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LYWB
9535
> or = 1.3 Positive
Control Antibody Index: < or = 1.0
Albumin Ratio: 1.2), accompanied by a Control Antibody Index of less than 1.0 and an
Albumin Ratio of less than 0.0078, is strong evidence for intrathecal synthesis of organism-specific
antibody, and thus CNS B. burgdorferi infection. Elevation of either the control antibody index, the
Albumin Ratio, or both may indicate leakage of antibody across the blood-brain barrier which may falsely
elevate the Lyme Disease Antibody Index.
Test Performed by: Focus Diagnostics, Inc.
5785 Corporate Avenue
Cypress, CA 90630-4750
Lyme Disease Antibody, Western Blot, Serum
Clinical Information: Lyme disease is caused by the spirochete Borrelia burgdorferi. The spirochete
is transmitted to humans through the bite of Ixodes species ticks. Endemic areas for Lyme disease in the
United States (U.S.) correspond with the distribution of 2 tick species, Ixodes dammini (Northeastern and
upper Midwestern U.S.) and Ixodes pacificus (West Coast U.S.). In Europe, Ixodes ricinus transmits the
spirochete. Lyme disease exhibits a variety of symptoms that may be confused with immune and
inflammatory disorders. Inflammation around the tick bite causes skin lesions. Erythema chronicum
migrans (ECM), a unique expanding skin lesion with central clearing that results in a ring-like
appearance, is the first stage of the disease. Any of the following clinical manifestations may be present in
patients with Lyme disease: arthritis, neurological or cardiac disease, or skin lesions. Neurologic and
cardiac symptoms may appear with stage 2 and arthritic symptoms with stage 3 of Lyme disease. In some
cases, a definitive distinction between stages is not always seen. Further, secondary symptoms may occur
even though the patient does not recall having a tick bite or a rash. Early antibiotic treatment of Lyme
disease can resolve clinical symptoms and prevent progression of the disease to later stages. However, the
early administration of antibiotics may suppress the antibody response to levels that are undetectable by
current laboratory tests. The Second National Conference on the Serologic Diagnosis of Lyme Disease
(1994) recommended that laboratories use a 2-test approach for the serologic diagnosis of Lyme disease.
Accordingly, specimens are first tested by the more sensitive EIA. A Western blot (WB) assay is used to
supplement positive or equivocal Lyme (EIA). WB identifies the specific proteins to which the patient's
antibodies bind. Although there are no proteins that specifically diagnose Borrelia burgdorferi infection,
the number of proteins recognized in the WB assay is correlated with diagnosis. Culture or PCR of skin
biopsies obtained near the margins of ECM are frequently positive. In late (chronic) stages of the disease,
serology is often positive and the diagnostic method of choice. PCR testing also may be of use in these
late stages if performed on synovial fluid or cerebrospinal fluid (CSF).
Useful For: Diagnosing Lyme disease IgM assay is useful for confirming stage 1 (acute) Lyme disease
IgG assay is useful for confirming stage 2 and stage 3 Lyme disease
Interpretation: IgM IgM antibodies to Borrelia burgdorferi may be detectable within 1 to 2 weeks
following the tick bite; they usually peak during the third to sixth week after disease onset, and then
demonstrate a gradual decline over a period of months. IgM antibody may persist for months even though
antimicrobial agents are given. The IgM assay is more likely to be useful during early disease, and should
only be tested during the first 4 to 6 weeks after disease onset. Negative specimens typically demonstrate
antibodies to less than 2 of the 3 significant Borrelia burgdorferi proteins. Additional specimens should be
submitted in 2 to 3 weeks if Borrelia burgdorferi exposure has not been ruled out. Individuals who have
recently seroconverted due to infection with Borrelia burgdorferi may display incomplete banding
patterns, but may develop increased reactivity (both in band intensity and number) when followed for a
period of 4 to 6 months. IgG Serum IgG is detected as early as 2 weeks after onset of disease. Significant
concentrations of antibody and Western blot banding patterns for Borrelia burgdorferi can be found years
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