Lyme Disease – Serology

*Uncontrolled print copy. Valid only on day of print: 22 March 2023.

Specimen Collection and Handling

Specimen Requirements

Test Requested	Required Requisition(s)	Specimen Type	Minimum Volume	Collection Kit
Borellia burgdorferi or Lyme disease^1,2	General Test Requisition	Blood or serum	5.0 ml blood or 1.0 ml serum	Blood, clotted - vacutainer tubes (SST) with gel sediment

Submission and Collection Notes

If European Lyme disease testing is required: enter 'European Lyme disease' under Test Description of the General Test Requisition Form and provide travel history including location of travel and dates.

European Lyme is referred to the National Microbiology Laboratory (NML) in Winnipeg.

Indicate the following on the General Test Requisition Form:

date of onset
date of collection
clinical signs and symptoms
travel history
exposure (e.g. tick bite)

Timing of Specimen Collection

An acute (collected early after the onset of symptoms) and a convalescent (collected 6 weeks later) may be required for laboratory diagnosis.

Limitations

Haemolysed, icteric, lipemic or microbially contaminated sera or plasma are not recommended for testing.

Storage and Transport

Label the specimen container with the patient’s full name, date of collection and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Special Instructions

Centrifuge if using SST. Label specimens with at least two identifiers; place it in biohazard bag and seal. Specimens should be stored at 2-8°C following collection and shipped to PHOL on ice packs.

Requisitions and Kit Ordering

Test Frequency and Turnaround Time (TAT)

Lyme disease testing is performed daily on Monday to Friday.

Turnaround time is up to the following number days from receipt by PHO laboratory:

non‐reactive results: less than seven days
reactive results: 14 days
European Lyme request requiring confirmation at NML: 21 days

Test Methods

PHL performs tests for antibody to Borrelia burgdorferi using a two-tier test method as recommended by the Canadian Public Health Laboratory Network.

Initially, a specimen is tested for total antibodies using a VlsE1/pepC10 Borrelia (Lyme) IgM/IgG ELISA. A specimen that is either reactive or indeterminate by ELISA will be further tested for IgM and IgG specific antibodies using western blot assay.

Any requests for European Lyme will be forwarded to National Microbiology Laboratory (NML) for western blot testing for antibodies to B.garinii and B. afzeli – the strains of Borrelia found in Europe.

Reporting

Results are reported to the ordering physician or health care provider as indicated on the requisition.

Specimens that are positive for Borrelia species antibodies are reported to the Medical Officer of Health as per Health Protection and Promotion Act.

References

LAB-SD-127, Lyme Disease Serology Update – Implementation of VIsE1/pepC10 IgM/IgG Borrelia assay

PCR testing on CSF and tissue samples

NML offers PCR testing for B. burgdorferi on CSF and tissue with prior approval. Contact the laboratory prior to submission.