Lyme Disease Serology

Serologic testing can be very useful in Lyme disease, but it can be subject to a number of limitations. Consequently, the diagnosis of Lyme disease can be guided, but not fully established, by laboratory results. Clinical criteria for diagnosis have been suggested by the Centers for Disease Control (CDC, MMWR 1997; 46: 531-535). The CDC clinical case epidemiologic surveillance criteria for the definition of Lyme disease are as follows:

Erythema migrans >= 5 cm in diameter, or
Laboratory confirmation of infection with objective evidence of musculoskeletal, neurologic, or cardiovascular disease.
Musculoskeletal manifestations include recurrent, brief attacks of objective joint swelling in one or more joints. Chronic progressive arthritis, chronic symmetrical arthritis, arthralgias, myalgias or fibromyalgia syndromes are not included as diagnostic criteria.
Neurological manifestations are lymphocytic meningitis, cranial neuritis, radiculoneuropathy, or encephalomyelitis. Encephalomyelitis must be confirmed by the demonstration of CSF antibody production, not by presence of headache, fatigue, paresthesias or mild stiff neck.
Cardiovascular manifestations include acute onset of second or third degree AV block.

The recommended test protocol for the diagnosis of Lyme disease is an initial screening assay by enzyme immunoassay (EIA) or immunofluorescent assay (IFA). Specimens negative on initial screening do not need further testing. Specimens testing positive by either method should be evaluated further by a standardized Western blot immunoassay.

The initial EIA detects class-specific antibodies (IgM or IgG) to Borrelia burgdorferi (Bb). IgM levels usually peak 3-6 weeks after infection. IgG antibodies begin to be detectable several weeks after infection. The IgG response may continue to develop over the course of several months and generally persists for years. A negative result indicates there was no serologic evidence of infection at the time of specimen collection. A negative result should not exclude Lyme disease, especially if the sample was collected within 2 weeks of symptom onset. If Lyme disease is strongly suspected, a second specimen should be tested 4 to 6 weeks after the first.

A positive or equivocal initial result by EIA is presumptive evidence of the presence of Bb antibody, and should always be followed by Western blot. All specimens testing positive or equivocal for Lyme antibody are automatically forwarded to Mayo Medical Laboratories for Western blot. Western blot testing in Lyme disease is not confirmatory, due to suboptimal specificity, especially for detecting IgM antibody. Thus a positive Western blot result can only support, but not establish, a clinical diagnosis of Lyme disease.

The Centers for Disease Control (CDC) recently has issued a cautionary statement (MMWR 54;125) regarding testing for Lyme disease. Several assays are available through commercial laboratories that do not have adequately established accuracy or clinical utility. These assays include urine antigen tests, immunofluorescent staining for cell-wall deficient forms of Borrelia burgdorferi, lymphocyte transformation tests and PCR on inappropriate specimens such as urine. Western immunoblot testing is also potentially problematic in that criteria for interpretation are often not consistent between laboratories.

Specimen requirement is one SST tube of blood.




Lactate Lactate Dehydrogenase Lactate Dehydrogenase Isoenzymes Lactose Tolerance LDL Cholesterol Lead Lecithin Sphingomyelin Ratio Legionella Direct Fluorescent Antibody Legionella Tests Leukemia Lymphoma Panel by Flow Cytometry Leukocyte Alkaline Phosphatase Leukocyte Antibody Leukocytosis and Thrombosis Lipase Lipid Panel Lipid Variability Lipoprint LDL Subfractions Lipoprotein a Cholesterol Lithium Lupus Anticoagulant Panel Luteinizing Hormone Lyme Disease Serology