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Test ID: STICK Tick-Borne Antibodies, Modified 2-Tier, ELISA, Serum


Ordering Guidance


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



Specimen Required


Supplies: Sarstedt 5 mL Aliquot Tube (T914)

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: 5-mL aliquot tube

Specimen Volume: 1.35 mL


Useful For

Evaluation of the most common tick-borne diseases found in the United States, including Lyme disease, human monocytic and granulocytic ehrlichiosis, and babesiosis using the modified 2-tier testing algorithm approach

 

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

 

Sero-epidemiological surveys of the prevalence of the infection in certain populations

 

Diagnosis of Lyme disease

Profile Information

Test ID Reporting Name Available Separately Always Performed
ANAP Anaplasma phagocytophilum Ab, IgG,S Yes Yes
EHRC Ehrlichia Chaffeensis (HME) Ab, IgG Yes Yes
BABG Babesia microti IgG Ab, S Yes Yes
SLYME Lyme Ab Modified 2-Tier w/Reflex, S Yes Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
TLYME Lyme IgM/IgG, WCS, EIA, S Yes No

Testing Algorithm

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

 

See Acute Tick-Borne Disease Testing Algorithm

Method Name

ANAP, EHRC, BABG: Immunofluorescence Assay (IFA)

SLYME: Enzyme-Linked Immunosorbent Assay (ELISA)

Reporting Name

Tick-Borne Abs w/ Lyme MTTTA, S

Specimen Type

Serum

Specimen Minimum Volume

1.1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 10 days
  Frozen  14 days

Clinical Information

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 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 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

Anaplasma phagocytophilum ANTIBODY, IgG

<1:64

Reference values apply to all ages.

 

Ehrlichia chaffeensis (HME) ANTIBODY, IgG

<1:64

Reference values apply to all ages.

 

Babesia microti IgG ANTIBODIES

<1:64

Reference values apply to all ages.

 

LYME ANTIBODY

Negative

Reference values apply to all ages.

Interpretation

Anaplasma phagocytophilum:

A positive immunofluorescence assay (titer ≥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.

 

Ehrlichia chaffeensis:

A positive immunofluorescence assay (titer ≥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.

 

Babesia microti:

A positive result of an indirect fluorescent antibody test (titer ≥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:

Negative for antibodies to Borrelia (Borreliella) species causing Lyme disease. Negative results may occur in patients recently infected (≤14 days) with Borrelia burgdorferi. If recent infection is suspected, repeat testing on a new sample collected in 7 to 14 days is recommended.

 

Equivocal or Positive:

Not diagnostic. Supplemental testing in accordance with the modified two-tiered testing algorithm for Lyme disease has been ordered by reflex.

Clinical Reference

1. Centers for Disease Control and Prevention (CDC). Tick-borne diseases of the United States: A Reference Manual for Health Care Providers. 5th ed. CDC; 2018. Available at www.cdc.gov/ticks/tickbornediseases/index.html

2. Mathieu ME, Wilson BB: Ticks (including tick paralysis). In: Mandell GL, Bennett JE, Dolin R, eds: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Vol 1. 5th ed. Churchill Livingston; 2000:2980-2983

3. Theel ES: The past, present and (possible) future of serologic testing for Lyme disease. J Clin Microbiol. 2016;54(5):1191-1196. doi: 10.1128/JCM.03394-15. 

4. Dattwyler RJ: Lyme borreliosis: an overview of clinical manifestations. Lab Med. 1990;21:290-292. doi: 10.3390/healthcare6030104.

5. Schwan TG, Burgdorfer W, Rosa PA: Borrelia. In: Murray PR, ed: Manual of Clinical Microbiology. 7th ed. ASM Press; 1999:746-758

6. Centers for Disease Control and Prevention (CDC): Recommendation for test performance and interpretation from second national conference on serological diagnosis of lyme disease. MMWR Morb Mortal Wkly Rep. 1996;45:481-484

Day(s) Performed

Monday through Friday

Report Available

2 to 4 days

Test Classification

See Individual Test IDs

CPT Code Information

86618

86666 x 2

86753

86617 x 2 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
STICK Tick-Borne Abs w/ Lyme MTTTA, S In Process

 

Result ID Test Result Name Result LOINC Value
81157 Anaplasma phagocytophilum Ab, IgG,S 23877-4
81128 Babesia microti IgG Ab, S 16117-4
81478 Ehrlichia Chaffeensis (HME) Ab, IgG 47405-6
SLYME Lyme Ab Modified 2-Tier w/Reflex, S 83081-0

Forms

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

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

mml-tickborne