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Test ID: LYWB Lyme Disease Antibody, Immunoblot, Serum

Reporting Name

Lyme Disease Ab, Immunoblot, S

Useful For

Aiding in the diagnosis of systemic Lyme disease


This test should not be used as a screening assay.

Clinical Information

Lyme disease is caused by the spirochete Borrelia burgdorferi. The spirochete is transmitted to humans through the bite of Ixodes species ticks. Endemic areas for Lyme disease in the United States correspond with the distribution of 2 tick species, Ixodes dammini (Northeastern and upper Midwestern US) and Ixodes pacificus (West Coast US). In Europe, Ixodes ricinus transmits the spirochete.


Lyme disease exhibits a variety of symptoms that may be confused with immune and inflammatory disorders. Inflammation around the tick bite causes skin lesions. Erythema chronicum migrans (ECM), a unique expanding skin lesion with central clearing, which results in a ring-like appearance, is the first stage of the disease. Any of the following clinical manifestations may be present in patients with Lyme disease: arthritis, neurological or cardiac disease, or skin lesions. Neurologic and cardiac symptoms may appear with stage 2 and arthritic symptoms with stage 3 of Lyme disease. In some cases, a definitive distinction between stages is not always seen. Further, secondary symptoms may occur even though the patient does not recall having a tick bite or a rash.


The Second National Conference on the Serologic Diagnosis of Lyme Disease (1994) recommended that laboratories use a 2-test approach for the serologic diagnosis of Lyme disease. Accordingly, specimens are first tested by the more sensitive enzyme immunoassay (EIA). An immunoblot assay is used to supplement positive or equivocal Lyme EIA results. An immunoblot identifies the specific proteins to which the patient's antibodies bind. Although there are no proteins that specifically diagnose B burgdorferi infection, the number of proteins recognized in the immunoblot assay is correlated with diagnosis. Recently, the Centers for Disease Control and Prevention and US Food and Drug Administration approved the use of a modified two-tiered testing algorithm for diagnosis of Lyme disease (see SLYME / Lyme Antibody Modified 2-Tier with Reflex, Serum).


Culture or polymerase chain reaction (PCR) of skin biopsies obtained near the margins of ECM are frequently positive. In late (chronic) stages of the disease, serology is often positive and the diagnostic method of choice. PCR testing also may be useful in these late stages if performed on synovial or cerebrospinal fluid.


Diagnosis of neuroinvasive Lyme disease (ie, neuroborreliosis) can be achieved by determining the Lyme antibody index value using paired serum and cerebrospinal fluid samples (LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index Reflex, Serum and Spinal Fluid).



IgM antibodies to Borrelia burgdorferi may be detectable within 1 to 2 weeks following the tick bite; they usually peak during the third to sixth week after disease onset and then demonstrate a gradual decline over a period of months. IgM antibody may persist for months following completion of treatment. IgM antibody results against B burgdorferi should only be considered during the 30 days following exposure and symptom onset.


Negative specimens typically demonstrate antibodies to fewer than 2 of the 3 significant B burgdorferi proteins. Additional specimens should be submitted in 2 to 3 weeks if B burgdorferi exposure has not been ruled out.



IgG antibodies to B burgdorferi can be detected approximately 2 weeks after onset of disease and can remain detectable for months to years following completion of therapy.


Normal specimens and false-positive enzyme immunoassay specimens generally have antibodies to 4 or fewer proteins. Except for early patients, antibodies from patients with Lyme disease generally bind to 5 or more proteins.

Report Available

Same day/1 to 4 days

Day(s) Performed

Monday, Wednesday, Friday

Clinical Reference

Theel ES: The past, present and (possible) future of serologic testing for Lyme disease. J Clin Microbiol. 2016 May;54(5):1191-1196

Method Name

Immunoblot Microarray

Specimen Type


Specimen Required


Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.75 mL

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  30 days

Reference Values

IgG: Negative

IgM: Negative

Reference values apply to all ages

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86617 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LYWB Lyme Disease Ab, Immunoblot, S 18203-0


Result ID Test Result Name Result LOINC Value
5744 IgG Immunoblot 6320-6
2992 IgG detected against: 13502-0
23931 IgM Immunoblot 6321-4
23932 IgM detected against: 13503-8
6241 Interpretation 12781-1

Testing Algorithm

For information see Acute Tick-Borne Disease Testing Algorithm.


If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Infectious Disease Serology Test Request (T916)

Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information: