Lyme Disease Serology, Serum (LAB 5136)
Lyme disease is rarely diagnosed in the St. Louis region without travel history.
- Lyme disease is a tick-borne infection caused by the bacteria Borrelia, most commonly Borrelia burgdorferi in the United States. It is transmitted through tick bites, particularly from infected black-legged ticks. The disease progresses through three stages: early localized, early disseminated, and late disseminated. Common symptoms include the characteristic skin rash called erythema migrans, flu-like symptoms, neurological and cardiac problems, fatigue, joint paint, and cognitive difficulties.
- Lyme disease is most commonly found in the northeastern and upper midwestern regions of the United States, including Connecticut, Massachusetts, New York, Pennsylvania, and Wisconsin. In Missouri and Southern Illinois, Borrelia is rarely diagnosed (excluding individuals with recent travel to endemic area), with only nine confirmed cases in Missouri reported by the CDC between 2016 and 2021.
- The Centers for Disease Control and Prevention (CDC) recommends a two-tiered serologic testing approach for Lyme disease. The process begins with an enzyme immunoassay (EIA) to detect antibodies. If the EIA yields a positive or equivocal result, a confirmatory test such as Western blot or secondary EIA is conducted. The overall result is considered positive only when the first test is positive (or equivocal) and the second test is positive.
- Lyme disease is not endemic to Missouri and is rarely diagnosed. Other tick-borne infections like Ehrlichia and Rickettsia are more common.
- During the early stages of infection, antibody levels may be low or undetectable, leading to false-negative results.
- False positive cross-reactions may occur in patients with other conditions, including relapsing fever, syphilis, rheumatoid arthritis, and Epstein-Barr virus infection.
- Borrelia is a rare tick-borne pathogen in Missouri, with only 9 confirmed cases reported by the CDC from 2016-2021.
- The most common tick-borne pathogens for patients from Missouri are Ehrlichia spp. (Ehrlichiosis) and Rickettsia rickettsii (Rocky Mountain Spotted Fever).
- A two-tiered serologic testing approach is the gold standard for diagnosis of Lyme disease.
- Centers for Disease Control and Prevention. 2024. Clinical Testing and Diagnosis for Lyme Disease. Available at: https://www.cdc.gov/lyme/hcp/diagnosis-testing/
- Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System, 2020 Annual Tables of Infectious Disease Data. Atlanta, GA. CDC Division of Health Informatics and Surveillance, 2023. Available at: https://www.cdc.gov/nndss/data-statistics/infectious-tables/index.html.
- Association of Public Health Laboratories. April 2024. Lyme Disease Serologic Testing and Reporting Guidelines. Available at: https://www.aphl.org/aboutAPHL/publications/Documents/ID-2024-Lyme-Disease-Serologic-Testing-Reporting.pdf
Written By: Madi Tichenor, DO
Reviewed By: Rebekah Dumm, PhD
Last Edited: 2024-12-04
Last Reviewed: 2024-12-04