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Test ID LNBAB Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid


Advisory Information


This test is preferred for diagnosis of neuroinvasive Lyme disease over testing of spinal fluid (CSF) by immunoblot for IgM and IgG class antibodies to Borrelia species associated with Lyme disease. This test is recommended because it can help distinguish true intrathecal synthesis of antibodies to Lyme disease in the CSF, indicating neuroinvasive infection, versus antibody presence due to passive diffusion through the blood-brain barrier or possibly, due to blood contamination of the CSF as a result of a traumatic lumbar puncture.

 

For Lyme testing on serum, order LYME / Lyme Disease Serology, Serum.



Additional Testing Requirements


Although a small percentage of patients with neuroinvasive Lyme disease may be seronegative, it is recommended that all patients tested by this assay also have standard 2-tiered testing for Lyme disease performed (LYME / Lyme Disease Serology, Serum).



Specimen Required


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

Specimen Type: Spinal Fluid

Collection Container/Tube: Sterile vial

Specimen Volume: 1.5 mL

Collection Instructions:

1. A spinal fluid sample of 1.5 mL needs to be collected within 24 hours of the serum specimen, preferably at the same time.

2. Label vial as spinal fluid or CSF.

3. CSF aliquot should be from the second, third, or fourth CSF vial collected during the lumbar puncture.

- Do not submit CSF from the first vial due to the possibility of blood contamination, which will cause specimen rejection.

4. Band specimens together.

 

Specimen Type: Serum

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 1.5 mL

Collection Instructions:

1. A serum sample of 1.5 mL needs to be collected within 24 hours of the spinal fluid specimen, preferably at the same time.

2. Label as serum.

3. Band specimens together.


Useful For

Aiding in the diagnosis of neuroinvasive Lyme disease or neuroborreliosis due to Borrelia species associated with Lyme disease (eg, B burgdorferi, B garinii, B afzelli)

Highlights

This test should be ordered in patients with suspected neuroinvasive Lyme disease.

 

Although a small percentage of patients with neuroinvasive Lyme disease may be seronegative, it is recommended that all patients test by the Lyme Antibody Index assay also have standard 2-tiered testing for Lyme disease performed on serum.

 

This test compares the level of IgG antibodies to Lyme disease-causing Borrelia species in spinal fluid (CSF) and serum. The level of anti-Borrelia species IgG is normalized to total IgG and albumin in CSF and serum.

 

This test can help identify whether the presence of IgG to Borrelia species in the CSF is due to true intrathecal antibody synthesis, suggesting neuroinvasive Lyme disease, versus antibody presence due to passive diffusion through the blood-brain barrier or possibly, due to blood contamination of the CSF as a result of a traumatic lumbar puncture.

Profile Information

Test ID Reporting Name Available Separately Always Performed
LNBAC Lyme CNS Infection IgG Screen, CSF No Yes
LNBAS Lyme CNS Infection IgG, S No No

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
LNBAI Lyme CNS Infection IgG, Ab Index No No

Testing Algorithm

This test begins with IgG screening of the spinal fluid (CSF) specimen. If the screen is negative, no additional testing will be performed.

 

If the screen is positive, the paired CSF and serum specimens will be used to establish the antibody index. In order to establish the antibody index, the paired serum and CSF samples (collected within 24 hours of each other) are tested on the same run using quantitative assays to determine levels for the following analytes:

1. Anti-Borrelia species IgG levels in CSF and serum

2. Total IgG in CSF and serum

3. Albumin in CSF and serum

 

These additional tests are necessary in order to normalize the level of anti-Borrelia antibodies to total IgG and albumin in the CSF and establish the antibody index ratio of anti-Borrelia antibodies in CSF-to-serum. This testing is performed at an additional charge.

 

The following algorithms are available in Special Instructions:

-Lyme Neuroborreliosis Diagnostic Algorithm

-Acute Tick-Bourne Disease Testing Algorithm

-Meningitis/Encephalitis Panel Algorithm

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Reporting Name

Lyme CNS Infection IgG w/ AI Reflex

Specimen Type

CSF
Serum

Specimen Minimum Volume

CSF: 1.2 mL
Serum: 1.2 mL

Specimen Stability Information

Specimen Type Temperature Time
CSF Refrigerated (preferred) 11 days
  Frozen  35 days
Serum Refrigerated (preferred) 11 days
  Frozen  35 days

Reference Values

Negative

 

Reference values apply to all ages.

Day(s) and Time(s) Performed

Monday, Wednesday, Friday; 8 a.m.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

86618-Lyme spinal fluid

86618 x 2-Lyme, Serum and spinal fluid if applicable for Antibody Index

82040-Albumin, serum if applicable for Antibody Index

82042-Albumin, spinal fluid if applicable for Antibody Index

82784 x 2-IgG, serum and spinal fluid if applicable for Antibody Index

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LNBAB Lyme CNS Infection IgG w/ AI Reflex 92815-0

 

Result ID Test Result Name Result LOINC Value
LNB1 Lyme CNS Infection IgG, CSF 92813-5
LNBAS Lyme CNS Infection IgG, S 92814-3
LNB2 Lyme CNS Infection IgG Interp 69048-7

NY State Approved

Yes

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.