Lyme-Borrelia Burgdorferi IgG

Bacterial/ Viral

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Detects antibodies to Borrelia burgdorferi.

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Lyme-Borrelia Burgdorferi IgG Test Guide

Why is it done?
- Test Purpose: Detects IgG antibodies against Borrelia burgdorferi, the spirochete bacterium that causes Lyme disease, transmitted through Ixodes tick bites.
- Primary Indications: Evaluation of suspected Lyme disease in patients with clinical symptoms such as erythema migrans (characteristic "bull's-eye" rash), arthralgia, arthritis, cardiac conduction abnormalities, or neurological manifestations (neuroborreliosis).
- Timing and Circumstances: Typically ordered 2-4 weeks after tick exposure or symptom onset; most useful in later-stage Lyme disease (weeks to months) when IgG antibodies have developed; employed in endemic areas during tick season (spring through fall).
- Clinical Scenarios: Post-Lyme disease syndrome evaluation, recurrent joint symptoms, persistent neurological symptoms, or follow-up of treated patients.
Normal Range
- Reference Range: Negative/Non-Reactive: <0.9 Index (may vary by laboratory; typically expressed as Index values, Optical Density ratios, or units/mL depending on methodology).
- Borderline/Equivocal: 0.9-1.0 Index (requires clinical correlation and consideration of repeat testing or confirmatory Western blot).
- Positive/Reactive: >1.0 Index (indicates presence of IgG antibodies to Borrelia burgdorferi; consistent with current or past infection).
- Units of Measurement: Index values (unitless), Optical Density (OD), or specific antibody units; exact cutoff values should be verified with individual laboratory reference ranges.
- Interpretation of Normal: Negative result indicates no detectable IgG antibodies; suggests no prior or current Borrelia burgdorferi infection, though early acute infection (first 2 weeks) may still be negative.
- Interpretation of Abnormal: Positive result indicates presence of IgG antibodies; may represent current infection, past resolved infection, or potential false positive (particularly in cases of other infections or autoimmune conditions).
Interpretation
- Negative IgG Result: Likely no Lyme disease infection; however, early acute Lyme disease (within first 2 weeks) may be IgG-negative while IgM-positive. If clinical suspicion remains high and symptoms persist, repeat testing in 2-4 weeks may be warranted or consider IgM testing.
- Equivocal/Borderline IgG Result: Requires clinical correlation with patient symptoms and epidemiological risk factors. Confirmatory testing with Western blot is recommended. May repeat serology in 2 weeks to assess for seroconversion pattern.
- Positive IgG Result: Indicates antibodies to Borrelia burgdorferi; suggests current or past infection. Confirmatory Western blot is recommended per CDC guidelines. Positive IgG with negative IgM suggests chronic or past infection rather than acute disease.
- IgG Positive with IgM Negative: Consistent with late-stage Lyme disease, past infection, or chronic sequelae. May indicate established infection beyond acute phase.
- Factors Affecting Results: Timing of infection relative to testing; cross-reactivity with other spirochetal infections (syphilis, relapsing fever); prior Lyme disease vaccination or history; immunosuppression; laboratory methodology and cutoff values; presence of rheumatoid factor.
- Clinical Significance Patterns: Rising IgG titers over time suggest active or recent infection. Persistently positive IgG in asymptomatic individuals may represent past resolved infection. Serial testing with clinical correlation is more informative than single results.
- False Positives: May occur with other infections (syphilis, relapsing fever, EBV), autoimmune diseases (rheumatoid arthritis, lupus), or chronic conditions; Western blot confirmation is essential.
Associated Organs
- Primary Organ Systems Involved: Skin (erythema migrans and acrodermatitis), musculoskeletal system (arthralgia, arthritis), nervous system (neuroborreliosis), cardiac system (conduction abnormalities), and immune system (chronic inflammation).
- Conditions Associated with Abnormal Results: Lyme arthritis (Lyme arthritis predominantly affects knee joints), Lyme neuroborreliosis (facial palsy, meningitis, encephalitis, peripheral neuropathy), Lyme carditis (atrioventricular block), acrodermatitis chronica atrophicans (European manifestation).
- Diseases Diagnosed or Monitored: Lyme disease (Borrelia burgdorferi infection), post-Lyme disease syndrome (PLDS), chronic Lyme arthritis, late-stage neuroborreliosis, and potential co-infections (Babesia, Anaplasma, Ehrlichia) transmitted by the same Ixodes tick vector.
- Potential Complications: Untreated late Lyme disease may result in chronic arthritis (particularly monoarticular knee arthritis), permanent neurological damage, cardiac arrhythmias, or inflammatory complications; chronic persistent infection may lead to long-term disability if not appropriately treated.
- Associated Laboratory Findings: Elevated inflammatory markers (ESR, CRP), cerebrospinal fluid lymphocytosis in neuroborreliosis, synovial fluid inflammation in Lyme arthritis, and elevated liver function tests in some cases.
Follow-up Tests
- Confirmatory Testing: Western blot for IgG (CDC-recommended two-step algorithm); should be performed on all positive or equivocal IgG ELISA results to confirm Borrelia burgdorferi infection and reduce false positives.
- Complementary Serologic Tests: Lyme-Borrelia burgdorferi IgM antibodies (for acute phase distinction), RPR/VDRL (to exclude syphilis cross-reactivity), and tests for co-infections such as Babesia serology, Anaplasma serology, or Ehrlichia serology.
- Further Investigation Tests: Cerebrospinal fluid (CSF) analysis with Lyme serology if neuroborreliosis suspected; synovial fluid analysis if arthritis present; cardiac monitoring (ECG) if carditis suspected; imaging studies (MRI) for neurological manifestations.
- Monitoring Frequency: Acute treatment: No routine antibody monitoring needed; antibodies persist indefinitely after infection. For treatment evaluation: clinical response assessment more important than repeat serology; repeat testing rarely needed unless symptoms recur.
- Related Tests for Differential Diagnosis: ANA and rheumatoid factor (autoimmune disease exclusion), ESR/CRP (inflammatory markers), HLA-B27 (arthritis workup), nerve conduction studies (peripheral neuropathy assessment), and joint imaging for arthritis evaluation.
- Post-Treatment Assessment: Clinical evaluation of symptom resolution; serological testing generally not recommended for treatment efficacy determination as IgG remains positive indefinitely; repeat serology only if clinical recurrence or new symptoms develop.
- PCR Testing: Borrelia burgdorferi PCR (blood, CSF, tissue) may be considered in research settings or when diagnosis remains unclear; not routinely used for clinical diagnosis but may support serology findings.
Fasting Required?
- Fasting Requirement: No
- Fasting Details: Fasting is not required for Lyme-Borrelia burgdorferi IgG antibody testing as this is a serological test measuring antibodies in blood serum, which is not affected by food intake.
- Medications to Avoid: No specific medications need to be discontinued prior to testing; however, antibiotic therapy (if recently initiated) does not affect antibody levels; immunosuppressive medications do not typically interfere with results.
- Patient Preparation Requirements: Standard blood draw preparation; patient may eat and drink normally; no special pre-test preparation needed; routine venipuncture technique used for serum sample collection.
- Sample Collection: Serum sample obtained by venipuncture into SST (serum separator tube) or red-top tube; no special handling required; sample stable at room temperature for several hours or refrigerated for longer periods.
- Timing Considerations: Can be performed at any time of day; optimal timing is 2-4 weeks after symptom onset to ensure adequate antibody production; testing too early may result in false-negative results.

How our test process works!