{"product_id":"infectious-serology-bacteriology-borrelia-anaplasma","title":"INFECTIOUS SEROLOGY – BACTERIOLOGY – BORRELIA | ANAPLASMA","description":"\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eLyme disease and anaplasmosis are tick-borne infections with potentially serious long-term effects if not treated promptly.\u003c\/li\u003e\n\u003cli\u003eTwo-level testing uses ELISA screening followed by immunoblot confirmation to reduce false positives.\u003c\/li\u003e\n\u003cli\u003eTest sensitivity for Lyme disease is only 20–50% in early localized infection, so repeat testing after 2–3 weeks may be needed.\u003c\/li\u003e\n\u003cli\u003eFor suspected neuroborreliosis, cerebrospinal fluid testing with Antibody Index calculation can confirm intrathecal antibody production.\u003c\/li\u003e\n\u003cli\u003eTests using recombinant antigens offer higher diagnostic confidence, with several assays showing sensitivity and specificity above 95%.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\nLyme disease and anaplasmosis are two tick-borne infections that can cause serious, long-lasting health problems if not diagnosed and treated promptly. This article explains how modern laboratory testing using ELISA, immunoblot, and Microblot-Array technology helps doctors detect these infections with high accuracy. Recent diagnostic tests can identify Lyme disease with 95–99% sensitivity and specificity, meaning they correctly detect both the presence and absence of infection in the vast majority of cases.\n\n# Understanding Lyme Disease and Anaplasmosis: A Patient's Guide to Modern Diagnostic Testing\n\n## Table of Contents\n\n\u003cul\u003e\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Two Tick-Borne Illnesses\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#phases\"\u003eThe Phases of Lyme Borreliosis\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#hga\"\u003eHuman Granulocytic Anaplasmosis (HGA)\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#diagnosis\"\u003eHow Doctors Diagnose These Infections\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#sensitivity\"\u003eTest Sensitivity Across Disease Stages\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#antigens\"\u003eThe Science Behind the Tests: Key Antigens\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#elisa\"\u003eELISA Testing Explained\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#immunoblot\"\u003eImmunoblot (Western Blot) Testing Explained\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#blueblot\"\u003eAutomated Testing with BlueBLOT-LINE\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#microblot\"\u003eMicroblot-Array: Advanced Multiplex Technology\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#neuroborreliosis\"\u003eNeuroborreliosis and the Antibody Index\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations and Important Considerations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"background\"\u003eBackground: Two Tick-Borne Illnesses\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eLyme borreliosis\u003c\/strong\u003e (commonly called Lyme disease) is a multi-system infectious disease caused by spiral-shaped bacteria called \u003cem\u003eBorrelia burgdorferi\u003c\/em\u003e (a type of spirochete). The infection is transmitted to humans through the bite of ticks belonging to the \u003cem\u003eIxodes\u003c\/em\u003e genus—the same deer ticks that are common in many parts of the world.\u003c\/p\u003e\n\n\u003cp\u003eLyme disease is characterized by both early and late clinical symptoms that can affect virtually any system in the body. \u003cstrong\u003eHuman granulocytic anaplasmosis (HGA)\u003c\/strong\u003e is a separate illness caused by a different bacterium called \u003cem\u003eAnaplasma phagocytophilum\u003c\/em\u003e. In many regions, the castor bean tick, \u003cem\u003eIxodes ricinus\u003c\/em\u003e, serves as the vector for both diseases. While the tick is sucking blood, the bacteria enter the host's cardiovascular system, where they attack blood cells.\u003c\/p\u003e\n\n\u003cp\u003eThese infections matter to patients because they are often missed or misdiagnosed. The symptoms can mimic many other conditions, and antibody testing is not always straightforward. Understanding how the tests work can help you ask the right questions if you or a loved one is being evaluated for a tick-borne illness.\u003c\/p\u003e\n\n\u003ch2 id=\"phases\"\u003eThe Phases of Lyme Borreliosis\u003c\/h2\u003e\n\n\u003cp\u003eLyme disease progresses through three distinct phases, each with its own set of symptoms and diagnostic challenges.\u003c\/p\u003e\n\n\u003ch3\u003eEarly Localized Infection (Days to Weeks)\u003c\/h3\u003e\n\u003cp\u003eThis first phase is characterized by \u003cstrong\u003eerythema migrans (EM)\u003c\/strong\u003e, the classic \"bull's-eye\" rash. Importantly, this rash appears in only \u003cstrong\u003e50% of patients\u003c\/strong\u003e. Early symptoms may also include \"flu-like\" symptoms, headache, and swollen lymph nodes (lymphadenitis). This means half of all infected patients may not have the tell-tale rash that most people associate with Lyme disease.\u003c\/p\u003e\n\n\u003ch3\u003eEarly Disseminated Infection (Weeks to Months)\u003c\/h3\u003e\n\u003cp\u003eDuring this phase, \u003cem\u003eBorrelia\u003c\/em\u003e bacteria spread through blood vessels and the lymphatic system to reach the central nervous system (CNS), joints, heart, eyes, skin, and other organs. The most frequently diagnosed symptoms at this stage include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNeuroborreliosis\u003c\/strong\u003e—infection of the nervous system\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eParesis neurofacialis\u003c\/strong\u003e—facial nerve paralysis (Bell's palsy)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBorrelial lymphocytoma\u003c\/strong\u003e—bluish-red swellings, often on the earlobes or knuckles\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBannwarth syndrome\u003c\/strong\u003e—a combination of nerve pain, meningitis, and facial palsy\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAdditional symptoms can include skin changes (in about \u003cstrong\u003e20% of cases\u003c\/strong\u003e) and non-specific symptoms that resemble many other illnesses: swollen glands, headaches, muscle pains, nausea, vomiting, abdominal problems, and frequent \u003cstrong\u003epareses\u003c\/strong\u003e (muscle weakness or partial paralysis).\u003c\/p\u003e\n\n\u003ch3\u003eLate Disseminated Infection (Months to Years)\u003c\/h3\u003e\n\u003cp\u003eWithout effective treatment, the disease can progress to a late phase lasting months or even years. The most typical immune-related changes diagnosed at this stage are:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAcrodermatitis chronica atrophicans (ACA)\u003c\/strong\u003e—chronic skin lesions that can cause skin thinning and discoloration\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eChronic neuroborreliosis\u003c\/strong\u003e—ongoing nervous system involvement\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBorrelial arthritis\u003c\/strong\u003e—inflammation of the joints, often the knees\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eExtensive studies have shown that different \u003cem\u003eBorrelia\u003c\/em\u003e genospecies (subtypes) are associated with different clinical presentations. \u003cem\u003eB. garinii\u003c\/em\u003e is associated with neurological symptoms, \u003cem\u003eB. afzelii\u003c\/em\u003e with chronic skin disorders (especially ACA), and \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu stricto is mainly related to joint injuries. All genospecies can, however, cause erythema migrans and many other clinical manifestations.\u003c\/p\u003e\n\n\u003ch2 id=\"hga\"\u003eHuman Granulocytic Anaplasmosis (HGA)\u003c\/h2\u003e\n\n\u003cp\u003eAnaplasmosis is an acute illness that typically develops within \u003cstrong\u003eone week\u003c\/strong\u003e after a tick bite. The symptoms can range from completely asymptomatic forms to serious, life-threatening conditions involving respiratory, gastrointestinal, renal, and neurological symptoms.\u003c\/p\u003e\n\n\u003cp\u003eThe first and most common sign is a \u003cstrong\u003efeverish state lasting at least 3 to 7 days\u003c\/strong\u003e following a tick bite. Serious complications are more likely in patients with weakened immune systems (immunodeficit), individuals who have undergone transplantation, and patients without a spleen. The disease is usually acute; however, more complicated cases that are not treated in time can become chronic and might even be life-threatening.\u003c\/p\u003e\n\n\u003cp\u003eOne notable epidemiological finding is that \u003cstrong\u003emen are four times more likely than women (4:1)\u003c\/strong\u003e to become ill with anaplasmosis.\u003c\/p\u003e\n\n\u003cp\u003eDiagnosing HGA based only on clinical symptoms is very difficult, which is why laboratory findings are essential. Characteristic laboratory findings include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLeukopenia\u003c\/strong\u003e—low white blood cell count\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eThrombocytopenia\u003c\/strong\u003e—low platelet count\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eElevated liver transaminases\u003c\/strong\u003e—signs of liver involvement on blood tests\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAntibody production begins within the first \u003cstrong\u003e2 weeks\u003c\/strong\u003e after disease onset. However, only \u003cstrong\u003e30–60% of patients\u003c\/strong\u003e test positive (seropositive) during the acute phase. This number rises to \u003cstrong\u003e70–90%\u003c\/strong\u003e during convalescence (the recovery period), which has important implications for when testing should occur.\u003c\/p\u003e\n\n\u003ch2 id=\"diagnosis\"\u003eHow Doctors Diagnose These Infections\u003c\/h2\u003e\n\n\u003cp\u003eThe diagnosis of Lyme disease and anaplasmosis is based on three elements: the patient's medical history (anamnesis), the clinical picture (symptoms and physical findings), and the results of laboratory tests. Currently, the diagnostic methods of choice are \u003cstrong\u003escreening for specific IgG and IgM antibodies using ELISA\u003c\/strong\u003e, followed by \u003cstrong\u003econfirmation of antibodies to specific antigens using immunoblot\u003c\/strong\u003e. Direct cultivation of the bacteria or electron microscopy is not practical for routine use.\u003c\/p\u003e\n\n\u003cp\u003eSerological diagnosis of borreliosis is challenging for several reasons:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe large genetic diversity of the species \u003cem\u003eBorrelia burgdorferi\u003c\/em\u003e sensu lato\u003c\/li\u003e\n  \u003cli\u003ePossible cross-reactivity with unrelated antigens from other microorganisms\u003c\/li\u003e\n  \u003cli\u003eBorrelia's richness in heat shock proteins, which can trigger non-specific immune responses\u003c\/li\u003e\n  \u003cli\u003eHighly variable individual serological reactivity\u003c\/li\u003e\n  \u003cli\u003eExtremely slow antibody production in the early phase of the disease\u003c\/li\u003e\n  \u003cli\u003eIgG and IgM antibodies can persist for more than \u003cstrong\u003eten years\u003c\/strong\u003e, making it hard to distinguish past from active infection\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eThe Two-Level Testing Approach\u003c\/h3\u003e\n\n\u003cp\u003eTo maximize accuracy, doctors use a two-level antibody detection strategy. This approach is endorsed by European and American guidelines (as summarized by Eldin et al., 2019).\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLevel 1 (Screening):\u003c\/strong\u003e Samples are tested with the ELISA method, which divides patients into positive or negative groups based on their antibody status.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLevel 2 (Confirmation):\u003c\/strong\u003e Positive and borderline results are confirmed using immunoblot, which detects antibodies against specific \u003cem\u003eBorrelia\u003c\/em\u003e antigens.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eIf the first test is negative but the patient's symptoms persist, a second (control) blood sample should be collected \u003cstrong\u003e2–3 weeks later\u003c\/strong\u003e and re-tested. This is important because antibody levels can be undetectable in the earliest stages of infection.\u003c\/p\u003e\n\n\u003cp\u003eThe number of disagreements between immunoblot (level 2) and ELISA (level 1) results is reduced when the ELISA method is based on recombinant antigens, as is the case with the TestLine assays described in this article.\u003c\/p\u003e\n\n\u003cp\u003eA test result alone does not make the diagnosis—it supports it. The final diagnosis is based on the \u003cstrong\u003ecomprehensive clinical picture of the patient\u003c\/strong\u003e, not only on the serological result.\u003c\/p\u003e\n\n\u003ch2 id=\"sensitivity\"\u003eTest Sensitivity Across Disease Stages\u003c\/h2\u003e\n\n\u003cp\u003eOne of the most important facts for patients to understand is that the sensitivity of these tests—their ability to detect the disease when it is present—varies dramatically depending on the stage of the illness. According to the German MiQ quality standards, the diagnostic sensitivity for different forms of Lyme borreliosis is:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLocalized early infection\u003c\/strong\u003e (erythema migrans, borrelial lymphocytoma, multiple EM): \u003cstrong\u003e20–50%\u003c\/strong\u003e\n\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDisseminated early infection\u003c\/strong\u003e (neuroborreliosis, Lyme arthritis, carditis): \u003cstrong\u003e70–90%\u003c\/strong\u003e\n\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDisseminated late infection\u003c\/strong\u003e (acrodermatitis chronica atrophicans, late neuroborreliosis): \u003cstrong\u003e90–100%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn other words, a negative test result early in the disease does not rule out Lyme disease. This is why repeat testing after 2–3 weeks is so important when symptoms persist.\u003c\/p\u003e\n\n\u003ch2 id=\"antigens\"\u003eThe Science Behind the Tests: Key Antigens\u003c\/h2\u003e\n\n\u003cp\u003eModern diagnostic tests do not just look for any antibody—they look for antibodies against \u003cstrong\u003especific proteins (antigens)\u003c\/strong\u003e of the bacteria. Each antigen appears at different times during infection and is associated with different clinical manifestations. Here are the key \u003cem\u003eBorrelia\u003c\/em\u003e antigens used in these tests:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eVlsE\u003c\/strong\u003e (Ba, Bg, Bs)—the main antigen of the early and late antibody response. It significantly increases test sensitivity; approximately \u003cstrong\u003e90% of positive sera and cerebrospinal fluid samples\u003c\/strong\u003e react to this antigen band.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ep83\u003c\/strong\u003e—the main extracellular protein, a late antibody response antigen highly typical of neuroborreliosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ep58\u003c\/strong\u003e (OppA-2)—a membrane transporter considered a marker of the disseminated stage of Lyme disease.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ep41\u003c\/strong\u003e (Ba, Bs)—the inner part of flagellin, a highly specific antigen of the early antibody response.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ep39\u003c\/strong\u003e (BmpA)—a glycosaminopeptide receptor and an antigen of the late response. It is significant for advanced disseminated Lyme disease and is often associated with Lyme arthritis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOspA\u003c\/strong\u003e (Ba, Bg, Bs)—outer surface protein A, a late response antigen typical for neuroborreliosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOspB\u003c\/strong\u003e—outer surface protein B, a late response antigen.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOspC\u003c\/strong\u003e (Ba, Bg, Bs, Bsp)—outer surface protein C, the immunodominant marker of the IgM antibody response (the earliest antibodies produced).\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOspE\u003c\/strong\u003e—outer surface protein E.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNapA\u003c\/strong\u003e—neutrophil activating protein A, a strong immunogen and a main marker of Lyme arthritis pathogenesis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ep17\u003c\/strong\u003e (DbpA)—decorin-binding protein A, involved in both early and late antibody responses and typical of neuroborreliosis.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe letters Ba, Bg, Bs, and Bsp refer to the specific bacterial subspecies the antigen comes from: \u003cem\u003eB. afzelii\u003c\/em\u003e, \u003cem\u003eB. garinii\u003c\/em\u003e, \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu stricto, and \u003cem\u003eB. spielmanii\u003c\/em\u003e.\u003c\/p\u003e\n\n\u003ch3\u003eAnaplasma and Cross-Reacting Antigens\u003c\/h3\u003e\n\n\u003cp\u003eFor anaplasmosis, the key antigens are \u003cstrong\u003ep44\u003c\/strong\u003e (the main antigen of the antibody response to HGA), \u003cstrong\u003eOmpA\u003c\/strong\u003e (an outer membrane protein and significant virulence marker), and \u003cstrong\u003eAsp62\u003c\/strong\u003e (a membrane transporter surface protein).\u003c\/p\u003e\n\n\u003cp\u003eTests also include antigens to detect cross-reactions with other infections: \u003cstrong\u003eTpN17\u003c\/strong\u003e, a highly specific membrane protein of \u003cem\u003eTreponema pallidum\u003c\/em\u003e (the bacterium that causes syphilis), and \u003cstrong\u003eVCA-p18\u003c\/strong\u003e, a viral capsid antigen that detects EBV (Epstein-Barr virus) infection. Including these antigens helps prevent false-positive results caused by antibodies to unrelated infections.\u003c\/p\u003e\n\n\u003ch2 id=\"elisa\"\u003eELISA Testing Explained\u003c\/h2\u003e\n\n\u003cp\u003eELISA (Enzyme-Linked Immunosorbent Assay) is the first-level screening test. The TestLine EIA assays are based on a sandwich-type ELISA method. They are designed for the detection of IgG and IgM antibodies in human serum, plasma, cerebrospinal fluid, or synovial (joint) fluid.\u003c\/p\u003e\n\n\u003ch3\u003ePatient-Friendly Protocol Overview\u003c\/h3\u003e\n\n\u003cp\u003eThe testing process is straightforward and takes about \u003cstrong\u003e1.5 hours total\u003c\/strong\u003e:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eSamples are diluted: serum\/plasma at 1:101 (10 μl + 1 ml), cerebrospinal fluid at 1:2 (110 μl + 110 μl), or synovial fluid at 1:21 or 1:41.\u003c\/li\u003e\n  \u003cli\u003eControls and diluted samples are pipetted into the microplate wells (100 μl each).\u003c\/li\u003e\n  \u003cli\u003eThe plate is incubated for 30 minutes at 37°C.\u003c\/li\u003e\n  \u003cli\u003eWells are aspirated and washed 4 times.\u003c\/li\u003e\n  \u003cli\u003eConjugate (the detection antibody) is added (100 μl), followed by another 30-minute incubation at 37°C.\u003c\/li\u003e\n  \u003cli\u003eWells are washed 5 times.\u003c\/li\u003e\n  \u003cli\u003eSubstrate solution (TMB-Complete) is added (100 μl) and incubated for 15 minutes at 37°C.\u003c\/li\u003e\n  \u003cli\u003eStopping solution is added, and the color intensity is read at 450 nm.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eResults are evaluated semiquantitatively using an Index of Positivity (IP), which compares the patient sample to the included cut-off control. The kits come with ready-to-use, color-coded components and breakable microplate strips, making them convenient for laboratories.\u003c\/p\u003e\n\n\u003ch3\u003eELISA Performance: What the Numbers Mean\u003c\/h3\u003e\n\n\u003cp\u003eThe diagnostic performance of these tests is remarkably high. For patients, this means you can trust a confirmed result. The key metrics are \u003cstrong\u003esensitivity\u003c\/strong\u003e (the ability to correctly identify those with the disease) and \u003cstrong\u003especificity\u003c\/strong\u003e (the ability to correctly identify those without the disease):\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia recombinant IgG:\u003c\/strong\u003e 98.3% sensitivity, 98.1% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia recombinant IgM:\u003c\/strong\u003e 99.1% sensitivity, 97.3% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia afzelii VlsE IgG:\u003c\/strong\u003e 98.9% sensitivity, 98.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia afzelii IgM:\u003c\/strong\u003e 95.6% sensitivity, 99.0% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia b. sensu stricto VlsE IgG:\u003c\/strong\u003e 98.9% sensitivity, 98.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia b. sensu stricto IgM:\u003c\/strong\u003e 97.5% sensitivity, 98.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia garinii VlsE IgG:\u003c\/strong\u003e 98.9% sensitivity, 99.0% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEIA Borrelia garinii IgM:\u003c\/strong\u003e 95.7% sensitivity, 98.9% specificity\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese kits use recombinant (genetically engineered) antigens from specific \u003cem\u003eBorrelia\u003c\/em\u003e species, including VlsE (Ba, Bg, Bs), p83, p58, p41 (internal flagellin), p39, OspA, OspB, OspC, OspE, p17, and NapA. Whole-cell antigen versions are also available, enriched with VlsE, for each major genospecies.\u003c\/p\u003e\n\n\u003ch3\u003eWhy Recombinant Antigens Matter: The Antibody Response Study\u003c\/h3\u003e\n\n\u003cp\u003eResearch shows that recombinant antigen tests detect the antibody response with higher dynamics (meaning they show clearer positive results) than tests using whole-cell antigens. In a study of \u003cstrong\u003e86 patients with Lyme neuroborreliosis\u003c\/strong\u003e, the Index of Positivity was consistently higher with recombinant antigen ELISAs (both IgG and IgM) compared to whole-cell antigen ELISAs. This translates to fewer borderline results and greater diagnostic confidence.\u003c\/p\u003e\n\n\u003ch2 id=\"immunoblot\"\u003eImmunoblot (Western Blot) Testing Explained\u003c\/h2\u003e\n\n\u003cp\u003eImmunoblot—commonly known as Western blot—is the second-level confirmation test. It works by separating specific bacterial proteins and fixing them onto a nitrocellulose membrane strip. If the patient's blood contains antibodies against these proteins, they bind to the strip and produce visible colored bands, rather like a barcode. This tells doctors exactly which bacterial proteins the immune system is reacting to.\u003c\/p\u003e\n\n\u003ch3\u003eWhat a Patient Should Know About the Procedure\u003c\/h3\u003e\n\n\u003col\u003e\n  \u003cli\u003eSamples are diluted: serum\/plasma at 1:51 (30 μl + 1.5 ml), cerebrospinal fluid at 1:2, or synovial fluid at 1:17.5.\u003c\/li\u003e\n  \u003cli\u003eStrips are soaked in a universal solution for 10 minutes.\u003c\/li\u003e\n  \u003cli\u003eDiluted samples are added and incubated for 30 minutes on a shaker.\u003c\/li\u003e\n  \u003cli\u003eStrips are washed 3 times for 5 minutes.\u003c\/li\u003e\n  \u003cli\u003eConjugate is added and incubated for 30 minutes.\u003c\/li\u003e\n  \u003cli\u003eStrips are washed again, then substrate solution (BCIP\/NBT) is added for 15 minutes.\u003c\/li\u003e\n  \u003cli\u003eAfter a final wash, strips are dried and evaluated.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eEach strip includes a control line to verify the test worked properly. The advantages of immunoblot testing include easy interpretation, high reproducibility, and the ability to detect antibodies in cerebrospinal fluid. The \u003cstrong\u003eBLOT-LINE\u003c\/strong\u003e series includes separate kits for \u003cem\u003eB. afzelii\u003c\/em\u003e, \u003cem\u003eB. garinii\u003c\/em\u003e, \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu stricto, combined Borrelia\/HGA, and standalone Anaplasma IgG and IgM testing.\u003c\/p\u003e\n\n\u003ch3\u003eImmunoblot Performance Data\u003c\/h3\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Anaplasma IgG:\u003c\/strong\u003e 92.0% sensitivity, 94.0% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Anaplasma IgM:\u003c\/strong\u003e 91.4% sensitivity, 99.0% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia\/HGA IgG:\u003c\/strong\u003e 96.8% sensitivity, 98.5% specificity (for Borrelia); 92.9% sensitivity, 96.3% specificity (for Anaplasma)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia\/HGA IgM:\u003c\/strong\u003e 97.1% sensitivity, 96.4% specificity (for Borrelia); 94.7% sensitivity, 97.1% specificity (for Anaplasma)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia afzelii IgG:\u003c\/strong\u003e 97.3% sensitivity, 96.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia afzelii IgM:\u003c\/strong\u003e 96.6% sensitivity, 95.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia garinii IgG:\u003c\/strong\u003e 97.1% sensitivity, 96.2% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia garinii IgM:\u003c\/strong\u003e 95.2% sensitivity, 97.0% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia b. sensu stricto IgG:\u003c\/strong\u003e 96.8% sensitivity, 96.9% specificity\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBLOT-LINE Borrelia b. sensu stricto IgM:\u003c\/strong\u003e 96.2% sensitivity, 96.8% specificity\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eWhich Borrelia Species Test Is Best for Neuroborreliosis?\u003c\/h3\u003e\n\n\u003cp\u003eA study of \u003cstrong\u003e60 patients with neuroborreliosis\u003c\/strong\u003e compared the reactivity of the three species-specific BLOT-LINE kits. The \u003cstrong\u003eBLOT-LINE Borrelia garinii kit showed more than 20% higher reactivity\u003c\/strong\u003e in this patient group compared to the \u003cem\u003eB. afzelii\u003c\/em\u003e and \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu stricto kits, for both IgM and IgG. This makes sense because \u003cem\u003eB. garinii\u003c\/em\u003e is the species most commonly associated with neurological symptoms. In a separate study of \u003cstrong\u003e87 patients with neuroborreliosis\u003c\/strong\u003e, antibodies against VlsE (a key diagnostic antigen) were found in approximately \u003cstrong\u003e80% of serum samples\u003c\/strong\u003e and \u003cstrong\u003e70% of CSF samples\u003c\/strong\u003e. In patients where neuroborreliosis was excluded, and in healthy controls (\u003cstrong\u003en=68\u003c\/strong\u003e), these rates were substantially lower. If you have neurological symptoms, your doctor may specifically order the \u003cem\u003eB. garinii\u003c\/em\u003e immunoblot because of its higher sensitivity for this form of the disease.\u003c\/p\u003e\n\n\u003ch2 id=\"blueblot\"\u003eAutomated Testing with BlueBLOT-LINE\u003c\/h2\u003e\n\n\u003cp\u003eFor high-volume laboratories, the \u003cstrong\u003eBlueDiver Instrument\u003c\/strong\u003e combined with \u003cstrong\u003eBlueBLOT-LINE Borrelia kits\u003c\/strong\u003e offers a fully automated solution. This system automatically handles batch and expiry control via barcode reading, pipetting, incubation, and washing—reducing the risk of human error.\u003c\/p\u003e\n\n\u003cp\u003eThe total assay time is \u003cstrong\u003e1 hour and 14 minutes\u003c\/strong\u003e: incubation with the sample for 30 minutes, 20 minutes with conjugate, and 10 minutes with substrate, with automated washing steps in between.\u003c\/p\u003e\n\n\u003cp\u003eThe BlueBLOT-LINE strips include reactive control lines and separate conjugate controls for IgG and IgM, plus a wide array of antigens: VlsE (Ba, Bg, Bs), p83, p58, p41, p39, OspB, OspA, OspC, p17, NapA, p44, OmpA, TpN17, and EBV p18. Performance data show:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBlueBLOT-LINE Borrelia IgG:\u003c\/strong\u003e 97.4% sensitivity, 99.0% specificity (for Borrelia); 83.0% sensitivity, 99.0% specificity (for Anaplasma)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBlueBLOT-LINE Borrelia IgM:\u003c\/strong\u003e 98.3% sensitivity, 99.0% specificity (for Borrelia); 92.0% sensitivity, 96.0% specificity (for Anaplasma)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"microblot\"\u003eMicroblot-Array: Advanced Multiplex Technology\u003c\/h2\u003e\n\n\u003cp\u003eThe \u003cstrong\u003eMicroblot-Array\u003c\/strong\u003e represents the newest generation of confirmation testing. Specific recombinant proteins are applied as tiny spots to a nitrocellulose membrane that fits into a standard microtitre plate well. This clever design means the test can be processed using standard ELISA laboratory equipment, while simultaneously testing for multiple infections at once (multiplex technology).\u003c\/p\u003e\n\n\u003cp\u003eOne key patient benefit is \u003cstrong\u003elow sample consumption\u003c\/strong\u003e—only tiny amounts of blood or fluid are needed. The antigens are spotted in triplicate to minimize statistical variation, and each well includes reference spots, test controls, conjugate controls (separate for IgG and IgM), and four calibration spots to ensure validity.\u003c\/p\u003e\n\n\u003ch3\u003eMicroblot-Array Performance Data\u003c\/h3\u003e\n\n\u003cp\u003eThis test was validated on human serum samples with the following results:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBorrelia IgG:\u003c\/strong\u003e 98.7% sensitivity (n=74), 98.9% specificity (n=100)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBorrelia IgM:\u003c\/strong\u003e 98.5% sensitivity (n=56), 99.9% specificity (n=95)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAnaplasma IgG:\u003c\/strong\u003e 92.0% sensitivity (n=25), 99.9% specificity (n=30)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAnaplasma IgM:\u003c\/strong\u003e 95.0% sensitivity (n=20), 99.9% specificity (n=38)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTreponema IgG:\u003c\/strong\u003e 98.3% sensitivity (n=59), 99.9% specificity (n=30)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEBV IgM:\u003c\/strong\u003e 99.9% sensitivity (n=39), 99.9% specificity (n=51)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eComparative studies showed that the Microblot-Array agrees with conventional ELISA results \u003cstrong\u003e92.2% of the time for IgG\u003c\/strong\u003e and \u003cstrong\u003e90.7% for IgM\u003c\/strong\u003e. When compared specifically to recombinant antigen ELISA and Western blot methods, agreement was \u003cstrong\u003e92%\u003c\/strong\u003e and \u003cstrong\u003e90%\u003c\/strong\u003e, respectively. The small percentage of disagreements (8–10%) highlights why clinical correlation is essential—no test is perfect, and a doctor's judgment matters.\u003c\/p\u003e\n\n\u003ch2 id=\"neuroborreliosis\"\u003eNeuroborreliosis and the Antibody Index\u003c\/h2\u003e\n\n\u003cp\u003eFor patients with suspected nervous system involvement (neuroborreliosis), a special calculation called the \u003cstrong\u003eAntibody Index (AI)\u003c\/strong\u003e is crucial. According to the international recommendation of the \u003cstrong\u003eEuropean Union Concerted Action on Lyme Borreliosis (EUCALB)\u003c\/strong\u003e, evidence of intrathecal antibody production is necessary for the diagnosis of early and late neuroborreliosis. In plain language, this means doctors must prove that antibodies are being produced \u003cem\u003einside the spinal fluid\u003c\/em\u003e, not just that they are present in the blood.\u003c\/p\u003e\n\n\u003cp\u003eThe antibody level in cerebrospinal fluid (CSF) depends on three factors:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eAntibodies present in blood serum (which can leak into the CSF)\u003c\/li\u003e\n  \u003cli\u003eThe permeability of the blood-CSF barrier\u003c\/li\u003e\n  \u003cli\u003eActual intrathecal (inside the spinal fluid) production of antibodies\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe presence of specific antibodies alone—whether in serum or CSF—is \u003cstrong\u003enot sufficient evidence\u003c\/strong\u003e of neuroborreliosis. The AI calculation compares the ratio of specific antibodies in the CSF and serum relative to the state of the blood-CSF barrier and total immunoglobulin levels. This test can be done with a small CSF sample of approximately \u003cstrong\u003e0.15 ml\u003c\/strong\u003e, and dedicated Antibody Index Software handles the calculations automatically.\u003c\/p\u003e\n\n\u003cp\u003eThe interpretation table is straightforward:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSerum negative, CSF positive:\u003c\/strong\u003e Intrathecal synthesis confirmed—positivity verified (EUCALB recommendation).\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSerum positive, CSF positive:\u003c\/strong\u003e Usually positive, but passive transfer of antibodies through a disturbed blood-CSF barrier is possible—AI determination is needed.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSerum positive, CSF negative:\u003c\/strong\u003e Possibly positive, provided the measured absorbance values in the CSF and serum are close to the cut-off control—AI determination is needed.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSerum negative, CSF negative:\u003c\/strong\u003e Negative.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe accuracy of AI calculations is regularly verified through participation in external quality assessment programs involving \u003cstrong\u003eover 200 laboratories\u003c\/strong\u003e, organized by the independent scientific society Instand e.V. TestLine's AI results have consistently performed well in these programs.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications for Patients\u003c\/h2\u003e\n\n\u003cp\u003eWhat does all this technical information mean for you as a patient? Several practical implications follow from the data:\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFirst, timing matters.\u003c\/strong\u003e If you were bitten by a tick and develop symptoms, testing too early can produce a false negative. The sensitivity of ELISA testing for early localized Lyme disease is only 20–50%. If your test is negative but symptoms persist, a repeat test in 2–3 weeks is essential. Similarly, anaplasmosis antibodies are only detectable in 30–60% of patients during the acute phase, rising to 70–90% during recovery.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSecond, the two-level testing strategy protects you.\u003c\/strong\u003e The combination of ELISA screening followed by immunoblot confirmation dramatically reduces false positives. Tests with specificity above 97% mean that fewer than 3 out of 100 healthy people will be incorrectly identified as infected—and confirmation testing catches most of those.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThird, the type of test matters.\u003c\/strong\u003e Tests using recombinant antigens (genetically engineered specific proteins) show higher dynamics of antibody response than whole-cell antigen tests. This means they produce clearer positive\/negative results with fewer ambiguous borderline readings, especially in patients with neuroborreliosis. If you have neurological symptoms, a \u003cem\u003eB. garinii\u003c\/em\u003e-specific test may be significantly more informative—it showed more than 20% higher reactivity in neuroborreliosis patients compared to tests for other Borrelia species.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFourth, CSF testing adds value for neurological symptoms.\u003c\/strong\u003e If your doctor suspects the infection has reached your nervous system, testing both blood and cerebrospinal fluid, and calculating the Antibody Index, can provide definitive evidence—beyond a doubt—of active neuroborreliosis.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations and Important Considerations\u003c\/h2\u003e\n\n\u003cp\u003eNo diagnostic test is perfect, and it is important to understand the limitations of serological testing for tick-borne diseases:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFalse negatives early in the disease:\u003c\/strong\u003e The immune system takes time to produce detectable antibodies. In early Lyme disease, sensitivity can be as low as 20–50%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAntibody persistence:\u003c\/strong\u003e IgG and IgM antibodies can persist for more than ten years after infection. A positive test does not necessarily mean you have an active infection requiring treatment—it could reflect a past infection.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCross-reactivity:\u003c\/strong\u003e Antibodies to other organisms (such as \u003cem\u003eTreponema pallidum\u003c\/em\u003e, the syphilis bacterium, or EBV) can sometimes cause false positives. This is why tests include specific antigens to detect and exclude these cross-reactions.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIndividual variation:\u003c\/strong\u003e Different people produce antibodies at different rates and intensities. Some patients may have borderline results that require repeat testing.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eThe test supports, but does not make, the diagnosis:\u003c\/strong\u003e The clinical picture—your symptoms, physical examination, and exposure history—is always the foundation of the diagnosis. Serological results must be interpreted in this context.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSerious complications in vulnerable patients:\u003c\/strong\u003e Patients with weakened immune systems, transplant recipients, and those without a spleen are at higher risk for severe anaplasmosis and should seek medical attention promptly after a tick bite.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eIf you are concerned about Lyme disease or anaplasmosis, here are practical, evidence-based recommendations:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSee a doctor promptly\u003c\/strong\u003e if you develop a fever, rash, headache, muscle pain, or neurological symptoms within weeks after a known tick bite. Do not wait for symptoms to resolve on their own.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow that the classic bull's-eye rash appears in only half of Lyme patients.\u003c\/strong\u003e The absence of a rash does not rule out the disease.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf your first test is negative but symptoms persist, ask about repeat testing in 2–3 weeks.\u003c\/strong\u003e A single early negative test is not definitive.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRequest the two-level testing approach:\u003c\/strong\u003e ELISA screening with immunoblot confirmation for positive or borderline results. This is the international standard of care.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have neurological symptoms\u003c\/strong\u003e (facial palsy, numbness, tingling, memory problems, persistent headache), ask your doctor whether cerebrospinal fluid testing with Antibody Index calculation is appropriate.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBe aware of the species-specific issue:\u003c\/strong\u003e If neuroborreliosis is suspected, a \u003cem\u003eB. garinii\u003c\/em\u003e-specific test may be more sensitive.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eProvide a complete history:\u003c\/strong\u003e Tell your doctor about any tick exposures, travel, outdoor activities, and all symptoms, even vague ones. The clinical picture is essential to correct interpretation of test results.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not self-diagnose or self-treat.\u003c\/strong\u003e Antibiotic treatment decisions should be made by a healthcare professional based on the full clinical picture and confirmed laboratory results.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is the two-level testing strategy for Lyme disease and why is it used?\u003c\/h3\u003e\n\u003cp\u003eDoctors first screen your blood with an ELISA test. If that result is positive or borderline, a second confirmation test called an immunoblot is done. This two-level approach is recommended by European and American guidelines. It reduces false positives and gives more accurate results, so you can trust a confirmed result.\u003c\/p\u003e\n\u003ch3\u003eMy Lyme disease test was negative, but I still have symptoms. What should I do?\u003c\/h3\u003e\n\u003cp\u003eIf your first test is negative but symptoms persist, ask your doctor about a repeat blood test in 2 to 3 weeks. Antibodies take time to develop, and early sensitivity can be as low as 20–50%. A single early negative test does not rule out Lyme disease.\u003c\/p\u003e\n\u003ch3\u003eWhy might my doctor order a cerebrospinal fluid (CSF) test for neurological symptoms?\u003c\/h3\u003e\n\u003cp\u003eIf your doctor suspects neuroborreliosis, testing CSF can check for antibody production inside the spinal fluid. A special calculation called the Antibody Index (AI) helps prove whether antibodies are made locally. This can give definitive evidence of active nervous system infection, even if blood tests are unclear.\u003c\/p\u003e\n\u003ch3\u003eWhat are the key differences between Lyme disease and anaplasmosis?\u003c\/h3\u003e\n\u003cp\u003eLyme disease is caused by Borrelia bacteria and can cause rash, joint pain, and neurological problems. Anaplasmosis is caused by Anaplasma bacteria and usually starts with fever within a week after a tick bite. Both are spread by the same ticks and can be serious if not treated. Laboratory tests help tell them apart.\u003c\/p\u003e\n\u003ch3\u003eHow accurate are modern tests for Lyme disease?\u003c\/h3\u003e\n\u003cp\u003eModern ELISA tests have sensitivity and specificity over 95% for most Lyme-specific tests. For example, the Borrelia recombinant IgG test has 98.3% sensitivity and 98.1% specificity. Immunoblot tests also show high accuracy, with sensitivity around 96–98% for Borrelia. However, early infection can still be missed, so timing matters.\u003c\/p\u003e\n\u003ch3\u003eWhat does a positive Lyme disease test mean if I was infected years ago?\u003c\/h3\u003e\n\u003cp\u003eAntibodies can persist for more than ten years after infection. A positive test does not necessarily mean you have an active infection requiring treatment. Your doctor will interpret the result along with your symptoms, physical exam, and exposure history to decide if treatment is needed.\u003c\/p\u003e\n\u003ch3\u003eMy Lyme disease test was negative but I still have symptoms. Should I get a second opinion?\u003c\/h3\u003e\n\u003cp\u003eYes, a second opinion can be valuable if your Lyme disease test is negative but symptoms persist. Early Lyme disease tests have only 20–50% sensitivity, so a negative result does not rule out infection. Repeat testing after 2–3 weeks is often needed. A second opinion can help ensure appropriate testing, such as immunoblot confirmation or cerebrospinal fluid analysis for neurological symptoms. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e INFECTIOUS SEROLOGY – BACTERIOLOGY – BORRELIA | ANAPLASMA\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eContent Source:\u003c\/strong\u003e This article is based on technical documentation from TestLine Clinical Diagnostics regarding their ELISA, Immunoblot, and Microblot-Array diagnostic kits for \u003cem\u003eBorrelia burgdorferi\u003c\/em\u003e and \u003cem\u003eAnaplasma phagocytophilum\u003c\/em\u003e. Data presented include the manufacturer's validation studies, external quality assessment results (Instand e.V., May 2021, over 200 participating laboratories), and a comparative study of 86 patients with Lyme neuroborreliosis and 60 patients in a species-reactivity study (data prepared for publication).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eGuideline Reference:\u003c\/strong\u003e The two-level antibody detection strategy is based on: Eldin C, Raffetin A, Bouiller K, et al. Review of European and American guidelines for the diagnosis of Lyme borreliosis. \u003cem\u003eMédecine et Maladies Infectieuses\u003c\/em\u003e. 2019;49(2):121-132. doi:10.1016\/j.medmal.2018.11.011\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research and manufacturer validation data. It is provided for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47458891661468,"sku":null,"price":0.0,"currency_code":"JPY","in_stock":true}],"url":"https:\/\/diagnosticdetectives.tw\/products\/infectious-serology-bacteriology-borrelia-anaplasma","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}