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Lyme Disease Serology

Alias: Borreliosis, Lyme borreliosis, Neuroborreliosis, Borrelia burgdorferi, erythema migrans

Discipline: Virology

Test information: Lyme disease is a tick-borne bacterial infection that can be transmitted to humans when they are bitten by an infected Ixodes ricinus tick. Lyme disease can be contracted anywhere in the UK but is more common in the south of England and the Scottish Highlands. Only a small minority of ticks in the UK are infected with the bacteria that causes Lyme disease. Being bitten by an infected tick does not necessarily result in Lyme disease. The diagnosis of Lyme disease is complex and all reactive samples are sent to the reference laboratory for confirmation. NICE recommend that patients with classical erythema migrans are treated on clinical grounds without serological testing.

Lyme disease: resources and guidance

Lyme disease NICE guideline

Availability: Available locally Monday - Friday during routine hours: 08:45 - 17:15. Confirmatory testing and testing for neuroborreliosis is referred to Rare and Imported Pathogens Laboratory (RIPL): Monday - Friday during routine hours: 08:45 - 17:15.

Turnaround Time: Locally 3 Days
Up to 7 Days upon receipt at Rare and Imported Pathogens Laboratory (RIPL) for confirmation serology.
Up to 4 Weeks upon receipt at Rare and Imported Pathogens Laboratory (RIPL) for neuroborreliosis.

Specimen Type(s)
  • Cerebrospinal fluid;
  • Clotted blood;
  • Joint fluids;
  • Tissue Biopsies;
Other Acceptable Specimen Type(s)
In addition to serology, PCR is also available and may be useful in testing joint fluid, biopsy tissue and CSF. Only available after discussion with RIPL clinician. PCR is not usually performed on blood.
Specimen Container - Adult
  • Gold Top SST BD;
  • Sterile CE-marked Universal Container;
Specimen Container - Paediatric
  • N/A;
  • Borrelia burgdorferi antibodies;
  • Pan Borrelia DNA;
Part of a test profile?
Volume (min) of sample to be sent to laboratory
Clotted Blood: 5 - 10mL
CSF: 600 uL
Joint Fluid: 350 uL
Tissue: 0.1g
Patient Preparation, Sample Handling and Transport
  • Minimum-clotting time 30 minutes.
  • Specimens should be transported to the laboratory as soon as possible.
  • Outside of normal hours samples should be refrigerated (2 °C to 8 °C).
  • Serological testing of CSF samples requires simultaneous testing of a contemporary serum in
  • order for the CSF results to be interpretable. It also requires measurement of albumin, IgM
  • and IgG levels in both the CSF and the serum.
  • Please state if the patient had a tick bite and the date of the tick bite.
  • Please state date of onset of symptoms and give details of symptoms.
  • Please indicate if patient has any neurological and/ or ophthalmic symptoms.
  • Take samples for testing 4-6 weeks after symptom onset - not earlier as there is then a higher risk of false negative results.
  • Do not send grossly haemolysed, lipemic or icteric specimens.
Maximum add on time
Units and Reference Ranges / Interpretation
Results: Negative / Equivocal / Positive

Patients in the early stages of infection or who have undergone antibiotic therapy, may not produce measurable IgM and IgG.

Negative Borrelia burgdorferi serology does not rule out recent infection. If recent infection is clinically suspected, consider sending follow up serology at 4 - 6 weeks after the original sample, as antibody production may be delayed.

If past infection was suspected, no further action is required.

Treat erythema migrans on clinical suspicion.

Treatment should be considered in patients without erythema migrans if there is a high clinical suspicion.

UKAS number
UKAS accredited test?

If you have any queries about a test or results interpretation please contact us.

Last updated: 03-06-2023