG by Western Blot |
| ARUP #: 0050255 |
| Methodology: Qualitative Western Blot |
| Use: Confirm an equivocal or positive antibody test performed >4 weeks after appearance of erythema migrans If known tick bite and erythema migrans present, proceed with treatment - no testing necessary Positive result reported when greater than or equal to 5 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, or 93kDA; all other bandings reported as negative |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Test name: Borrelia Species DNA Detection by PCR (Lyme Disease) |
| ARUP #: 0055570 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Use: Diagnose Lyme disease in patient with negative serologic results but disease still strongly suspected or with immune deficiency If known tick bite and erythema migrans present, proceed with treatment - no testing necessary |
| Limitations: Negative result does not rule out presence of PCR inhibitors or B. burgdorferi DNA concentrations below detection level of assay No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features, combined with available laboratory tests |
| Test name: Cell Count, CSF |
| ARUP #: 0095018 |
| Methodology: Cell Count/Differential |
| Use: Aids in differentiating Lyme disease from other forms of meningitis |
| Test name: Protein, Total, CSF |
| ARUP #: 0020514 |
| Methodology: Reflectance Spectrophotometry |
| Use: Aids in differentiating Lyme disease from other forms of meningitis |
| Test name: Glucose, CSF |
| ARUP #: 0020515 |
| Methodology: Enzymatic |
| Use: Aids in differentiating Lyme disease from other forms of meningitis |
| Test name: CSF Bacterial Culture (Includes Gram Stain 0060101) |
| ARUP #: 0060106 |
| Methodology: Standard reference procedures for bacterial stain, aerobic culture, and identification |
| Use: Aids in differentiating Lyme disease from other forms of meningitis |
| Test name: Borrelia burgdorferi Antibody, IgG by Western Blot (CSF) |
| ARUP #: 0055259 |
| Methodology: Qualitative Western Blot |
| Use: Adjunct test for neuroborreliosis in patient with neurological symptoms >4 weeks after onset of disease Positive result reported when greater than or equal to 5 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, or 93kDA; all other bandings reported as negative |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Follow-up: Detection of antibodies to B. burgdorferi in CSF may indicate CNS infection Consider possible contamination by blood or transfer of serum antibodies across blood-brain barrier |
| Test name: Borrelia burgdorferi C6 Peptide Antibodies, Total by ELISA (CSF) |
| ARUP #: 0051046 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Use: Adjunct test for neuroborreliosis in patient with neurologic symptoms <4 weeks from onset of disease |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Follow-up: Detection of antibodies of B. burgdorferi in CSF may indicate CNS infection Consider possible contamination by blood or transfer of serum antibodies across blood-brain barrier For equivocal results, repeat testing in 10-14 days may be helpful |
| Test name: Borrelia burgdorferi Antibodies, Total by ELISA (CSF) |
| ARUP #: 0099483 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Use: Screening test (confirmed by Western Blot) for neuroborreliosis in patient with neurologic symptoms <4 weeks from onset of disease |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests |
| Follow-up: Detection of antibodies to B. burgdorferi in CSF may indicate CNS infection Consider possible contamination by blood or transfer of serum antibodies across blood-brain barrier Retesting in 10-14 days may be helpful when serology test results are equivocal |
| Test name: Borrelia burgdorferi Antibodies, IgG & IgM by Western Blot (CSF) |
| ARUP #: 0055260 |
| Methodology: Qualitative Western Blot |
| Use: Confirm positive test for CSF antibodies |
| Limitations: No objective tests for Lyme borreliosis are 100% sensitive and 100% specific Diagnosis depends on clinical features combined with available laboratory tests For IgG, positive result reported when greater than or equal to 5 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, or 93kDA; all other bandings reported as negative For IgM, positive result reported when greater than or equal to 2 bands are present: 23, 39, or 41kDa; all others reported as negative |
| Follow-up: Detection of antibodies to B. burgdorferi in CSF may indicate CNS infection Consider possible contamination by blood or transfer of serum antibodies across the blood-brain barrier |
| Test name: Babesia microti Antibodies, IgG & IgM by IFA |
| ARUP #: 0093048 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Use: Consider for patients testing negative for Lyme disease antibodies but who live in endemic areas and have compatible symptoms |
| Test name: Anaplasma phagocytophilum (HGA) Antibodies, IgG & IgM |
| ARUP #: 0097303 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Use: Consider for patients testing negative for Lyme disease antibodies but who live in endemic areas and have compatible symptoms |
| Test name: Ehrlichia and Anaplasma Species by Real-Time PCR |
| ARUP #: 2003078 |
| Methodology: Real-Time Polymerase Chain Reaction/DNA Probe Hybridization |
| Use: Consider for patients testing negative for Lyme disease antibodies but who live in endemic areas and have compatible symptoms |
| Test name: Borrelia burgdorferi C6 Peptide Antibodies, Total by ELISA |
| ARUP #: 0051044 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Borrelia burgdorferi Antibody, IgM by Western Blot |
| ARUP #: 0050253 |
| Methodology: Qualitative Western Blot |
| Comments: Positive result reported when greater than or equal to 2 bands are present: 23, 39, or 41kDa; all others reported as negative |
| Test name: Borrelia burgdorferi Total Antibodies, IgG and/or IgM by ELISA with Reflex to IgG by Western Blot (Late Disease) |
| ARUP #: 0050268 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Western Blot |
| Comments: |
| Test name: Borrelia burgdorferi Antibody, IgM by Western Blot (CSF) |
| ARUP #: 0055258 |
| Methodology: Qualitative Western Blot |
| Comments: Positive result reported when greater than or equal to 2 bands are present: 23, 39, or 41kDa; all others reported as negative |
| Test name: Borrelia hermsii Antibody Panel, IFA |
| ARUP #: 0093170 |
| Methodology: Semi Quantitative Immunofluorescence Assay |
| Comments: |
| Test name: Borrelia burgdorferi Antibodies, Total by ELISA |
| ARUP #: 0050216 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Borrelia burgdorferi C6 Peptide Antibodies, Total by ELISA with Reflex to IgG by Western Blot |
| ARUP #: 0051045 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Western Blot |
| Comments: |
| Test name: Ehrlichia chaffeensis Antibodies, IgG & IgM by IFA |
| ARUP #: 0051002 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: Consider for those who test negative for Lyme disease antibodies but who live in endemic areas and have compatible symptoms |