Tuesday, September 20, 2022

Lyme Disease Antibodies Igg Igm Immunoblot

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Borrelia Species Pcr Results

Antibody Testing: IgG and IgM explained

Borrelia species DNA may occasionally be detected in the blood by PCR, but a negative PCR test is of no value in excluding localised Lyme disease.

The overall sensitivity of PCR on a skin biopsy of an EM or ACA rash is around 50% and is limited by the chance of a single biopsy hitting a site with a significant number of organisms.

In neurological Lyme disease involving the CNS, up to 10% of cases may be PCR positive on a CSF sample a negative PCR result does not exclude the diagnosis.

Synovial fluid may be positive by PCR in up to 50% of cases. A negative result does not exclude the diagnosis.

Investigation Of Suspected Lyme Disease

Erythema migrans is a clinical diagnosis and does not require confirmation by laboratory testing. Lyme disease is not a notifiable disease so there is no statutory requirement to notify clinically suspected cases to the local Health Protection Team.

The 2018 NICE Lyme disease guideline provides detailed advice about when a diagnosis of Lyme disease should be suspected and about which tests to use and when.

The NICE Lyme disease guideline also contains a useful summary diagram of the routine serological testing recommendations for Lyme disease.

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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Sample Types For Lyme Disease Testing

For routine Lyme disease serological testing, you must send a serum sample .

For testing for neurological Lyme disease, you must send paired CSF and serum samples taken on the same day. If possible, please provide CSF cell count and total albumin, IgG and IgM values. If albumin, IgG and IgM measurements are not available, RIPL will make arrangements for these measurements at additional cost.

PCR testing is available. We recommend that specialists call RIPL to discuss appropriate sample types for PCR. These may include joint fluid, biopsy tissue, CSF and EDTA plasma. Please submit biopsies as fresh tissue in a sterile container, ideally with a drop of sterile saline to prevent the tissue drying out.

T Cells B Cells And Your Immune System

Lyme Disease Antibodies (IgG, IgM), Immunoblot

Your immune system is a complex network of cells, chemicals, and organs that work together to help fight off harmful microorganisms like viruses or bacteria, known as pathogens. Antigens are proteins that are found on the surface of pathogens.

When your immune system doesnt recognize a certain substance, the antigens on the pathogen cause your immune system cells to produce antibodies to fight it off. This is called an immune response.

The immune system is composed of two main types of Lymphocytes, or white blood cells: T cells and B cells. T cells and B cells work together to recognize antigens, or foreign substances. Together they are responsible for your adaptive immunity.

B cells are responsible for making antibodies that can destroy foreign substances. There are two different types of T cells, however. Helper T-cells stimulate B-cells to make antibodies, and help develop the other types of T-cells Killer T-cells. These Killer T-cells kill cells that have been infected by a foreign pathogen.

During an immune response to a foreign antigen, B cells begin to secrete antibodies. The first antibodies it secretes are called IgM . After more exposure to the antigen, B-cells then begin to produce IgG antibodies .

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Finding The Right Lyme Disease Test

Symptoms of Lyme disease can mimic a wide range of illnesses, which can cause tick-borne infections to go misdiagnosed for long periods of time. Laboratory testing is vital for confirming a diagnosis so that people can get the treatment that they need.

However, it can be difficult to find the testing and care you need after potential infection of Lyme disease. Not all Lyme testing is created equal. For example, the CDC-recommended two-tiered testing is notoriously unreliable, as many commercially available tests are not always sensitive enough to detect active infections.

IGeneX tests, on the other hand, provide higher sensitivity testing to detect the bacteria that causes Lyme and other tick-borne diseases. IGeneX test panels contain tests designed to detect IgM or IgG antibodies, meaning they can detect disease at multiple stages.

Serological Testing Of Csf For The Diagnosis Of Neurological Lyme Disease

Serological testing for neurological Lyme disease is based on demonstrating intrathecal synthesis of Borrelia-specific antibodies in CSF. For laboratory testing for neurological Lyme disease, IgG ViraChip® serology assays are performed on CSF and paired serum and the results compared.

CSF samples must be tested in parallel with a contemporaneous serum sample and albumin and total IgG levels compared between the 2 sample types to produce a meaningful result.

For necessary sample types and volumes see Sample types for Lyme disease testing.

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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.

Molecular Testing For Detection Of Borrelia Species Bacterial Dna

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PCR is available for Borrelia species DNA detection but is of limited value in routine testing for Lyme disease because the organism is only present in blood during the early stages of the disease and is predominantly restricted to the affected tissues.

Diagnostic molecular testing for Borrelia species DNA is available on request for relevant specimen types. Please call RIPL to discuss individual cases.

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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.

Access To Lyme Disease Testing Services

This guidance on the laboratory diagnosis of Lyme disease is intended for healthcare professionals in the UK. Patients concerned about possible Lyme infection should consult an appropriate healthcare professional, for example their GP, in the first instance.

Health professionals wishing to discuss a possible case or ascertain local arrangements for testing should contact a local Infection specialist .

NHS testing for Lyme disease is available through local service providers and the Rare and Imported Pathogens Laboratory at UK Health Security Agency Porton where ISO15189 accredited confirmatory testing is also provided. RIPL also provides a testing service for neurological Lyme disease.

RIPL provides medical and laboratory specialist services to the NHS and other healthcare providers, covering advice and diagnosis of a wide range of unusual bacterial and viral infections, including Lyme disease.

RIPL continuously updates its methods and will make further information on Lyme disease diagnostic testing available as it arises.

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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:

Management Of Individuals Without Symptoms Following A Tick Bite

Lyme Disease Antibody Test

Diagnostic testing is not recommended for individuals who do not develop any symptoms suggestive of Lyme disease after a tick bite.

Some commercial companies offer services to test removed ticks for the presence of the bacteria that cause Lyme disease. UKHSA does not provide such tick-testing services. The results of such tests should not be used to inform diagnosis or treatment. A positive result does not mean that the infected tick will have passed on the bacteria there are many factors that determine whether Lyme disease results from the bite of an infected tick. A negative result may not be technically valid and could give false assurance, as it does not exclude the possibility that another tick elsewhere on the body has been missed by the patient.

UKHSA runs a tick surveillance scheme and is happy to receive ticks for species identification and to monitor tick distribution.

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Alternative Diagnostic Tests Not Available At Ripl

Tests used by the NHS and UKHSA to identify Lyme disease are well characterised, standardised, and are highly reproducible between laboratories. They are the methods of choice recommended in the 2018 NICE Lyme disease guidelines, following an extensive review of the evidence and literature. International external quality assurance schemes are in place to ensure consistency between different centres offering these tests.

Several private laboratories in Europe and the US offer an alternative type of test called an ELISpot to diagnose Lyme disease. This looks for different markers in blood samples compared to conventional validated Lyme disease serology tests. The laboratories using these tests in the diagnosis of Lyme disease do not publish their methods, and have not produced peer reviewed publications on their clinical value.

This makes it very difficult to verify their results, especially as there are no national or international EQA schemes for Lyme disease ELISpot tests and therefore no independent verification of performance between laboratories. Without independent evidence it is impossible to determine the validity of results produced using these alternative tests.

RIPL cannot interpret the results of alternative diagnostic tests.

Investigation Of Suspected Neurological Lyme Disease

The diagnosis of neurological Lyme disease can only be confirmed by examination of the CSF and a paired serum sample. A definite diagnosis is based on the presence of a pleocytosis in the CSF, demonstration of intrathecal synthesis of specific antibodies to Borrelia species in CSF by comparison to serum and the presence of neurological symptoms. It is not possible to confirm intrathecal synthesis and hence definite neurological Lyme disease without a paired serum .

In 2018 RIPL introduced a service for the detection of intrathecal synthesis of Borrelia-specific antibodies which is summarised in this flow diagram. An accessible text version of this flowchart is available below.

Clinicians may ask for guidance on laboratory testing of CSF from RIPL if required.

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What Is A Lyme Disease Blood Test

A Lyme disease blood test is used to determine if you have contracted Borrelia burgdorferi , the bacterium that causes Lyme disease. Lyme disease tests are conducted with a routine blood draw.

While there are other species of Borrelia that cause Lyme disease, B. burgdorferi is the most common cause in the United States. Most antibody tests in the United States only test for B. burgdorferi, but other species-specific tests are available depending on a persons travel history.

Lyme disease is transmitted to humans through ticks that are infected with Borrelia.

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Lyme disease can be difficult to diagnose. Ticks are very small, and the bites are not always noticeable. Symptoms of the disease can vary from person to person. Not everyone experiences the classic bulls-eye rash pattern around a tick bite.

It should be noted that testing is not always required to make a diagnosis. For people with a classic bulls-eye rash living in a high risk area, testing is not recommended for diagnosis.

Your doctor will use the results of a Lyme disease antibody test, along with the report of your symptoms, to confirm a diagnosis.

Antibodies are proteins your body makes in response to foreign or harmful substances called antigens. Common antigens include:

Your body produces antibodies if you have contracted B. burgdorferi. These Lyme disease-specific antibodies will be present in your blood, and your test will be positive if you have the bacterial infection.

Lyme Disease Western Blot Test

IgM and IgG antibodies represent different stages of an immune response against COVID-19

The Lyme Disease Western Blot test is typically used as a confirmatory test for people who have had positive results from previous Lyme Disease testing. The immunoblot test is also known as a Lyme Disease Line Blot test. This test looks for the presence of both IgG and IgM antigen bands to confirm both recent and previous exposure. The detection of multiple bands is required for a positive result. The CDC does not recommend the Western Blot test as a front-line screening as some conditions other than Lyme Disease may cause a false positive.

Lyme Disease is caused by infection with the bacteria Borrelia burgdorferi. It is most commonly spread by the Deer Tick or Black Legged Tick and is the most common tick-borne illness in the United States and Europe. Lyme disease can be difficult to diagnose because the symptoms are often similar to other afflictions. While some people will display a distinctive “bulls-eye” rash around the site of the bite, others may experience common flu-like symptoms such as fever, chills, fatigue, and headache. The ticks which spread the disease are typically very small and many people do not even realize they have been bitten. If left untreated, Lyme Disease can cause joint pain, numbness in the arms and legs, facial paralysis, Meningitis, heart problems, or memory problems.

Turnaround time for the Lyme Disease Immunoblot test is typically 1-5 business days.

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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:

Igg Vs Igm Antibodies

Getting accurate test results is the first step in getting treatment for Lyme disease. Still, it can be difficult to navigate the world of testing and understand how different tests work. Were here to help clear up some of the confusion, specifically when it comes to different types of cells and antibodies.

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Antibodies And Lyme Disease Testing

Remember that IgM antibodies appear early on as a response to an infection, but levels typically decline over time. Because of this, tests that rely on the detection of IgM antibodies, like the Lyme IgM Antibody Serology, may only be positive for two to six weeks after exposure.

Other tests like the Lyme Broad Coverage Ab Assay, Lyme ImmunoBlot, and Lyme Western Blot detect multiple types of antibodies and may able to detect Lyme disease in the case of later re-activation of infection.

Tests that depend on the detection of antibodies, specifically IgM antibodies, are time sensitive, and typically only have a small window which they can be used after exposure to a tick. Luckily there are other tests available for people who are in the late stages or have Chronic Lyme disease. These tests include the Lyme Multiplex PCR, Lyme Western Blot IgM, and the Lyme Dot-Blot Assay .

Serological Testing Of Serum For The Diagnosis Of Lyme Disease

All Lab Tests

The most commonly used tests look for antibodies to the Borrelia species that cause Lyme disease in the UK and Europe, but they also detect infections from strains of Borrelia from the US.

The antibody response takes several weeks to reach a detectable level, so antibody tests in the first few weeks of infection may be negative. If the first sample was taken within 4 weeks from the onset of symptoms and is negative and there is a clinical suspicion of Lyme disease, then retesting in 4 to 6 weeks may be useful.

It is very rare for patients to have negative antibody tests in longstanding infections. Borrelia antibodies persist indefinitely in some patients and this does not indicate continuing disease or a need for re-treatment.

Serological testing for Lyme disease in the UK and much of the world follows a two-step approach:

  • The first stage of testing uses a sensitive screening ELISA test. Since 17 Dec 2020, RIPL has used the Borrelia VlsE1/pepC10 IgG/IgMELISA Test System . This replaced the C6 Lyme ELISA which was withdrawn from the market for commercial reasons.
  • Sensitive tests have the disadvantage of occasionally detecting other diseases and producing false positive results, so a second more specific confirmatory test is run on all samples giving a positive or indeterminate preliminary screening test result. RIPL uses the Borrelia ViraChip® IgG, IgM test to confirm the presence of Borrelia-specific antibodies .
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