Test Catalog

Test Id : EHBAP

Ehrlichia/Babesia Antibody Panel, Immunofluorescence, Serum

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

As an adjunct in the diagnosis of infection with Anaplasma phagocytophilum, Ehrlichia chaffeensis or Babesia microti

 

Seroepidemiological surveys of the prevalence of the infection in certain populations

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
ANAP Anaplasma phagocytophilum Ab, IgG,S Yes Yes
EHRC Ehrlichia Chaffeensis (HME) Ab, IgG Yes Yes
BABG Babesia microti IgG Ab, S Yes Yes

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

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

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

Method Name
A short description of the method used to perform the test

Immunofluorescence Assay (IFA)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Ehrlichia/Babesia Ab Panel, S, IFA

Aliases
Lists additional common names for a test, as an aid in searching

A. phagocytophilum

E. chaffeensis

HME (Human Monocytotropic Ehrlichiosis)

HGA (Human Granulocytic Anaplasmosis)

HGE (Human Granulocytic Ehrlichiosis)

Tick Borne Diseases

Babesiosis Serology

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

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

Specimen Type
Describes the specimen type validated for testing

Serum

Ordering Guidance

This test may be nonreactive during the acute phase of the infection. For patients presenting with suspected acute infections of Ehrlichia chaffeensis or Anaplasma phagocytophilum, consider EHRL / Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.6 mL

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

Forms

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject
Heat-inactivated specimen Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
Frozen 14 days

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

As an adjunct in the diagnosis of infection with Anaplasma phagocytophilum, Ehrlichia chaffeensis or Babesia microti

 

Seroepidemiological surveys of the prevalence of the infection in certain populations

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

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

Anaplasma phagocytophilum:

Anaplasma phagocytophilum, an intracellular rickettsia-like bacterium, preferentially infects granulocytes and forms inclusion bodies, referred to as morulae. A phagocytophilum is transmitted by Ixodes species ticks, which also transmit Borrelia burgdorferi and Babesia species. Infection with A phagocytophilum is also referred to as human granulocytic anaplasmosis (HGA) and symptoms in otherwise healthy individuals are often mild and nonspecific, including fever, myalgia, arthralgia, and nausea. Clues to the diagnosis of anaplasmosis in a patient with an acute febrile illness after tick exposure include laboratory findings of leukopenia or thrombocytopenia and elevated liver enzymes. HGA is most prevalent in the upper Midwest and in other areas of the United States that are endemic for Lyme disease.

 

Ehrlichia chaffeensis:

Ehrlichia chaffeensis is an intracellular rickettsia-like bacterium that preferentially infects monocytes and is sequestered in parasitophorous vacuoles referred to as morulae. Infections with E chaffeensis are also referred to as human monocytotropic ehrlichiosis (HME). E chaffeensis is transmitted by Amblyomma species ticks, which are found throughout the southeastern and south central United States.

 

Babesia microti:

Many cases of HME are subclinical or mild; however, the infection can be severe and life-threatening, particularly in immunosuppressed individuals. Reported mortality rates range from 2% to 3%. Fever, fatigue, malaise, headache, and other "flu-like" symptoms occur most commonly. Leukopenia, thrombocytopenia, and elevated hepatic transaminases are frequent laboratory findings.

 

Babesiosis is a zoonotic infection caused by the protozoan parasite Babesia microti. The infection is acquired by contact with Ixodes ticks carrying the parasite. The deer mouse is the animal reservoir, and overall, the epidemiology of this infection is much like that of Lyme disease. Babesiosis is most prevalent in the Northeast, upper Midwest, and Pacific coast of the United States.

 

Infectious forms (sporozoites) are injected during tick bites and the organism enters the vascular system where it infects red blood cells (RBC). In this intraerythrocytic stage it becomes disseminated throughout the reticuloendothelial system. Asexual reproduction occurs in RBC, and daughter cells (merozoites) are formed, which are liberated on rupture (hemolysis) of the RBC.

 

Most cases of babesiosis are probably subclinical or mild, but the infection can be severe and life threatening, especially in older or asplenic patients. Fever, fatigue, malaise, headache, and other flu-like symptoms occur most commonly. In the most severe cases, hemolysis, acute respiratory distress syndrome, and shock may develop. Patients may have hepatomegaly and splenomegaly.

 

A serologic test can be used as an adjunct in the diagnosis and follow-up of babesiosis, when infection is chronic or persistent, or in seroepidemiologic surveys of the prevalence of the infection in certain populations. Babesiosis is usually diagnosed by observing the organisms in infected RBC on Giemsa-stained thin blood films of smeared peripheral blood. Serology may also be useful if the parasitemia is too low to detect or if the infection has cleared naturally or following treatment.

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.

ANAPLASMA PHAGOCYTOPHILUM

<1:64

Reference values apply to all ages.

 

EHRLICHIA CHAFFEENSIS

<1:64

Reference values apply to all ages.

 

BABESIA MICROTI

<1:64

Reference values apply to all ages.

Interpretation
Provides information to assist in interpretation of the test results

Anaplasma phagocytophilum:

A positive result of an immunofluorescence assay (IFA) test (titer > or =1:64) suggests current or previous infection with human granulocytic ehrlichiosis. In general, the higher the titer, the more likely it is that the patient has an active infection.

 

Seroconversion may also be demonstrated by a significant increase in IFA titers.

 

During the acute phase of the infection, serologic tests are often nonreactive, polymerase chain reaction (PCR) testing is available to aid in the diagnosis of these cases (see EHRL / Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood).

 

Ehrlichia chaffeensis:

A positive immunofluorescence assay (titer > or =1:64) suggests current or previous infection. In general, the higher the titer, the more likely the patient has an active infection. Four-fold rises in titer also indicate active infection.

 

Previous episodes of ehrlichiosis may produce a positive serology although antibody levels decline significantly during the year following infection.

 

Babesia microti:

A positive result of an indirect fluorescent antibody test (titer > or =1:64) suggests current or previous infection with Babesia microti. In general, the higher the titer, the more likely it is that the patient has an active infection. Patients with documented infections have usually had titers ranging from 1:320 to 1:2,560.

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

Performance characteristics have not been established for hemolyzed or lipemic specimens.

 

Anaplasma phagocytophilum:

Previous episodes of human granulocytic ehrlichiosis may produce a positive serologic result.

 

In rare instances, clinical evidence of infection may also be derived by direct microscopic examination of Giemsa- or Diff-Quik-stained peripheral blood buffy coat smears, which may reveal clusters of round, dark-purple stained, small dots or clusters of dots (morulae) in the cytoplasm of polymorphonuclear cells. However, this is a very insensitive method.

 

 

Ehrlichia chaffeensis:

Serology for IgG may be negative during the acute phase of infection (<7 days post-symptom onset), during which time detection using targeted nucleic acid amplification testing (eg, polymerase chain reaction: PCR) is recommended.

 

Detectable IgG-class antibodies typically appear within 7 to 10 days post-symptom onset.

 

IgG-class antibodies may remain detectable for months to years following prior infection. Therefore, a single time point-positive titer needs to be interpreted alongside other findings to differentiate recent versus past infection.

 

Other members of the Ehrlichia genus (eg, Ehrlichia ewingii) may not be detected by this assay.

 

Babesia microti:

Previous episodes of babesiosis may produce a positive serologic result.

 

In selected cases, documentation of infection may be attempted by animal inoculation or PCR methods (LBAB / Babesia species, Molecular Detection, PCR, Blood)

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

Centers for Disease Control and Prevention: Tickborne Diseases of the United States: A Reference Manual for Health Care Providers. 4th ed. Department of Health and Human Services; 2017

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

Method Description
Describes how the test is performed and provides a method-specific reference

Anaplasma phagocytophilum and Ehrlichia chaffeensis:

The patient's serum is diluted and is placed in microscopic slide wells that have been coated with Anaplasma phagocytophilum and/or Ehrlichia chaffeensis-infected cells. After incubation, the slides are washed and a fluorescein-isothiocyanate conjugate is added to each well. The slides are then read using a fluorescence microscope and significant fluorescent staining of intracellular organisms constitutes a positive reaction.(Dumler JS, Asanovich KM, Bakken JS, et al: Serologic cross-reactions among Ehrlichia equi, Ehrlichia phagcoytophilia, and human granulocytic ehrlichia. J Clin Microbiol. 1995;33:1098-1103; Pancholi P, Kolbert CP, Mitchell PD, et al: Ixodes dammini as a potential vector of human granulocytic ehrlichiosis. J Infect Dis. 1995;172:1007-1012; Dawson JE, Fishbein DB, Eng TR, et al: Diagnosis of human ehrlichiosis with the indirect fluorescent antibody test: kinetics and specificity. J Infect Dis. 1990;162:91-95)

 

Babesia microti:

This immunofluorescence assay (IFA) detects antibodies against Babesia microti. The patient's serum is diluted and is placed in microscopic slide wells which have been coated with Babesia microti infected red blood cells (RBC) from Syrian hamsters. After incubation, the slides are washed and a fluorescein isothiocyanate conjugate is added to each well. The slides are then read using a fluorescence microscope and significant fluorescent staining of intraerythrocytic organisms constitutes a positive reaction.(Krause PJ, Telford SR III, Ryan R, et al: Diagnosis of babesiosis: Evaluation of a serologic test for the detection of Babesia microti antibody. J Infect Dis. 1994;169:923-926)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

Same day/1 to 3 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

86666 x 2

86753

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
EHBAP Ehrlichia/Babesia Ab Panel, S, IFA In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
81157 Anaplasma phagocytophilum Ab, IgG,S 23877-4
81128 Babesia microti IgG Ab, S 16117-4
81478 Ehrlichia Chaffeensis (HME) Ab, IgG 47405-6

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports