Test Id : TICKS

If the Lyme disease screen result is positive or equivocal, then Lyme disease antibody confirmation by immunoblot will be performed at an additional charge.

For more information see Acute Tick-Borne Disease Testing Algorithm

During the acute phase of an Anaplasma phagocytophilum, Ehrlichia chaffeensis or Babesia infection, serologic tests are often nonreactive; polymerase chain reaction (PCR) testing is available to aid in the diagnosis of these cases; see TIKLB / Tick-Borne Panel, Molecular Detection, PCR, Blood.

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

• Acute Tickborne Disease Testing Algorithm

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

See Specimen Required

Evaluation of the most common tick-borne diseases found in the United States, including Lyme disease, human monocytic and granulocytic ehrlichiosis, and babesiosis

Evaluation of patients with a history of, or suspected, tick exposure who are presenting with fever, myalgia, headache, nausea, and other nonspecific symptoms

Seroepidemiological surveys of the prevalence of the infection in certain populations

If the Lyme disease screen result is positive or equivocal, then Lyme disease antibody confirmation by immunoblot will be performed at an additional charge.

For more information see Acute Tick-Borne Disease Testing Algorithm

In North America, ticks are the primary vectors of infectious diseases.(1) Worldwide, ticks rank second only to mosquitoes in disease transmission. In the United States, tickborne diseases include Lyme disease, Rocky Mountain spotted fever, human monocytic and granulocytic ehrlichiosis, babesiosis, tularemia, relapsing fever, and Colorado tick fever.

Symptoms of the various tick-vectored diseases range from mild to life-threatening and significantly overlap. Early symptoms, which include fever, aches, and malaise, do not aid in distinguishing the various diseases. Because early treatment can minimize or eliminate the risk of severe disease, early detection is essential, yet patients may not have developed distinctive symptoms to help in the differential diagnosis. A tickborne panel can assist in identifying the pathogen, allowing treatment to be initiated.

For information on the specific diseases, see the individual test IDs.

Ehrlichia chaffeensis (HME) ANTIBODY, IgG

<1:64

Reference values apply to all ages.

Anaplasma phagocytophilum ANTIBODY, IgG

<1:64

Reference values apply to all ages.

Babesia microti IgG ANTIBODIES

<1:64

Reference values apply to all ages.

LYME DISEASE SEROLOGY

Negative

Reference values apply to all ages.

Ehrlichia chaffeensis:

A positive immunofluorescence assay result (titer > or =1:64) suggests current or previous infection. In general, the higher the titer, the more likely the patient has an active infection. Four-fold rises in titer also indicate active infection.

Previous episodes of ehrlichiosis may produce a positive serology result although antibody levels decline significantly during the year following infection.

Anaplasma phagocytophilum:

A positive immunofluorescence assay result (titer > or =1:64) suggests current or previous infection. In general, the higher the titer, the more likely the patient has an active infection. Four-fold rises in titer also indicate active infection.

Previous episodes of ehrlichiosis may produce a positive serology result although antibody levels decline significantly during the year following infection.

Babesia microti:

A positive result of an indirect fluorescent antibody test (titer > or =1:64) suggests current or previous infection with Babesia microti. In general, the higher the titer, the more likely it is that the patient has an active infection. Patients with documented infections have usually had titers ranging from 1:320 to 1:2560.

Lyme disease:

Negative: No evidence of antibodies to Borrelia burgdorferi detected. False-negative results may occur in recently infected patients (< or =2 weeks) due to low or undetectable antibody levels to B burgdorferi. If recent exposure is suspected, a second sample should be collected and tested in 2 to 4 weeks.

Equivocal or Positive: Not diagnostic. Supplemental testing by immunoblot has been ordered by reflex.

Ehrlichia chaffeensis and Anaplasma phagocytophilum:

Serology results for IgG may be negative during the acute phase of infection (<7 days post-symptom onset), during which time detection using targeted nucleic acid amplification testing (eg, polymerase chain reaction: PCR) is recommended.

Detectable IgG-class antibodies typically appear within 7 to 10 days post-symptom onset.

IgG-class antibodies may remain detectable for months to years following prior infection. Therefore, a single time point-positive titer needs to be interpreted alongside other findings to differentiate recent versus past infection.

Other members of the Ehrlichia genus (eg, Ehrlichia ewingii) may not be detected by this assay.

Babesia microti:

Previous episodes of babesiosis may produce a positive serologic result.

In selected cases, documentation of infection may be attempted by animal inoculation or PCR methods (BABPB / Babesia species, Molecular Detection, PCR, Blood)

Performance characteristics have not been established for the following specimen characteristics:

-Lipemic

-Hemolyzed

Lyme disease:

A negative result does not exclude the possibility of infection with Borrelia burgdorferi. Patients in the early stages of Lyme disease and those who have been treated with antibiotics may not exhibit detectable antibody titers. Patients with clinical history, signs, or symptoms suggestive of Lyme disease should be retested in 2 to 4 weeks if the initial test result is negative.

A positive result is not definitive evidence of infection with B burgdorferi. It is possible that other disease conditions may produce artifactual reactivity in the assay (eg, infectious mononucleosis, syphilis). All equivocal or positive results should be supplemented immunoblot testing for IgM- and IgG-class antibodies in accordance with Centers for Disease Control and Prevention and the Association of State and Territorial Public Health Laboratory Directors' recommendations.

Patients infected with other members of the B burgdorferi sensu lato complex, including Borrelia garinii, Borrelia afzelii, and Borrelia mayonii will be detected by this assay; however, they cannot be differentiated.

This test should not be performed as a screening procedure for the general population. The predictive value of a positive or negative result depends on the prevalence of analyte (antibodies present to VlsE1 and pepC10 antigens) in a given population. Testing should only be performed when clinical evidence suggests the diagnosis of Borrelia infection or related etiological conditions observed by the physician.

This test will not distinguish results that are both IgG and IgM positive from results that are either IgG or IgM positive.

Lyme serology should not be used for treatment monitoring as IgG can remain for years post resolution of infection. Instead, monitoring resolution of symptoms in response to treatment is recommended.

1. Centers for Disease Control and Prevention (CDC), Division of Vector-Borne Diseases. Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. 6th ed. US Department of Health and Human Services; 2022. Accessed September 29, 2022. Available at www.cdc.gov/ticks/tickbornediseases/TickborneDiseases-P.pdf

2. Diaz JH. Ticks, including tick paralysis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:3505-3526

Ehrlichia chaffeensis and Anaplasma phagocytophilum:

The patient's serum is diluted and is placed in microscopic slide wells that have been coated with Ehrlichia chaffeensis-infected cells. After incubation, the slides are washed and a fluorescein-isothiocyanate conjugate is added to each well. The slides are then read using a fluorescence microscope and significant fluorescent staining of intracellular organisms constitutes a positive reaction.(Dumler JS, Asanovich KM, Bakken JS, Richter P, Kimsey R, Madigan JE. Serologic cross-reactions among Ehrlichia equi, Ehrlichia phagocytophila, and human granulocytic Ehrlichia. J Clin Microbiol. 1995;33[5]:1098-1103; Pancholi P, Kolbert CP, Mitchell PD, et al. Ixodes dammini as a potential vector of human granulocytic ehrlichiosis. J Infect Dis. 1995;172[4]:1007-1012; Dawson JE, Fishbein DB, Eng TR, Redus MA, Green NR. Diagnosis of human ehrlichiosis with the indirect fluorescent antibody test: kinetics and specificity. J Infect Dis. 1990;162[1]:91-95; package inserts: Ehrlichia chaffeensis IFA IgG. Anaplasma phagocytophilum IFA IgG. DiaSorin Molecular; 8/12/2016)

Babesia microti:

The patient's serum is diluted and is placed in microscopic slide wells that have been coated with Babesia microti-infected red blood cells from Syrian hamsters. After incubation, the slides are washed and a fluorescein-isothiocyanate conjugate is added to each well. The slides are then read using a fluorescence microscope and significant fluorescent staining of intraerythrocytic organisms constitutes a positive reaction.(Krause PJ, Telford III SR, Ryan R, et al. Diagnosis of babesiosis: evaluation of a serologic test for the detection of Babesia microti antibody. J Infect Dis. 1994;169[4]:923-926; package insert: Babesia IFA IgG. DiaSorin Molecular; 8/12/2016)

Lyme disease:

The first-tier Lyme disease screening enzyme-linked immunosorbent assay (ELISA) used is the Zeus ELISA Borrelia VlsE1/pepC10 IgG/IgM test system. The Zeus ELISA Borrelia VlsE1/pepC10 IgG/IgM test system is designed to detect IgG- and IgM-class antibodies (not differentiated by the assay in the final result) in human sera to VlsE1 and pepC10 antigens. Diluted test sera are incubated in antigen-coated microwells. Any antigen-specific antibody in the sample will bind to the immobilized antigen. The plate is washed to remove unbound antibody and other serum components. Peroxidase-conjugated goat-antihuman IgG and IgM are added to the wells and the plate is incubated. The conjugate will react with IgG and IgM antibodies immobilized on the plate. The wells are washed to remove unreacted conjugate. The microwells containing immobilized peroxidase conjugate are incubated with peroxidase substrate solution. Hydrolysis of the substrate by peroxidase produces a color change. After a time-period, the reaction is stopped, and the color intensity of the solution is measured photometrically. The color intensity of the solution depends upon the antibody concentration in the original test sample.(Package inserts: Borrelia VlsE1/pepC10 IgG/IgM Test System. Zeus Scientific, Inc; Rev, 05/25/2021; Immunetics C6 B burgdorferi (Lyme) ELISA Kit. Immunetics Inc; 02210-2377, 2013)

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See Individual Test IDs

86618

86666 x 2

86753

86617 x 2-Lyme disease Western blot (if appropriate)