Lyme Disease Antibodies, CSF (IgG, IgM)

This panel uses an immunoblot assay to detect IgG and IgM antibodies against the bacterium Borrelia burgdorferi, the main causative agent of Lyme disease, in cerebrospinal fluid (CSF). CSF serology is not recommended for diagnosing Lyme disease involving the central nerve system (CNS); the CSF: serum antibody index serves as a more accurate test [1].

Lyme neuroborreliosis is a neurologic manifestation of Lyme disease that can affect both the CNS and peripheral (PNS). Early Lyme neuroborreliosis develops in the first few months of infection and may present as meningitis, cranial neuritis, radiculoneuritis, and encephalomyelitis. Serum antibody testing is the preferred approach for assessing Lyme neuroborreliosis [1]. CSF examination in patients with active CNS Lyme neuroborreliosis often reveals lymphocytic/monocytic pleocytosis. Presence of IgM or IgG antibodies to B burgdorferi in CSF may be due to passive diffusion from blood, and therefore, cannot be used as evidence of intrathecal antibody production. Demonstrating local antibody production in CSF with a CSF: serum antibody index is more specific for supporting the diagnosis of CNS Lyme neuroborreliosis [1]. Quest Diagnostics offers Lyme Disease Antibody Index (test code 34194) for this purpose.

Evaluation of intrathecal antibody production with Western immunoblot assay on CSF or parallel CSF and serum samples is not indicated other than for research purposes [1].

The results of this test should be interpreted in the context of pertinent clinical history and physical examination findings.

Reference
1. Lantos PM, et al. Clin Infect Dis. 2021;72(1):1-8.