II. Labs: Two tiered protocol
- See Lyme Test
- Tier 1: Lyme Titer (ELISA)
- Not needed if Erythema Migrans in endemic areas
- False Positive Rate is high
- Positives are reflexed to Western Blot
- Tier 2: Lyme Western Blot
- Confirms Lyme Titer result
III. Labs: Other
-
Synovial Fluid Lyme PCR
- Joint Aspiration in cases of suspected Lyme Arthritis
- Cerebrospinal fluid (CSF) for Intrathecal Lyme Antibody production
- Indicated for neurologic symptoms
- Skin Biopsy of Erythema Migrans for Quantitative PCR
- Most sensitive test in early Erythema Migrans
- May be indicated in atypical rash presentations
- Sensitivity: 81%
- Nowakowski (2001) Clin Infect Dis 33:2023-7 [PubMed]
- Skin Culture of Erythema Migrans (uncommonly performed)
- Sensitivity: 60-80% for organisms
- Sample types
- Saline-lavage needle aspirate
- Punch Biopsy (2 mm) of leading edge
- C6 Peptide assay (IgG Enzyme Linked Immunosorbent Assay)
- Under study as of 2012 for replacement of the two tiered protocol
IV. Labs: Precautions
- Lyme urine Antigen
- High False Positive Rate and not recommended
-
Borrelia Burgdorferi IgG and IgM
- Persists for years following effective antibiotic treatment
- Positive test after treatment does not indicate failed antibiotics or chronic infection