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HelpTest Code LNBAB Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid
Ordering Guidance
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.
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
Container/Tube: Sterile vial
Specimen Volume: 1.2 mL
Collection Instructions:
1. 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.
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
Submission Container/Tube: Plastic vial
Specimen Volume: 1.2 mL
Collection Instructions:
1. A serum sample of 1.2 mL needs to be collected within 24 hours of the spinal fluid specimen, preferably at the same time.
2. Centrifuge and aliquot serum into a plastic vial.
3. Label as serum.
4. Band specimens together.
Secondary ID
63502Useful For
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)
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
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:
-Lyme Neuroborreliosis Diagnostic Algorithm
Method Name
Enzyme-Linked Immunosorbent Assay (ELISA)
Reporting Name
Lyme CNS Infection IgG w/ AI ReflexSpecimen Type
CSFSerum
Specimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 11 days | |
| Frozen | 35 days | ||
| Serum | Refrigerated (preferred) | 11 days | |
| Frozen | 35 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| CSF contaminated with blood | Reject |
Reference Values
Negative
Reference values apply to all ages.
Method Description
The test kit contains microtiter strips with break-off reagent wells coated with a mix of Bb sl antigens (whole antigen extracts of Borrelia burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii and recombinant VlsE of B burgdorferi sensu stricto). In the first reaction step, diluted patient samples are incubated in the wells. In the case of positive samples, Borrelia-specific-IgG antibodies will bind to the antigens. To detect the bound antibodies, a second incubation is carried out using an enzyme-labelled antihuman IgG (enzyme conjugate), followed by a third incubation using chromogen/substrate, which catalyzes a color reaction that is then measured for optical density (OD) using spectrophotometry. The obtained OD values of the paired patient serum and spinal fluid samples are compared against a 6-level calibration curve to quantitatively determine the relative anti-Borrelia IgG antibody titers.(Unpublished Mayo method)
Day(s) Performed
Monday, Wednesday, Friday
Report Available
Same day/1 to 4 daysPerforming 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. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
86618
86618 x2 - if applicable
82040 - if applicable
82042- if applicable
82784 x2 - if applicable
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 |
Special Instructions
Forms
If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.