Topic Name

Message

If ARUP Consult does not answer your test selection and interpretation questions, or if you would like to suggest ways to improve content or usability, please send a message to the Consult editorial staff.

Please do not include any patient-specific or personal health information (PHI) in your message.

Email Address

An email address is not required, but providing one allows the ARUP Consult editorial staff to respond directly. ARUP will only use your email address to respond to your feedback. See the ARUP privacy policy for more information regarding email use.

CAPTCHA

What code is in the image?

Enter the characters shown in the image.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Borrelia burgdorferi Antibodies With Reflex to ELISA

3006053

Borrelia burgdorferi VlsE1/pepC10 Antibodies, Total by ELISA With Reflex to IgM and IgG by ELISA (Modified Two-Tier Testing) 3006053

Method

Semiquantitative Enzyme-Linked Immunosorbent Assay

Preferred reflex test to diagnose Lyme disease in symptomatic individuals. Reflex pattern follows the modified two-tier testing (MTTT) approach; a positive or equivocal screen is confirmed by immunoassay.

Lyme disease is one of the most common tickborne diseases in the United States. Infection is often accompanied by a characteristic erythema migrans (EM) rash, which alongside the appropriate history of tick exposure, can be used to issue a clinical diagnosis. Although laboratory testing is not always necessary for diagnosis, it is recommended for individuals with atypical presentations or specific neurologic symptoms. When testing is indicated, the CDC recommends two-tiered serologic testing.

For additional information, refer to the ARUP Consult Tickborne Diseases topic or Lyme Disease - Modified Two-Tiered Testing Algorithm.

Test Interpretation

Reference Range

Negative: ≤0.90 IV
Equivocal: 0.91-1.09 IV
Positive: ≥1.10 IV

Results

Testing Tier	Result	Interpretation
Tier 1: VlsE1/pepC10 antibodies by ELISA	Negative	Antibodies to Borrelia burgdorferi were not detected. Test will not reflex to tier 2. If suspicion of recent infection (≤14 days) remains, consider testing a new specimen after 7-14 days.
Tier 1: VlsE1/pepC10 antibodies by ELISA	Positive/equivocal	Antibodies to B. burgdorferi were detected. Test will reflex to tier 2.
Tier 2: Reflex to IgM and IgG antibodies by ELISA	Negative IgM and IgG	Antibodies to B. burgdorferi were not detected. If suspicion of recent infection (≤14 days) remains, consider testing a new specimen after 7-14 days.
	Equivocal IgM and IgG	If tier 1 results were positive, an equivocal tier 2 result supports a diagnosis of Lyme disease. If both tier 1 and tier 2 results are equivocal, consider testing a new specimen after 7-14 days.
	Positive IgM only	IgM antibodies to B. burgdorferi were detected, suggesting an acute or recent infection. IgM antibody results should only be considered to suggest recent or acute infection for specimens drawn ≤30 days from symptom onset.
	Positive IgG only	IgG antibodies to B. burgdorferi were detected, suggesting a recent or past infection.
	Positive IgM and IgG	IgM and IgG antibodies to B. burgdorferi were detected, suggesting a recent or past infection.
ELISA, enzyme-linked immunosorbent assay; Ig, immunoglobulin

Limitations

Serologic testing is not useful to assess treatment response.
IgM antibody results should only be considered for specimens drawn within 30 days of symptom onset.

References

33483734

Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021;72(1):1-8.

CDC - tickborne diseases of the United States 6th ed

Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for healthcare providers. 6th edition, 2022. Last reviewed Aug 2022; accessed Jun 2023.

Feedback