Lyme-Borrelia Burgdorferi IgM

Bacterial/ Viral

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No Fasting Required

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Detects antibodies to Borrelia burgdorferi.

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Lyme-Borrelia Burgdorferi IgM Test Information Guide

Why is it done?
- Test Purpose: Detects IgM antibodies against Borrelia burgdorferi, the spirochete bacterium that causes Lyme disease, indicating acute or early-stage infection
- Primary Indications: Symptoms of acute Lyme disease such as erythema migrans (bull's-eye rash), fever, joint pain, and fatigue within 2-4 weeks of tick exposure
- Clinical Timing: Typically ordered during the first 2-4 weeks of symptom onset; IgM antibodies appear early in infection (usually by week 1-2) and peak by week 4-6
- Risk Assessment: Particularly useful for patients in endemic regions with known tick exposure or travel to Lyme disease-endemic areas
- Differential Diagnosis: Helps distinguish Lyme disease from other tick-borne illnesses and arthropod-related conditions presenting with similar symptoms
Normal Range
- Normal/Negative Result: <0.91 Index Value or Negative by qualitative interpretation; indicates absence of IgM antibodies to B. burgdorferi
- Positive Result: ≥0.91 Index Value or Positive by qualitative interpretation; indicates presence of IgM antibodies suggesting acute or early Lyme disease infection
- Borderline/Equivocal Results: 0.81-0.90 Index Value; requires clinical correlation and may necessitate repeat testing or confirmation with IgG testing or Western blot
- Units of Measurement: Index Value (ratio) or qualitative (Positive/Negative); some laboratories may report as antibody titer or optical density
- Clinical Interpretation: Normal (negative) results effectively rule out acute Lyme disease when tested within the appropriate clinical window; abnormal (positive) results support the diagnosis of acute Lyme disease infection in the context of clinical symptoms
Interpretation
- Positive IgM Result: Indicates acute or early-stage Lyme disease infection, typically appearing within the first 2-4 weeks of infection; suggests recent exposure to B. burgdorferi
- Negative IgM Result in Early Symptoms: Does not exclude Lyme disease if tested very early (before antibody development); should be repeated 2-3 weeks later or combined with clinical assessment
- IgM Persistence: IgM typically peaks at 4-6 weeks and usually declines within 3-6 months; persistence beyond 6 months is unusual and may suggest continued or recurrent infection
- IgM Decline with IgG Rise: Progressive decline of IgM while IgG increases indicates transition to chronic infection; suggests disease progression beyond acute phase
- Cross-Reactivity Considerations: False positives may occur with other spirochetal infections (syphilis, relapsing fever), autoimmune diseases, or following vaccination; clinical correlation essential
- Erythema Migrans Significance: Clinical diagnosis of erythema migrans rash (characteristic bull's-eye appearance) may warrant treatment even with negative IgM, as antibody development may lag behind symptom onset
- Two-Tier Testing: CDC recommends two-tier testing; positive or equivocal IgM should be confirmed with Western blot to reduce false positives and improve diagnostic accuracy
Associated Organs
- Organ Systems Involved: Skin (primary site of erythema migrans), musculoskeletal system (joints, connective tissues), nervous system (CNS/PNS), cardiovascular system (heart), and lymphoid tissue
- Primary Diagnosis: Acute Lyme disease caused by Borrelia burgdorferi spirochete transmitted by Ixodes tick bite
- Common Associated Conditions: Erythema migrans, Lyme arthritis, Lyme neuroborreliosis, Lyme carditis, facial palsy (Bell's palsy), meningitis, peripheral neuropathy
- Musculoskeletal Manifestations: Migratory joint pain (arthralgias) progressing to Lyme arthritis affecting knees and other large joints; chronic arthropathy if untreated
- Neurological Complications: Lyme neuroborreliosis with meningitis, encephalitis, cranial nerve palsies, peripheral neuropathy, and cognitive changes (memory, concentration problems)
- Cardiac Involvement: Lyme carditis presenting with heart block, myocarditis, and pericarditis; rhythm abnormalities and potential for sudden cardiac death if untreated
- Constitutional Symptoms: Fever, chills, fatigue, malaise, headache, and lymphadenopathy occurring concurrently with or following erythema migrans rash
Follow-up Tests
- IgG Antibody Testing: Recommended to assess for chronic or late-stage Lyme disease; IgG appears after 3-4 weeks and indicates ongoing or past infection
- Western Blot Confirmation: CDC-recommended confirmatory test for positive or equivocal IgM results; improves diagnostic specificity and reduces false positives (part of two-tier testing protocol)
- Repeat IgM Testing: Recommended 2-3 weeks after initial negative test if clinical suspicion remains high; allows time for antibody development in early-stage infection
- Cerebrospinal Fluid (CSF) Testing: Lumbar puncture for CSF analysis (IgM and IgG antibodies, PCR) if neurological symptoms present, particularly for meningitis or encephalitis
- PCR and Culture: Borrelia burgdorferi PCR or culture from tissue/CSF rarely performed; primarily used in research settings due to low sensitivity
- Cardiac Workup: EKG, cardiac enzymes, and echocardiography if cardiac symptoms develop; monitoring for arrhythmias and heart block in Lyme carditis
- Other Co-Infection Screening: Testing for Babesiosis (Babesia microti) and Anaplasmosis (Anaplasma phagocytophilum), which are frequently co-transmitted with B. burgdorferi by Ixodes ticks
- Monitoring Intervals: Follow-up testing typically performed 4-6 weeks after initial test to assess for treatment response and disease progression; additional tests if symptoms persist despite treatment
Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for Lyme-Borrelia Burgdorferi IgM testing
- Sample Collection: Serum sample collected via venipuncture; patient may eat and drink normally before blood draw
- Medications: No medications need to be avoided; testing accuracy is not affected by antibiotic therapy, though antibiotics should be initiated promptly if Lyme disease is suspected based on clinical presentation
- Special Preparation Instructions: No special preparation needed; routine blood draw precautions apply (arm verification, proper sanitization); patient should be at rest for 5-10 minutes before collection if possible
- Timing Considerations: Optimal timing for IgM testing is 3-6 weeks after symptom onset; very early testing (first 2 weeks) may yield false negatives despite infection
- Clinical Symptoms Affecting Testing: Fever or acute illness does not contraindicate testing; patient should report fever, rash characteristics, and exact symptom onset date to aid interpretation

How our test process works!