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Test Catalog

Test ID: TICKS    
Tick-Borne Disease Antibodies Panel, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

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

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If Lyme disease screen is positive or equivocal, then Lyme disease antibody confirmation (by Western blot) will be performed at an additional charge.

 

See Acute Tick-Borne Disease Testing Algorithm in Special Instructions.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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, tick-borne 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. 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 tick-borne panel can assist in identifying the pathogen, allowing treatment to be initiated.

 

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

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

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.

Interpretation Provides information to assist in interpretation of the test results

Ehrlichia chaffeensis:

A positive immunofluorescence assay (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 although antibody levels decline significantly during the year following infection.

 

Anaplasma phagocytophilum:

A positive immunofluorescence assay (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 although antibody levels decline significantly during the year following infection.

 

During the acute phase of the infection, serologic tests are often nonreactive, PCR testing is available to aid in the diagnosis of these cases (see EHRL / Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood).

 

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 1:2,560.

 

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

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

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Ehrlichia chaffeensis:

Serology for IgG may be negative during the acute phase of infection (<7 days postsymptom onset), during which time detection using targeted nucleic acid amplification testing (eg, PCR) is recommended.

 

Detectable IgG-class antibodies typically appear within 7 to 10 days postsymptom 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, E ewingii) may not be detected by this assay.

 

Anaplasma phagocytophilum:

Serology for IgG may be negative during the acute phase of infection (<7 days postsymptom onset), during which time detection using targeted nucleic acid amplification testing (eg, PCR) is recommended.

 

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

 

IgG-class antibodies may remain detectable to 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, E. 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 (LBAB / 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 in the event that 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 (CDC/ASTPHLD) recommendations.

 

Patients infected with other members of the B burgdorferi sensu lato complex, including B garinii, B afzelii, and B 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 postresolution of infection. Instead, monitoring resolution of symptoms in response to treatment is recommended.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. CDC. Tick-borne diseases of the United States: A Reference Manual for Health Care Providers. Fourth Edition, 2017

2. Mathieu ME, Wilson BB: Ticks (including tick paralysis). In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Vol 1. Fifth edition. Edited by GL Mandell, JE Bennett, R Dolin. Philadelphia, Churchill Livingston, 2000, pp 2980-2983

Special Instructions Library of PDFs including pertinent information and forms related to the test