Mayo Test Catalog, (Sorted By Test Name) - Mayo Medical ...

CLYWB
83857
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 after onset. Normal specimens and false-positive EIA specimens
generally have antibodies to 4 or fewer proteins. Except for early patients, antibodies from patients with
Lyme disease generally bind to 5 or more proteins. For persons who have received recombinant OspA
vaccine and who are not infected with Borrelia burgdorferi, an intense band representing antibody to the
OspA protein (band 30) should be visible on the Western blot.
Reference Values:
IgG: negative
IgM: negative
Clinical References: 1. Dressler F, Whalen JA, Reinhardt BN, Steere AC: Western blotting in the
serodiagnosis of Lyme disease. J Infect Dis 1993;167(2):392-400 2. Brown SL, Hansen SL, Langone JJ:
Role of serology in the diagnosis of Lyme disease. JAMA 1999;282:62-66 3. Anonymous: Lyme
disease-United States, 1995. MMWR Morb Mortal Wkly Rep 1996;June 14;45(23):481-484
Lyme Disease Antibody, Western Blot, Spinal Fluid
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. Any of the following clinical manifestations may be present in
patients with Lyme disease: skin lesions or cardiac or neurological disease. In the first stage of disease,
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