Babesia microti, Borrelia burgdorferi, E. chaffeensis, Lyme Disease, Tick-Borne Diseases, Western Blot Assay, Spirochetes, Anaplasma phagocytophilum, HME (Human Monocytotropic Ehrlichiosis), Human Granulocytic Anaplasmosis (HGA)
Ehrlichia chaffeensis Ab IgG, Anaplasma phagocytophilum Ab IgG, Babesia microti Ab IgG, Lyme Disease Serology
If the Lyme disease screen result is positive or equivocal, then Lyme disease antibody confirmation by immunoblot will be performed at an additional charge.
Evaluation of the most common tick-borne diseases found in the United States, including Lyme disease, human monocytic and granulocytic ehrlichiosis, and babesiosis
Evaluation of patients with a history of, or suspected, tick exposure who are presenting with fever, myalgia, headache, nausea, and other nonspecific symptoms
Sero-epidemiological surveys of the prevalence of the infection in certain populations
Ehrlichia chaffeensis and Anaplasma phagocytophilum:
Serology for IgG may be negative during the acute phase of infection (<7 days post-symptom onset), during which time detection using targeted nucleic acid amplification testing (eg, polymerase chain reaction: PCR) is recommended.
Detectable IgG-class antibodies typically appear within 7 to 10 days post-symptom onset.
IgG-class antibodies may remain detectable for months to years following prior infection. Therefore, a single time point-positive titer needs to be interpreted alongside other findings to differentiate recent versus past infection.
Other members of the Ehrlichia genus (eg, Ehrlichia ewingii) may not be detected by this assay.
Previous episodes of babesiosis may produce a positive serologic result.
In selected cases, documentation of infection may be attempted by animal inoculation or PCR methods (LBAB / Babesia species, Molecular Detection, PCR, Blood)
Performance characteristics have not been established for the following specimen characteristics:
A negative result does not exclude the possibility of infection with Borrelia burgdorferi. Patients in the early stages of Lyme disease and those who have been treated with antibiotics may not exhibit detectable antibody titers. Patients with clinical history, signs, or symptoms suggestive of Lyme disease should be retested in 2 to 4 weeks in the event that the initial test result is negative.
A positive result is not definitive evidence of infection with B burgdorferi. It is possible that other disease conditions may produce artifactual reactivity in the assay (eg, infectious mononucleosis, syphilis). All equivocal or positive results should be supplemented immunoblot testing for IgM- and IgG-class antibodies in accordance with Centers for Disease Control and Prevention and the Association of State and Territorial Public Health Laboratory. Directors (CDC/ASTPHLD) recommendations.
Patients infected with other members of the B burgdorferi sensu lato complex, including Borrelia garinii, Borrelia afzelii, and Borrelia mayonii will be detected by this assay; however, they cannot be differentiated.
This test should not be performed as a screening procedure for the general population. The predictive value of a positive or negative result depends on the prevalence of analyte (antibodies present to VlsE1 and pepC10 antigens) in a given population. Testing should only be performed when clinical evidence suggests the diagnosis of Borrelia infection or related etiological conditions observed by the physician.
This test will not distinguish results that are both IgG and IgM positive from results that are either IgG or IgM positive.
Lyme serology should not be used for treatment monitoring as IgG can remain for years post resolution of infection. Instead, monitoring resolution of symptoms in response to treatment is recommended.
EHRC, ANAP, BABG: Immunofluorescence Assay (IFA)
LYME: Enzyme-Linked Immunosorbent Assay (ELISA)
Ehrlichia chaffeensis (HME) ANTIBODY, IgG
Reference values apply to all ages.
Anaplasma phagocytophilum ANTIBODY, IgG
Babesia microti IgG ANTIBODIES
LYME DISEASE SEROLOGY
A positive immunofluorescence assay (titer > or =1:64) suggests current or previous infection. In general, the higher the titer, the more likely the patient has an active infection. Four-fold rises in titer also indicate active infection.
Previous episodes of ehrlichiosis may produce a positive serology although antibody levels decline significantly during the year following infection.
A positive result of an indirect fluorescent antibody test (titer > or =1:64) suggests current or previous infection with Babesia microti. In general, the higher the titer, the more likely it is that the patient has an active infection. Patients with documented infections have usually had titers ranging from 1:320 to 1:2560.
Negative: No evidence of antibodies to Borrelia burgdorferi detected. False-negative results may occur in recently infected patients (< or =2 weeks) due to low or undetectable antibody levels to B burgdorferi. If recent exposure is suspected, a second sample should be collected and tested in 2 to 4 weeks.
Equivocal or Positive: Not diagnostic. Supplemental testing by immunoblot has been ordered by reflex.