Updates in Lyme testing; Neuroborreliosis
Lyme is one of the endemic disease that plagues New England. One of the manifestations of lyme disease is neuroborreliosis. To help with diagnosis of this affection NorDx is offering the following orderable send-out tests starting June 12th 2018
- LYME DISEASE WESTERN BLOT CSF (LYSF test code); Detection of anti-borrelia antibodies in CSF using an immunoblot that recognizes IgG antibodies against 10 B. burgdorferi antigens and IgM antibodies against 3 B. burgdorferi specific antigens. The presents of 5 out of the 10 antigens for IgG or 2 out of the 3 antigens for IgM represents a positive result. The disadvantage of this test is related to the fact that the detected antibodies could be actually serum proteins that leaked in the CSF and the result is not specific for locally produced immunoglobulins. A high pretest probability is indicated before ordering this test.
- LYME CNS INF IGG W/ AB INDEX REFLEX (LYCNS test code). The anti-borrelia antibodies are measured both in serum as well as in CSF using specific immunoassays. The results are compared with the total proteins and an index is calculated. If the value exceeds 1, the interpretation is that the antibodies are produced at the nervous system level and the patient is positive for neuroborreliosis. The disadvantage of this test is that both blood and CSF need to be collected simultaneously, the collection tubes need to be banded together and sent to the laboratory. The serum antibody test will be performed first and if this test is negative the laboratory will not measure the antibody concentration in the CSF.
- Both tests are difficult to perform both from the collection point of view as well as from the testing perspective. In order to avoid unnecessary testing we strongly suggest to order this test only on patients with demonstrated lyme antibody presence in serum or with a proven history of lyme disease.
NorDx is offering the two tiered serologic analyses (Lyme disease antibody serum; test code LYMES) represented by a screening immunoassay followed by a confirmatory immunoblot. This test can be ordered by itself or as part of different tick panels (together with molecular detection for Babesia, Anaplasma and Ehrlichia species). As an aid for laboratory diagnosis we are offering an algorithm. Please see below the recommended testing algorithm based on different clinical presentations:
Moore A, Nelson CA, Molins C, et al. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States. Emerging Infectious Diseases. 2016;22(7):1169-1177. doi:10.3201/eid2207.151694.
Please visit our test catalog at www.Nordx.org or call us 207-396-7830 for any questions or suggestions.
Monica Ianosi-Irimie MD, PhD / Laboratory Director / NorDx, MaineHealth