Test Catalog

Test ID: ELYME    
Lyme Disease European Antibody Screen, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Aiding in the diagnosis of Lyme disease caused by infection with Borrelia species endemic to Europe and Asia, including Borrelia garinii and Borrelia afzelii


This test should not be used to screen the general population. It is only intended for use in patients with recent travel to and exposure to ticks in Europe or regions of Asia who are suspected to have Lyme disease caused by Borrelia species endemic to Europe/Asia.

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If this test is positive or equivocal, then immunoblot testing will be performed at an additional charge.


See Acute Tick-Borne Disease Testing Algorithm in Special Instructions.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Lyme disease (LD) is caused by infection with a member of the Borrelia burgdorferi sensu lato complex. Among the genospecies within this complex, B burgdorferi sensu stricto (B burgdorferi) is the primary agent causing LD in North America. While B burgdorferi is also found abroad, Borrelia garinii and Borrelia afzelii are more prevalent in Europe and regions of Asia. These spirochetes are transmitted to humans through the bite of Ixodes species ticks, primarily Ixodes ricinus and, to a lesser extent, Ixodes persulcatus, which are both found throughout Europe, the Baltic regions, and parts of Asia. Therefore, residents of, or travelers to, these areas who are bitten by ticks are at increased risk for LD caused by a European Borrelia species.


Transmission of LD-associated Borrelia requires at least 36 hours of tick attachment. Approximately 80% of infected individuals will develop a unique expanding skin lesion with a central zone of clearing, referred to as erythema migrans (EM; stage 1). In the absence of treatment, patients may progress to early disseminated disease (stage 2), which is characterized by neurologic manifestations (eg, meningitis, cranial neuropathy, radiculoneuropathy) and is often associated with B garinii infection. Patients with late LD often present with intermittent or persistent arthralgia, most often associated with B burgdorferi infection, or with acrodermatitis chronica atrophicans (ACA), typically due to infection with B afzelii.


Diagnosis of LD is currently based on a 2-tiered serologic testing algorithm to detect antibodies to LD-associated Borrelia species. Importantly, patients may be seronegative until 2 weeks post onset of symptoms. An IgM-class antibody response usually peaks 3 to 6 weeks after infection but may persist for years in some cases. IgG-class antibodies to Borrelia spirochetes are detectable 2 to 3 weeks postinfection and may remain elevated for years after resolution of symptoms. In patients with EM, culture of skin biopsies obtained near the margins of the rash are frequently positive, though this technique is not commonly available. In late (chronic) stages of the disease, serology is often positive and is the diagnostic method of choice. Polymerase chain reaction (PCR) testing may also be of use in these late stages if performed on synovial fluid or tissue.


Early antibiotic treatment of Lyme disease can resolve clinical symptoms and prevent progression of the disease to later stages. Also, if provided early in disease, treatment may suppress the immune response to the bacteria leading to negative serologic results.


The 2-tiered testing algorithm for LD involves an initial screening assay for detection of total antibodies to LD-causing Borrelia species. For this algorithm, the C6 enzyme-linked immunosorbent assay (ELISA) is used to screen all specimens, and those with positive or equivocal results are reflexed for supplemental testing by immunoblot for detection of IgM and IgG antibodies to LD-causing Borrelia species. Importantly, while most screening ELISAs detect antibodies to all major LD-associated Borrelia species, the immunoblots used for supplemental testing in North America are specifically designed to detect antibodies to the B burgdorferi B31 strain. Despite similarity between the genospecies, the North America immunoblots have a reported sensitivity of approximately 50% for LD caused by the European Borrelia species (eg, B afzelii and B garinii). In order to improve upon the ability to detect antibodies to the European Borrelia species, immunoblot tests designed to detect IgM- and IgG-class antibodies B garinii, B afzelii and B burgdorferi are used for supplemental testing of all specimens with positive or equivocal results by the LD screening ELISA.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


Interpretation Provides information to assist in interpretation of the test results

Negative result:

No antibodies to Lyme disease Borrelia species (eg Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii) detected. Repeat testing on a new specimen collected in 2 to 3 weeks should be considered if acute Lyme disease due to one of these Borrelia species is suspected. 


Equivocal result:

Not diagnostic. Supplemental immunoblot testing has been ordered by reflex.


Positive result:

Not diagnostic. Supplemental immunoblot testing has been ordered by reflex.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

The predictive value of the assay is a function of the pretest probability of Lyme disease in the population tested. Hence, only patients with clinical symptoms of Lyme disease with recent travel to or residence in Europe or parts of Asia should be tested for Lyme disease caused by Borrelia species endemic to Europe.


A negative result does not exclude the possibility of infection with Lyme disease-associated Borrelia species, including Borrelia afzelii or Borrelia garinii.


A positive result is not definitive evidence of infection with Lyme disease-associated Borrelia species. Supplemental testing of all specimens that result as positive or equivocal by the Lyme disease screening enzyme-linked immunosorbent assay (ELISA) require supplemental testing by immunoblot for IgM- and IgG-class antibodies to Borrelia species endemic in Europe and regions of Asia.  


Falsely reactive screening ELISA results may occur in patients with other disease conditions, including syphilis, periodontal disease, rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune diseases.


Test results should be used in conjunction with exposure history, travel history, clinical presentation, and other clinical findings.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Branda JA, Strle F, Strle K, Sikand N, et al: Performance of United States serologic assays in diagnosis of Lyme borreliosis acquired in Europe. Clin Infect Dis. 2013;57:333-340

2. Liang FT, Steere AC, Marques AR, et al: Sensitive and specific serodiagnosis of Lyme disease by enzyme-linked immunosorbent assay with a peptide based on an immunodominant conserved region of Borrelia burgdorferi VisE. J Clin Microbiol. 1999;37(12):3990-3996

Special Instructions Library of PDFs including pertinent information and forms related to the test