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Lyme Ab Western Blot Reflex

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How Are Reflex To Blots Used For Lyme Disease

The Western Blot Test And Lyme

Lyme Disease Ab with Reflex to Blot Lyme disease is caused by a bacterium borrelia burgdorferi and is transmitted by ticks. A screening test with high sensitivity is used as the first step in the CDC recommended algorithm. Immunoblot testing qualitatively examines, with high specificity, antibodies in a patients specimen.

Question 12 Where Can I Find Information On Additional Tests For Tick

Click here for a list of additional tests for tick-borne infectious diseases at Quest.


  • Lyme Disease. Centers for Disease Control and Prevention. Reviewed December 16, 2019. Accessed June 15, 2020.
  • Centers for Disease Control and Prevention. Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. 5th ed. US Department of Health and Human Services 2018. Accessed June 15, 2020.
  • Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019 68:703. doi:10.15585/mmwr.mm6832a4
  • Zeus ELISA Borrelia VIsE1/pepC10 IgG/IgM Test System. Package insert. Zeus Scientific Inc 2019.
  • Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 43:10891134. doi:10.1086/508667
  • Waddell LA, Greig J, Mascarenhas M, et al. The accuracy of diagnostic tests for Lyme disease in humans, a systematic review and meta-analysis of North American research. PLoS One. 2016 11: e0168613. doi:10.1371/journal.pone.0168613
  • Kalish RA, Kaplan RF, Taylor E, et al. Evaluation of study patients with Lyme disease, 1020-year follow-up. J Infect Dis. 2001 183:453-460. doi:10.1086/318082
  • What Is Treatment For Lyme Disease

    Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well.

    Also Check: Lyme Disease And Liver Enzymes

    Lyme Disease Blood Test Igm Early Test With Reflex

    A Lyme Disease Blood Test, IgM, Early Test With Reflex is used to detect Lyme disease antibodies, IgM, EIA supplementary Western blots for all positives from antibody test. Used to aid in the diagnosis of acute infection with the Lyme disease agent.

    Methodology: Enzyme immunoassay Western blot

    Preparation: No special preparation required.

    Test Results: 3-5 Days. May take longer based on weather, holiday or lab delays.

    Early Signs And Symptoms

    Rb Antibody Sampler Kit #9969
    • Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes
    • Erythema migrans rash:
    • Occurs in approximately 70 to 80 percent of infected persons
    • Begins at the site of a tick bite after a delay of 3 to 30 days
    • Expands gradually over a period of days reaching up to 12 inches or more across
    • May feel warm to the touch but is rarely itchy or painful
    • Sometimes clears as it enlarges, resulting in a target or bull’s-eye appearance
    • May appear on any area of the body

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    What Does It Mean If Your Lyme Disease Ab Blot Result Is Too High

    Two types of antibodies are detected in the Western blot test.

    IgM antibodies reflect a relatively recent infection. IgG antibodies in contrast are a sign of an older infection.

    IgM antibodies usually disappear after eight weeks post-exposure. IgG remains in the serum for a very long time.

    In the Western blot test there are three bands for IgM and 10 bands for IgG.

    Here is the important part:

    – You need to have 2 out of 3 for the positive IgM result

    – Or you need to have 5 out of 10 for the positive IgG result.

    This marker is called Lyme Disease AB , Blot and is an aggregate marker for the three IgM results. So if this marker is positive you have at least 2 out of 3 of the IgM markers positive.

    Here is the 2nd important part when it comes to a diagnosis:

    If a person doesn’t have signs or symptoms of Lyme disease, then the person does not have Lyme disease as the definition of disease requires symptoms.

    What could some of those symptoms be?

    What are the symptoms of Lyme disease?

    Lyme disease symptoms are wide-ranging, with more than a hundred different symptoms recorded. Symptoms can also change over time, as the bacteria spreads throughout the body. To make things more confusing, Lyme disease symptoms will also vary from patient-to-patient. Lyme disease can mimic hundreds of other conditions since its symptoms mirror many medical problems such as multiple sclerosis, arthritis, chronic fatigue syndrome or lupus, and is sometimes known as The Great Imitator because of this.

    Key Points To Remember

    • Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
    • Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
    • Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
    • Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
    • Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.

    Recommended Reading: Lyme Disease Diagnosis And Treatment

    Standard Tests: Lyme Ab/western Blot Reflex

    The Centers for Disease Control and Prevention recommends a two-tiered test. First, you take an enzyme assay or an immunofluorescence assay . More specifically, you usually take an enzyme-linked immunosorbent assay . This screening test is the only Lyme test most PCPs order. Sadly, it has a low sensitivity rate.

    According to Lab Tests Online, DiagnosticSensitivity is the ability of a test to correctly identify people who have a given disease or disorder.

    In other words, a test with a low sensitivity rate will yield many false negatives. As a result, many people with Lyme go undiagnosed, allowing the bacteria to multiply.

    In the CDC process, if your screening test is positive or equivocal, only then will your PCP order the western blot. If the western blot is positive, you are then diagnosed with Lyme disease.

    For two reasons, I recommend you ask your doctor to order both tests right away:

    1. You wont have to wait for your screening test results before getting the western blot. Why is this important? Especially with Lyme, the quicker youre diagnosed and begin treatment, the better.

    2. You may test positive on the western blot, but negative on the screening test.

    Types Of Lyme Disease Tests

    Describe a positive western blot for Lyme disease

    Antibody titer tests for Lyme disease measure antibodies that are specific to the bacteria that can trigger the condition. Antibodies are part of the bodys immune response. Tests look for two types of antibodies, known as immunoglobulin M and immunoglobulin G .

    IgM antibodies usually peak within a few weeks after an infection with Borrelia bacteria and start to collapse 4-6 months after infection. IgG antibodies are slower to develop, beginning to show 4-6 weeks after exposure and may peak 4-6 months after exposure. While IgM tends to be associated with an active infection, both IgM and IgG can persist in the blood for many years.

    The Centers for Disease Control and Prevention recommends a two-stage or two-tiered test for these antibodies. If the initial blood test is positive for IgM or IgG antibodies associated with the Borrelia bacteria, a second test is done, often using different laboratory methods.

    Testing for IgM and IgG can support the finding that you have been exposed to Borrelia, but this on its own does not prove whether or not you have Lyme disease.

    Follow-up testing may be necessary if testing is inconclusive. This could involve repeat blood tests or the use of different types of medical tests to rule out other health conditions. In people suspected of bacterial reinfection, imaging tests may be used to detect joint inflammation.

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    A Better Test: C6 B Burgdorferi

    The newer C6 Lyme ELISA is a more sensitive test thats still highly specific.

    According to Lab Tests Online, Diagnostic Specificity is the ability of a test to correctly exclude individuals who do not have a given disease or disorder.

    In other words, a test with a high specificity rate will yield few false positives. The C6 scores almost as high on specificity as the two-tiered test . Yet, the C6 test scores higher on sensitivity. In other words, false positives are rare for both, but false negatives are less common with the C6.

    To Halt The Spread Of Lyme Nantucket Residents Consider Genetically Engineered Mice

    Her ordeal is a common one every year, some 300,000 people in the United States are diagnosed with Lyme disease, according to the Centers for Disease Control and Prevention, and that number is on the rise. Some people wait months or years to get a correct Lyme diagnosis. And their cases highlight a problem: Tests for Lyme in the first month of infection are frequently wrong. When diagnosed and treated early the infection is a simple one to get rid of, but left untreated it can cause a myriad of lingering symptoms, from severe arthritis to short-term memory problems.

    Now, a number of research groups are working to improve Lyme tests to catch infections in the early stages. One avenue being studied by the CDC aims to create a Lyme signature of small molecules in the blood an approach that, in early testing, catches a dramatically higher share of early infections.

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    Which Lyme Tests Should You Ask Your Doctor To Order

    Youve discovered you have some symptoms of Lyme disease. In fact, youve already made a doctors appointment with your primary care provider . Unfortunatelyor, rather, fortunatelyyou also know most only order one unreliable test. So, which other Lyme tests should you ask your PCP to order?

    Below youll find the blood tests my Lyme specialist ordered from insurance-covered LabCorp.

    Question 6 Can Serologic Testing Detect Lyme Disease Immediately After Infection


    No, not immediately. Lyme disease develops in stages: the early stage, which is divided into early localized infection, early disseminated, and then a late disseminated infection.1 Spirochetemia occurs early, with widespread dissemination through tissue and body fluids. However, antibodies usually take at least 2 weeks to develop, so patients may be seronegative within 2 weeks of a suspected tick bite.1-3 The sensitivity of serologic testing increases markedly with the progression of B burgdorferi infection from early to late Lyme disease.

    Identification of Borrelia species DNA in the blood by polymerase chain reaction may be useful in the first two weeks of infection.1

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    Lyme Disease Antibody W/ Reflex To Blot

    Test Code: 6646

    CPT Code: 86618

    Includes: If Lyme Disease Antibody Screen is Equivocal or Positive, Lyme Disease Antibodies , Immunoblot will be performed at an additional charge : 86617 x2).

    Methodology: Immunoassay

    Clinical Significance: Lyme disease is caused by a bacterium borrelia burgdorferi and is transmitted by ticks. EIA is the screening test with high sensitivity for antibody detection. Immunoblot testing qualitatively examines with high specificity antibodies in a patient’s specimen. Immunoblot testing is appropriate for confirming a detected EIA test result.

    Alternative Name: Borrelia burgdorferi, Lyme Screening, Lyme Antibody Screen

    Collection Guide:

    Getting Tested For Lyme Disease

    Lyme disease testing is usually ordered by a doctor and is used when there are signs or symptoms consistent with Lyme disease.

    A blood sample can be drawn in a doctors office or other medical setting. If a test of cerebrospinal fluid is needed, an outpatient procedure called a lumbar puncture can be done in a hospital. Samples are then analyzed in a credentialed laboratory.

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    Question 7 What Are Some Prominent Limitations Of Serologic Testing For Lyme Disease

    As noted above, serologic tests may yield negative results early during infection, before antibodies have reached detectable levels. In addition, serologic assays may give false-positive results in individuals with other conditions, including 3,5,6

    • Pathogenic spirochetal diseases, such as syphilis, yaws, pinta leptospirosis, relapsing fever, and periodontal disease
    • Other bacterial and viral infections, such as Rocky Mountain spotted fever, Epstein-Barr virus, and cytomegalovirus
    • Connective tissue autoimmune diseases associated with positivity for anti-nuclear antibody, including rheumatoid arthritis and systemic lupus erythematosus

    Who Should Get Testing

    Lyme Disease: POSITIVE IGM Western Blot Test (2013)

    Testing is usually indicated if a person has symptoms of Lyme disease and a known or possible exposure to ticks that can carry the Borrelia bacteria. However, because it takes time for antibodies to develop, the timing of testing is important to consider.

    Lyme disease symptoms depend on the extent of the bacterial infection. Three phases are used to describe the infection:

  • Early localized: In this initial phase, symptoms are normally found only near the tick bite. This early stage is called erythema migrans and involves a noticeable rash that typically develops within a few weeks after being bitten.
  • Early disseminated: In this phase, the bacteria move through the blood to affect other parts of the body and can cause general symptoms like fever, headaches, and pain. In some cases, the bacteria can affect the heart or nervous system.
  • Late disease: This phase occurs long after the initial tick bite and most often includes symptoms affecting the joints or nervous system.
  • It is important to understand these phases because testing is not equally valuable in each stage. With early localized disease and erythema migrans, blood testing is generally not helpful because antibodies have not had enough time to develop.

    Because of similar concerns about potential false positive results, random screening for Lyme disease in people without symptoms is not recommended even in areas that are known to have ticks that can carry the Borrelia bacteria.

    Recommended Reading: Lyme Disease Association Doctor Referral

    Lyme Disease Antibody With Reflex To Blot


    CPT Code: 86618Order Code: C1473Includes: Lyme Disease Ab ScreenIf Lyme Disease Ab Screen is 0.90, then Lyme Disease Ab , Blot and Lyme Disease Ab , Blot will be performed at an additional charge .ABN Requirement: NoContainer: Gel-barrier tube


  • Collect and label sample according to standard protocols.
  • Gently invert tube 5 times immediately after draw. DO NOT SHAKE.
  • Let tube stand in a vertical position to allow blood to clot 30 minutes.
  • Centrifuge for 10 minutes.
  • Transport: Store serum at 2-8°C after collection and ship the same day per packaging instructions included with the provided shipping box.


    Ambient : 7 daysRefrigerated : 14 daysFrozen : 30 days

    Causes for Rejection: Specimens other than serum improper labeling samples not stored properly samples older than stability limits grossly hemolyzed, grossly lipemic, or grossly icteric samples

    Methodology: Immunoassay Reflex: Immunoblot

    Turn Around Time: 3 to 4 days

    Reference Range:

    > 1.09

    Clinical Significance: Lyme Disease Antibody with Reflex to Blot Lyme disease is caused by a bacterium borrelia burgdorferi and is transmitted by ticks. A screening test with high sensitivity is used as the first step in the CDC recommended algorithm. Immunoblot testing qualitatively examines, with high specificity, antibodies in a patients specimen. Immunoblot testing is appropriate for confirming a detected screening result.


    Question 2 How Is The Diagnosis Of Lyme Disease Made

    Diagnosis of Lyme disease is made through clinical assessment or clinical assessment supported by laboratory testing. The presence of an erythema migrans rash is diagnostic of Lyme disease without laboratory investigation.1,2

    Patients who do not develop a rash but have symptoms suggesting Lyme disease, and have been to areas with a high risk of tick exposure, may undergo laboratory testing to help identify the cause of symptoms.1,2 For more information, see the Quest Diagnostics Clinical Focus Tick-borne Diseases: Laboratory Support of Diagnosis and Management available here.

    Read Also: Lyme Disease How Is It Diagnosed

    Lyme Disease Antibody Test Procedure

    The Lyme disease antibody test requires no advance preparation. A lab technician will swab the inside of your elbow with an antiseptic before drawing your blood. Your blood will be drawn from a vein in your arm using a small needle.

    The blood draw should not be painful, though you might feel a slight prick when the needle is inserted into your vein.

    The blood sample will be collected in a vial. The puncture site will be bandaged, if needed, after the needle is removed. After the blood draw, you are free to go home.

    There are very few risks associated with the Lyme disease antibody test. Excessive bleeding is possible, but there may be an increased risk if you take blood thinning medications or certain anti-inflammatory drugs like:

    • heparin

    Question 10 What Other Infections Can A Tick Transmit To Humans Besides Lyme Disease


    I scapularis ticks can also carry other human pathogens that have a high degree of symptom overlap, including Borrelia miyamotoi, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Babesia microti.2,10-12 Several studies on co-infected ticks indicate as many as 20% of Ixodid ticks can be coinfected with B burgdorferi and one or more of these other tick-borne human pathogens.10-12

    Molecular tests can be useful to detect these organisms in early/acute stages of infection, when genetic material from the pathogen can be detected but antibodies remain below the limit of detection of serologic assays.2,10-12 Quest offers molecular and/or serological tests for B burgdorferi, B miyamotoi, A phagocytophilum, E chaffeensis, and B microti, individually and in 2 panels .

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    Question 8 Is There A Test To Prove Cure For Lyme Disease

    There is no test to prove cure for Lyme disease. Antibodies frequently persist in the blood for months or even years after the infection is resolved, despite absence of detectable/viable B burgdorferi.7 Therefore, antibody tests cannot be used to determine a cure. There is no evidence that antibiotics cause Lyme serology blood tests to become negative following treatment.3,5,6

    The Role Of Lyme Disease Tests

    The purpose of the most common type of Lyme disease testing is to determine whether you have developed antibodies as a result of past exposure to the Borrelia bacteria that cause Lyme disease. Antibodies are proteins created by the immune system that target specific threats like bacteria and viruses.

    Blood testing alone cannot determine whether you have Lyme disease. Instead, testing can provide helpful information that your doctor can consider along with other factors, such as any symptoms youve had and whether youve been exposed to ticks that can carry Borrelia, to determine if a diagnosis of Lyme disease is appropriate.

    Beyond blood testing, it is possible to analyze fluid from the central nervous system for signs of the Borrelia bacteria.

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