II. Labs: Two tiered protocol

  1. See Lyme Test
  2. Tier 1: Lyme Titer (ELISA)
    1. Not needed if Erythema Migrans in endemic areas
    2. False Positive Rate is high
    3. Positives are reflexed to Western Blot
  3. Tier 2: Lyme Western Blot
    1. Confirms Lyme Titer result

III. Labs: Other

  1. Synovial Fluid Lyme PCR
    1. Joint aspiration in cases of suspected Lyme Arthritis
  2. Cerebrospinal fluid (CSF) for Intrathecal Lyme Antibody production
    1. Indicated for neurologic symptoms
  3. Skin Biopsy of Erythema Migrans for Quantitative PCR
    1. Most sensitive test in early Erythema Migrans
    2. May be indicated in atypical rash presentations
    3. Sensitivity: 81%
    4. Nowakowski (2001) Clin Infect Dis 33:2023-7 [PubMed]
  4. Skin Culture of Erythema Migrans (uncommonly performed)
    1. Sensitivity: 60-80% for organisms
    2. Sample types
      1. Saline-lavage needle aspirate
      2. Punch Biopsy (2 mm) of leading edge
  5. C6 Peptide assay (IgG enzyme linked immunosorbent assay)
    1. Under study as of 2012 for replacement of the two tiered protocol

IV. Labs: Precautions

  1. Lyme urine antigen
    1. High False Positive Rate and not recommended
  2. Borrelia Burgdorferi IgG and IgM
    1. Persists for years following effective antibiotic treatment
    2. Positive test after treatment does not indicate failed antibiotics or chronic infection

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