Test Catalog

Test Id : LNBAI

Lyme Central Nervous System Infection IgG, Antibody Index, Spinal Fluid

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

Providing antibody index information to aid in the diagnosis of neuroinvasive Lyme disease or neuroborreliosis due to Borrelia species associated with Lyme disease (eg, Borrelia burgdorferi, Borrelia garinii, Borrelia afzelli)

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

If LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid is reactive, then this test is performed at an additional charge.

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

Only orderable as part of a profile. For more information see LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid.

 

Enzyme-Linked Immunosorbent Assay (ELISA)

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

Lyme CNS Infection IgG, Ab Index

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

Neuroinvasive Lyme Disease

Neuroborreliosis

Lyme disease in the central nervous system

Lyme CNS disease

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

If LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid is reactive, then this test is performed at an additional charge.

Specimen Type
Describes the specimen type validated for testing

CSF

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

Only orderable as part of a profile. For more information see LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid.

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

Gross hemolysis Reject
Gross lipemia Reject
CSF contaminated with blood 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
CSF Refrigerated (preferred) 11 days
Frozen 35 days

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

Providing antibody index information to aid in the diagnosis of neuroinvasive Lyme disease or neuroborreliosis due to Borrelia species associated with Lyme disease (eg, Borrelia burgdorferi, Borrelia garinii, Borrelia afzelli)

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

If LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid is reactive, then this test is performed at an additional charge.

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

Lyme disease is a multisystem and multistage tick-transmitted infection caused by spirochetal bacteria in the Borrelia burgdorferi sensu lato (Bbsl) complex. Nearly all human infections are caused by 3 Bbsl species; B burgdorferi sensu stricto (hereafter referred to as B burgdorferi) is the primary cause of Lyme disease in North America, while Borrelia afzelii and Borrelia garinii are the primary causes of Lyme disease in Europe and parts of Asia.

 

Lyme disease is the most commonly reported tick-borne infection in North America and Europe, causing an estimated 300,000 cases in the United States each year and 85,000 cases in Europe. The clinical features of Lyme disease are broad and may be confused with various immune and inflammatory disorders. The classic presenting sign of early localized Lyme disease caused by B burgdorferi is erythema migrans (EM), which occurs in approximately 80% of individuals. Other early signs and symptoms include malaise, headache, fever, lymphadenopathy, and myalgia. Arthritis, cardiac disease, and neurological disease may be later stage manifestations.

 

Neuroinvasive Lyme disease (NLD) can affect either the peripheral or central nervous system, with patients classically presenting with the triad of lymphocytic meningitis, cranial neuropathy (especially facial nerve palsy) and radiculoneuritis, which can affect the motor or sensory nerves, or both. These symptoms can occur in any combination or alone. Some patients may present with Bannwarth syndrome, which includes painful radiculoneuritis with variable motor weakness. 

 

NLD should be considered in individuals presenting with appropriate symptoms who have had exposure to ticks in a Lyme endemic region of the United States, Europe or Asia. Patients meeting these criteria should be evaluated for the presence of anti-Bbsl antibodies in serum using the standard 2-tiered testing algorithm (LYME / Lyme Disease Serology, Serum) as recommended by the Centers for Disease Control and Prevention. Briefly, the STTTA includes testing of serum specimens by an anti-Bbsl antibody enzyme-linked immunosorbent assay (ELISA), followed by supplemental testing of all reactive samples using an immunoblot or western blot for detection of IgM- and IgG- class antibodies to Bbsl. Notably, the majority of patients with NLD, more than 99%, will be seropositive in serum. This alongside appropriate exposure history and clinical presentation may be used to establish a diagnosis of NLD.

 

Cerebrospinal fluid (CSF) may also be tested for the presence of antibodies to Bbsl using the current 2-tiered testing algorithm as defined for serum samples. However, there are currently no interpretive criteria for assessment of anti-Bbsl IgM and IgG immunoblot banding patterns in CSF. Additionally, while the presence of antibodies to Bbsl in CSF may be due to true intrathecal antibody synthesis, thus indicating central nervous system (CNS) infection, antibodies may alternatively be present as a result of passive diffusion through the blood-brain barrier or due to blood contamination of CSF during a traumatic lumbar puncture.

 

The Lyme CNS antibody index (AI) quantitatively measures the level of anti-Bbsl antibodies in CSF and serum, ideally collected within 24 hours of each other, and normalizes those levels to total IgG and albumin in both specimen sources. A positive Lyme CNS AI indicates true intrathecal antibody synthesis of antibodies to Bbsl, which alongside clinical and exposure history can be used to establish a diagnosis of NLD.

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.

Only orderable as part of a profile. For more information see LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid.

 

0.6-1.2

Interpretation
Provides information to assist in interpretation of the test results

Negative (Lyme CNS AI 0.6 to <1.3): Results indicate lack of intrathecal antibody synthesis to Lyme disease associated Borrelia species. This suggests the absence of neuroinvasive Lyme disease. The initial screen reactive result may be due to anti-Borrelia species antibodies present in the cerebrospinal fluid (CSF) due to increased permeability of the blood-brain barrier or transient introduction during lumbar puncture.

 

Equivocal (Lyme CNS AI 1.3 to 1.5): Low level of intrathecal antibody synthesis to Lyme disease associated Borrelia species detected. Results should be correlated with exposure history and clinical presentation to establish a diagnosis of neuroinvasive Lyme disease.

 

Positive (Lyme CNS AI >1.5): Results indicate the presence of intrathecal antibody synthesis to Lyme disease associated Borrelia species, suggesting neuroinvasive Lyme disease. Results should be correlated with exposure history and clinical presentation to establish the diagnosis.

 

Invalid (Lyme CNS AI <0.6): Result is due to abnormally elevated total IgG levels in CSF. This may be due to passive diffusion through the blood-brain barrier or contamination of the CSF with blood during a traumatic lumbar puncture. Repeat testing may be considered.

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

A single negative result should not be used to exclude the diagnosis of neuroinvasive Lyme disease in a patient with appropriate exposure history and symptoms suggestive of infection. Testing of serum samples using the Centers of Disease Control and Prevention recommended Standard Two Tiered Testing Algorithm should be performed.

 

False-negative results may be acquired in patients tested soon after infection, prior to the development of a detectable level of antibodies in the cerebrospinal fluid.

 

Falsely reactive results may occur in patients with syphilis or Leptospira infections. Patient management decisions should not be made on a single reactive result.

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

1. Halperin JJ: Neuroborreliosis. J Neurol. 2017;264(6):1292-1297

2. Theel ES: The past, present and (possible) future of serologic testing for Lyme disease. J Clin Micro. 2016;54(5):1191-1196

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

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 (TMB/H2O2), 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 cerebrospinal fluid (CSF) samples are compared against a 6-level calibration curve to quantitatively determine the relative anti-Borrelia IgG antibody titers.(Package insert: Antibodies of the IgG class against Borrelia in cerebrospinal fluid. Euroimmun Ag; 6/15/2015)

 

The quantitative test results obtained on paired serum and CSF specimens using the Borrelia IgG enzyme-linked immunosorbent assay (ELISA) are expressed as relative units (U/mL) and must be used along with the total IgG and albumin levels in the patient's paired serum and CSF samples to calculate the anti-Borrelia antibody index (AI), which determines the absence or presence of intrathecal anti-Borrelia IgG antibody synthesis. Total IgG and albumin testing on serum and CSF is performed using the Siemens BN II nephelometric testing system (Instruction manual: Siemens Nephelometer II Operations. Siemens, Inc; Version 2.3, 2008; Addendum to the Instruction Manual 2.3, 08/2017).

 

To detect an infection of the central nervous system (CNS), it is necessary to differentiate between intrathecally produced antibodies and antibodies passed from blood into the CSF. The AI is the value of intrathecal pathogen-specific antibody production. This AI value represents the portion of pathogen-specific antibodies in total IgG of CSF and the portion of pathogen-specific antibodies in total IgG of serum. The patient's AI is calculated using the Reiber and Lange method.(Reiber H, Lange P: Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem. 1991;37(7):1153-1160)

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, Wednesday, 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 day

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, and its performance characteristics 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.

86618 x 2

82040

82042

82784 x 2

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