Skip to main content

Lyme Testing Update

May 15, 2018

Updates in Lyme testing; Neuroborreliosis

Lyme is one of the endemic disease that plagues New England. One of the manifestations of lyme disease is neuroborreliosis. To help with diagnosis of this affection NorDx is offering the following orderable send-out tests starting June 12th 2018

  1. LYME DISEASE WESTERN BLOT CSF (LYSF test code); Detection of anti-borrelia antibodies in CSF using an immunoblot that recognizes IgG antibodies against 10 B. burgdorferi antigens and IgM antibodies against 3 B. burgdorferi specific antigens. The presents of 5 out of the 10 antigens for IgG or 2 out of the 3 antigens for IgM represents a positive result. The disadvantage of this test is related to the fact that the detected antibodies could be actually serum proteins that leaked in the CSF and the result is not specific for locally produced immunoglobulins. A high pretest probability is indicated before ordering this test.


  2. LYME CNS INF IGG W/ AB INDEX REFLEX (LYCNS test code). The anti-borrelia antibodies are measured both in serum as well as in CSF using specific immunoassays. The results are compared with the total proteins and an index is calculated. If the value exceeds 1, the interpretation is that the antibodies are produced at the nervous system level and the patient is positive for neuroborreliosis. The disadvantage of this test is that both blood and CSF need to be collected simultaneously, the collection tubes need to be banded together and sent to the laboratory. The serum antibody test will be performed first and if this test is negative the laboratory will not measure the antibody concentration in the CSF.


  3. Both tests are difficult to perform both from the collection point of view as well as from the testing perspective. In order to avoid unnecessary testing we strongly suggest to order this test only on patients with demonstrated lyme antibody presence in serum or with a proven history of lyme disease.

NorDx is offering the two tiered serologic analyses (Lyme disease antibody serum; test code LYMES) represented by a screening immunoassay followed by a confirmatory immunoblot. This test can be ordered by itself or as part of different tick panels (together with molecular detection for Babesia, Anaplasma and Ehrlichia species). As an aid for laboratory diagnosis we are offering an algorithm. Please see below the recommended testing algorithm based on different clinical presentations:

Moore A, Nelson CA, Molins C, et al. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States. Emerging Infectious Diseases. 2016;22(7):1169-1177. doi:10.3201/eid2207.151694.

Please visit our test catalog at or call us 207-396-7830 for any questions or suggestions.

Monica Ianosi-Irimie MD, PhD / Laboratory Director / NorDx, MaineHealth

News from Around MaineHealth

View All
MaineHealth to Require Care Team COVID-19 Vaccinations as Condition of Employment
As MaineHealth seeks to limit the spread of COVID-19, vaccination will be a requirement for employment, with very few exceptions, as of Oct. 1, 2021.
MaineHealth makes significant workforce investment, raising wages for its care team members starting Aug. 8
In addition to a base wage increase for nearly all employees, the minimum pay rate across the health system will rise from $14 to $17 an hour, and market adjustments will be made for hard-to-fill roles.
MaineHealth Administers First Doses of COVID-19 Vaccine to Front-line Caregivers
Hours after the arrival of the Pfizer vaccine at its hospitals, MaineHealth began inoculating team members who provide direct care to patients infected with the novel coronavirus.
MaineHealth Establishes Plan for Inoculating Front-line Care Givers Following State Plan for Distribution of COVID-19 Vaccines
The health system expects to be able to vaccinate all its front-line care team members following the delivery of a second allotment that is expected to include both Pfizer and Moderna vaccines.
MaineHealth’s Access to Care team connects Mainers with coverage during 2021 Open Enrollment
MaineHealth’s Access to Care team is prepared to assist and educate Mainers in shopping for health insurance plans during the Open Enrollment period, which runs November 1 through December 15.
MaineHealth Earns 2020 CHIME Digital Health Most Wired Recognition
The CHIME Digital Health Most Wired program conducts an annual survey to assess how effectively healthcare organizations apply core and advanced technologies into their clinical and business programs to improve health and care in their communities.
MaineHealth Welcomes Susan Ahern, Vice President of Innovation
MaineHealth is pleased to welcome Susan Ahern as Vice President of Innovation, a new systemwide role responsible for planning and development of the MaineHealth Innovation Center.
Top Public Health Official to Join MaineHealth
Dr. Dora Anne Mills, who oversaw the state of Maine’s public health initiatives for 15 years, will lead efforts to create healthier communities for 1.1 million people across Maine and New Hampshire.
Lyme Testing Update
Lyme is one of the endemic disease that plagues New England. One of the manifestations of lyme disease is neuroborreliosis. To help with diagnosis of this affection NorDx is offering the following orderable send-out tests starting June 12th 2018
Biotin Interference
The consumption of biotin (vitamin B7, component of multivitamins and of hair and nail products, medication for Multiple Sclerosis) has increased and as result interfering patterns have been observed: