Ordering Recommendation

Preferred reflex test to detect Lyme disease in individuals with ≤4 weeks of clinical symptoms or exposure to tick. Positive/equivocal screen confirmed by immunoblot.

Mnemonic
LYME ACUTE
Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Immunoblot

Performed

Sun-Sat

Reported

1-3 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect

Serum separator tube.

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.15 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

CSF or plasma. Contaminated, heat-inactivated, hemolyzed, or severely lipemic specimens.

Remarks
Stability

After separation from cells: Ambient: 48 hours; Refrigerated: 2 weeks; Frozen: 1 year (avoid repeated freeze/thaw cycles)

Reference Interval
Test Number
Components
Reference Interval
0050216 Borrelia burgdorferi Antibodies, Total by ELISA
0.99 LIV or less Negative - Antibody to B. burgdorferi not detected.
1.00-1.20 LIV Equivocal - Repeat testing in 10-14 days may be helpful.
1.21 LIV or greater Positive - Probable presence of antibody to B. burgdorferi detected.

0050255 Borrelia burgdorferi Antibody, IgG by Immunoblot Effective August 15, 2011

Negative
0050253 Borrelia burgdorferi Antibody, IgM by Immunoblot Effective August 15, 2011

Negative

Interpretive Data

Refer to report.

Compliance Category

FDA

Note

This panel is appropriate for Lyme disease testing less than 4 weeks from erythema migrans or onset of disease symptoms.

A negative result indicates the immunoblot evaluation for B. burgdorferi antibody demonstrates no antibodies unique to B. burgdorferi and is, therefore, not supportive of Lyme disease.

A positive result indicates that the immunoblot evaluation for B. burgdorferi antibody is consistent with the presence of antibody produced by patients in response to infection by B. burgdorferi and suggests the presence of Lyme disease. Although the test has been shown to have a high degree of reliability for diagnostic purposes, laboratory data should always be correlated with clinical findings.

Current CDC recommendations for the serological diagnosis of Lyme disease are to screen with a polyvalent ELISA test and confirm equivocals and positives with immunoblot. Both IgM and IgG immunoblots should be performed on specimens obtained less than 4 weeks after appearance of erythema migrans. Only IgG immunoblot is to be performed on specimens greater than 4 weeks after disease onset. IgM immunoblot in the chronic stage is not recommended and does not aid in the diagnosis of neuroborreliosis or chronic Lyme disease.

If ELISA result is 1.00 LIV or greater, then IgG and IgM immunoblot will be added. Additional charges apply.

Hotline History
N/A
CPT Codes

86618; if reflexed, add 86617 x2

Components
Component Test Code* Component Chart Name LOINC
0050216 Borrelia burgdorferi Abs, Total by ELISA 5060-9
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • Early Lyme Disease Ab Reflex
  • Lyme Disease
  • Lyme Disease Ab, ELISA to Western Blot
  • Lyme Disease Reflex Panel, Early Disease
  • Lyme Disease, Acute Reflexive Panel
Borrelia burgdorferi Antibodies, Total by ELISA with Reflex to IgG and IgM by Immunoblot (Early Disease)