Additionally, while the presence of antibodies to Bbsl in CSF may be due to true intrathecal antibody synthesis, thus indicating central nervous system (CNS) infection, antibodies may alternatively be present as a result of passive diffusion through the blood-brain barrier or due to blood contamination of CSF during a traumatic lumbar puncture. Spinal fluid (CSF) should not be tested for the presence of antibodies to Bbsl using the current 2-tiered testing algorithm as there are no interpretive criteria for assessment of anti-Bbsl IgM and IgG immunoblot banding patterns in CSF. Results from these assays, alongside appropriate exposure history and clinical presentation, may be used to establish a diagnosis of NLD. Therefore, it is recommended that all patients tested by this assay also have LYME / Lyme Disease Serology, Serum performed. Notably, the majority of patients with NLD will be seropositive in serum. Briefly, the LYME test includes testing of serum specimens by an anti-Bbsl antibody enzyme-linked immunosorbent assay, followed by supplemental testing of all reactive samples using an immunoblot or western blot for detection of IgM- and IgG-class antibodies to Bbsl. Patients meeting these criteria should be evaluated for the presence of anti-Bbsl antibodies in serum using the standard 2-tiered testing algorithm (LYME / Lyme Disease Serology, Serum) as recommended by the Centers for Disease Control and Prevention. NLD should be considered in individuals presenting with appropriate symptoms who have had exposure to ticks in a Lyme endemic region of the United States, Europe, or Asia. Some patients may present with Bannwarth syndrome, which includes painful radiculoneuritis with variable motor weakness. These symptoms can occur in any combination or alone. Neuroinvasive Lyme disease (NLD) can affect either the peripheral or central nervous system, with patients classically presenting with the triad of lymphocytic meningitis, cranial neuropathy (especially facial nerve palsy) and radiculoneuritis, which can affect the motor or sensory nerves, or both. Arthritis, cardiac disease, and neurological disease may be later stage manifestations. Other early signs and symptoms include malaise, headache, fever, lymphadenopathy, and myalgia. The classic presenting sign of early localized Lyme disease caused by B burgdorferi is erythema migrans, which occurs in approximately 80% of individuals. The clinical features of Lyme disease are broad and may be confused with various immune and inflammatory disorders. Lyme disease is the most commonly reported tick-borne infection in North America and Europe, causing an estimated 300,000 cases in the United States each year and 85,000 cases in Europe. Nearly all human infections are caused by 3 Bbsl species B burgdorferi sensu stricto (hereafter referred to as B burgdorferi) is the primary cause of Lyme disease in North America, while Borrelia afzelii and Borrelia garinii are the primary causes of Lyme disease in Europe and parts of Asia. Lyme disease is a multisystem and multistage tick-transmitted infection caused by spirochetal bacteria in the Borrelia burgdorferi sensu lato (Bbsl) complex. Centrifuge and aliquot serum into a plastic vial. A serum sample of 1.2 mL needs to be collected within 24 hours of the spinal fluid specimen, preferably at the same time.Ģ. CSF aliquot should be from the second, third, or fourth CSF vial collected during the lumbar puncture.ĭo not submit CSF from the first vial due to the possibility of blood contamination, which will cause specimen rejection. A spinal fluid (CSF) sample of 1.2 mL needs to be collected within 24 hours of the serum specimen, preferably at the same time.ģ. CSF and serum must be collected within 24 hours (maximum) of each other.ġ. Meningitis/Encephalitis Panel Algorithmīoth spinal fluid (CSF) and serum are required for this test. Acute Tick-Bourne Disease Testing Algorithm Lyme Neuroborreliosis Diagnostic Algorithm This testing is performed at an additional charge. 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. Anti- Borrelia species IgG levels in CSF and serum 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:ġ. If the screen is positive, the paired CSF and serum specimens will be used to establish the antibody index. If the screen is negative, no additional testing will be performed. This test begins with IgG screening of the spinal fluid specimen.
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