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26063 Lyme CNS Infection, IGG with Antibody Index Reflex (LNBAB)

Lyme CNS Infection, IGG with Antibody Index Reflex (LNBAB)
Test Code: LNBABSO
Synonyms/Keywords
Neuroinvasive Lyme Disease, Neuroborreliosis, Lyme Disease in the Central Nervous System, Lyme CNS Disease
Test Components

Lyme CNS Infection IgG Screen

Reflex test: Lyme CNS Infection, IgG

Useful For
Aid in the diagnosis of neuroinvasive Lyme disease or neuroborreliosis due to Borrelia species associated with Lyme disease (eg, B. burgdorferi, B. garinii, or B. afzelli).
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​No

​Serum

Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1.2 mL ​1.2 mL
​No ​CSF ​Sterile vial ​Plastic vial ​1.2 mL ​1.2 mL
Collection Processing Instructions

Both cerebrospinal fluid (CSF) and serum are required for this test. CSF and serum must be collected within 24 hours (maximum) of each other.

CSF aliqout should be from the second, third, or fourth CSF vial collected uring the lumbar puncture.

Specimen Stability Information
Specimen Type Temperature Time
​Serum and CSF ​ ​Refrigerate (preferred) ​11 days
​Frozen ​35 days
Rejection Criteria

​Gross hemolysis

Gross Lipemia

CSF contaminated with blood

Interference

​A single negative result should not be used to exclude the diagnosis of neuroinvasive Lyme disease in a patient with appropriate exposure history and symptoms suggestive of infection. Testing of serum samples using the Centers for Disease Control and Prevention (CDC) recommended standard 2-tiered testing algorithm should be performed (LYME / Lyme Disease Serology, Serum).

False-negative results may be acquired in patients tested soon after infection, prior to the development of a detectable level of antibodies in the spinal fluid.

False-reactive results may occur in patients with syphilis or Leptospira infections. Patient management decisions should not be made on a single reactive result.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday, Wednesday, Friday ​1-4 days ​Enzyme-Linked Immunosorbent Assay (ELISA)
Reference Lab
Test Information

​Lyme disease is a multisystem and multistage tick-transmitted infection caused by spirochetal bacteria in the Borrelia burgdorferi sensu lato (Bbsl) complex. Nearly all human infections are caused by 3 Bbsl species; B burgdorferi sensu stricto (hereafter referred to as B burgdorferi) is the primary cause of Lyme disease in North America, while Borrelia afzelii and Borrelia garinii are the primary causes of Lyme disease in Europe and parts of Asia.

Lyme disease is the most commonly reported tick-borne infection in North America and Europe, causing an estimated 300,000 cases in the United States each year and 85,000 cases in Europe. The clinical features of Lyme disease are broad and may be confused with various immune and inflammatory disorders. The classic presenting sign of early localized Lyme disease caused by B burgdorferi is erythema migrans (EM), which occurs in approximately 80% of individuals. Other early signs and symptoms include malaise, headache, fever, lymphadenopathy, and myalgia. Arthritis, cardiac disease, and neurological disease may be later stage manifestations.

Neuroinvasive Lyme disease (NLD) can affect either the peripheral or central nervous system, with patients classically presenting with the triad of lymphocytic meningitis, cranial neuropathy (especially facial nerve palsy) and radiculoneuritis, which can affect the motor or sensory nerves, or both. These symptoms can occur in any combination or alone. Some patients may present with Bannwarth syndrome, which includes painful radiculoneuritis with variable motor weakness.

NLD should be considered in individuals presenting with appropriate symptoms who have had exposure to ticks in a Lyme endemic region of the United States, Europe or Asia. Patients meeting these criteria should be evaluated for the presence of anti-Bbsl antibodies in serum using the standard 2-tiered testing algorithm (LYME / Lyme Disease Serology, Serum) as recommended by the Centers for Disease Control and Prevention. Briefly, the LYME test includes testing of serum specimens by an anti-Bbsl antibody enzyme-linked immunosorbent assay (ELISA), followed by supplemental testing of all reactive samples using an immunoblot or western blot for detection of IgM- and IgG-class antibodies to Bbsl. Notably, the majority of patients with NLD will be seropositive in serum. Therefore, it is recommended that all patients tested by this assay also have LYME / Lyme Disease Serology, Serum performed. Results from these assays, alongside appropriate exposure history and clinical presentation, may be used to establish a diagnosis of NLD.

 Spinal fluid (CSF) should not be tested for the presence of antibodies to Bbsl using the current 2-tiered testing algorithm as there are no interpretive criteria for assessment of anti-Bbsl IgM and IgG immunoblot banding patterns in CSF. Additionally, while the presence of antibodies to Bbsl in CSF may be due to true intrathecal antibody synthesis, thus indicating central nervous system (CNS) infection, antibodies may alternatively be present as a result of passive diffusion through the blood-brain barrier or due to blood contamination of CSF during a traumatic lumbar puncture.

The Lyme CNS infection antibody index (AI) is performed as a reflex and quantitatively measures the level of anti-Bbsl antibodies in CSF and serum, ideally collected within 24 hours of each other, and normalizes those levels to total IgG and albumin in both specimen sources. A positive Lyme CNS AI indicates true intrathecal antibody synthesis of antibodies to Bbsl, which alongside clinical and exposure history can be used to establish a diagnosis of NLD.

 

Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories

​Negative

Reference values apply to all ages.

Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​86618 ​1 ​Antibody borrelia burgdorferi lyme disease
​86618 ​2 ​Antibody borrelia burgdorferi lyme disease ​if needed - for Antibody Index
​82040 ​1 ​Albumin, serum plasma/whole blood ​​if needed - for Antibody Index
​82042 ​1 ​Albumin urine/other source quantitative, eac specimen ​​if needed - for Antibody Index
​82784 ​2 ​IgG ​​if needed - for Antibody Index
Synonyms/Keywords
Neuroinvasive Lyme Disease, Neuroborreliosis, Lyme Disease in the Central Nervous System, Lyme CNS Disease
Test Components

Lyme CNS Infection IgG Screen

Reflex test: Lyme CNS Infection, IgG

Ordering Applications
Ordering Application Description
​Clinical Order Manager ​Lyme CNS Infection, IGG with Antibody Index Reflex (LNBAB)
​Cerner ​Lyme CNS Infection, IGG with Antibody Index Reflex (LNBAB)
​Centricity ​Lyme CNS Infection, IGG with Antibody Index Reflex (LNBAB)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​No

​Serum

Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1.2 mL ​1.2 mL
​No ​CSF ​Sterile vial ​Plastic vial ​1.2 mL ​1.2 mL
Collection Processing

Both cerebrospinal fluid (CSF) and serum are required for this test. CSF and serum must be collected within 24 hours (maximum) of each other.

CSF aliqout should be from the second, third, or fourth CSF vial collected uring the lumbar puncture.

Specimen Stability Information
Specimen Type Temperature Time
​Serum and CSF ​ ​Refrigerate (preferred) ​11 days
​Frozen ​35 days
Rejection Criteria

​Gross hemolysis

Gross Lipemia

CSF contaminated with blood

Interference

​A single negative result should not be used to exclude the diagnosis of neuroinvasive Lyme disease in a patient with appropriate exposure history and symptoms suggestive of infection. Testing of serum samples using the Centers for Disease Control and Prevention (CDC) recommended standard 2-tiered testing algorithm should be performed (LYME / Lyme Disease Serology, Serum).

False-negative results may be acquired in patients tested soon after infection, prior to the development of a detectable level of antibodies in the spinal fluid.

False-reactive results may occur in patients with syphilis or Leptospira infections. Patient management decisions should not be made on a single reactive result.

Useful For
Aid in the diagnosis of neuroinvasive Lyme disease or neuroborreliosis due to Borrelia species associated with Lyme disease (eg, B. burgdorferi, B. garinii, or B. afzelli).
Test Components

Lyme CNS Infection IgG Screen

Reflex test: Lyme CNS Infection, IgG

Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories

​Negative

Reference values apply to all ages.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday, Wednesday, Friday ​1-4 days ​Enzyme-Linked Immunosorbent Assay (ELISA)
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​86618 ​1 ​Antibody borrelia burgdorferi lyme disease
​86618 ​2 ​Antibody borrelia burgdorferi lyme disease ​if needed - for Antibody Index
​82040 ​1 ​Albumin, serum plasma/whole blood ​​if needed - for Antibody Index
​82042 ​1 ​Albumin urine/other source quantitative, eac specimen ​​if needed - for Antibody Index
​82784 ​2 ​IgG ​​if needed - for Antibody Index
For most current information refer to the Marshfield Laboratory online reference manual.