Test Directory

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

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

Specimen Type: CSF AND Serum

Collection Container: CSF-Sterile, Non-additive Container AND Gold Top, Serum Separator

Alternate Collection Container: CSF-Sterile, Non-additive Container AND Red Top, Plain

Desired Specimen Volume: 1.2 mL CSF AND 1.2 mL Serum

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

CSF

1. Collect CSF via lumbar puncture.

Serum

1. Collect a gold top, serum separator tube via venipuncture.
2. Collect serum preferably at the same time as lumbar puncture.

Both spinal fluid (CSF) and serum are required for this test.

CSF

1. Do not submit CSF from the first vial due to the possibility of blood contamination, which will cause specimen rejection.
2. Transfer 1.2 mL of CSF to a sterile aliquot tube (screw cap).

Serum

1. Separate serum from cells.
2. Transfer 1.2 mL of serum to a clear aliquot tube (screw cap).

Transport to the laboratory refrigerated. 

• Gross hemolysis
• Gross lipemia
• CSF contaminated with blood

See patient report.

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 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.