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HelpTest Code TICKS Tick-Borne Disease Antibodies Panel, Serum
Reporting Name
Tick-Borne Ab Panel, SUseful For
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
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| EHRC | Ehrlichia Chaffeensis (HME) Ab, IgG | Yes | Yes |
| ANAP | Anaplasma phagocytophilum Ab, IgG,S | Yes | Yes |
| BABG | Babesia microti IgG Ab, S | Yes | Yes |
| LYME | Lyme Disease Serology, S | Yes | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| LYWB | Lyme Disease Ab, Immunoblot, S | Yes | No |
Testing Algorithm
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
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
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.
Specimen Required
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.
Specimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 10 days | |
| Frozen | 14 days |
Reference Values
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.
Day(s) Performed
Monday through Friday
CPT Code Information
86618
86666 x 2
86753
86617 x 2-Lyme disease Western blot (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TICKS | Tick-Borne Ab Panel, S | 87547-6 |
| 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 |
| LYME | Lyme Disease Serology, S | 20449-5 |
Special Instructions
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, 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.
Interpretation
Ehrlichia chaffeensis:
A positive immunofluorescence assay result (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 result although antibody levels decline significantly during the year following infection.
Anaplasma phagocytophilum:
A positive immunofluorescence assay result (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 result 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: No evidence of antibodies to Borrelia burgdorferi detected. False-negative results may occur in recently infected patients (≤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.
Cautions
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.
Report Available
2 to 4 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
| Heat-inactivated specimen | Reject |
Method Name
EHRC, ANAP, BABG: Immunofluorescence Assay (IFA)
LYME: Enzyme-Linked Immunosorbent Assay (ELISA)
Forms
If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.