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Information ⬇

Synonym/Acronym

N/A

Rationale

To detect antibodies to the organism that causes Lyme disease.

Patient Preparation

There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

(Method: Enzyme immunoassay [EIA]) Negative; positives are confirmed either by an FDA approved EIA test that has been cleared for use in the serodiagnosis of Lyme disease or by Western blot analysis (immunoblot). The criterion for interpretation of a positive immunoblot test requires the identification of at least five specific bands.

Critical Findings and Potential Interventions ⬆ ⬇

Specific infectious organisms are required to be reported to local, state, and national departments of health. Lists of specific organisms may vary among facilities. State health departments provide information regarding reportable diseases, which can be accessed at each state health department Web site. The CDC provides information regarding national notifiable diseases at https://ndc.services.cdc.gov /search-results-year/.

Overview ⬆ ⬇

Study type: Blood collected in a gold-, red-, or red/gray-top tube; related body system: Immune system.

Borrelia burgdorferi, a deer tick–borne spirochete, is the organism that causes Lyme disease. Lyme disease affects multiple systems and is characterized by fever, arthralgia, and arthritis. The circular, red rash characterizing erythema migrans can appear 3 to 30 days after the tick bite. About one-half of patients in the early stage of Lyme disease (stage 1) and generally all of those in the advanced stage (stage 2, with cardiac, neurological, and rheumatoid manifestations) will have a positive test result. Some laboratories perform IgG and IgM specific testing, other laboratories use a combined method (total or IgG and IgM). Patients in remission will also have a positive test response. The presence of immunoglobulin M (IgM) antibodies indicates acute infection. The presence of IgG antibodies indicates current or past infection. However, other diseases such as anaplasmosis (formerly granulocytic ehrlichiosis), autoimmune disorders (e.g., lupus erythematosus, rheumatoid arthritis), endocarditis (bacterial), Epstein-Barr virus infection, Helicobacter pylori infection, leptospirosis, syphilis, tick-borne relapsing fever, or Treponema denticola infection can produce a positive EIA test, when the patient does not have Lyme disease.

Up until recently, the Centers for Disease Control and Prevention (CDC) had recommended a two-step testing process that begins with an EIA test and is confirmed by using a Western blot test. On July 29, 2019, the FDA cleared several newer EIA-based assays with performance characteristics that surpass those of the standard screening serologic test kits on the market. The FDA deemed the new assays appropriate for use in a modified two-step testing process that uses a second EIA test in place of the more time-consuming Western blot assay. The specific assays recently cleared by the FDA can be considered as CDC-recommended procedures indicated for the serodiagnosis of Lyme disease.

Indications ⬆ ⬇

Assist in establishing a diagnosis of Lyme disease.

Interfering Factors ⬆ ⬇

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Positive Findings in

Lyme disease

Negative Findings in

N/A

Nursing Implications, Nursing Process, Clinical Judgement ⬆

Potential Nursing Problems: Assessment & Nursing Diagnosis

ProblemsSigns and Symptoms
Infection (related to Borrelia burgdorferi bacteria, transmission of B. burgdorferi bacteria in utero from infected mother to baby)Macular flush, flu-like symptoms, headache, extreme fatigue, neck pain, joint pain, joint swelling, bone pain, classic bull’s-eye rash, unexplained fever, difficulty swallowing, chest pain, shortness of breath, heart palpitations, nausea, vomiting, pain in feet, twitching, numbness, irritability, visual disturbance, mood swings, depression, paranoia

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Discuss how this test can assist in diagnosing Lyme disease.
  • Explain that a blood sample is needed for the test. Warn the patient that false-positive and false-negative test results can occur.

Potential Nursing Actions

  • Discuss history of exposure; ask the patient if he or she lives in or visits wooded areas, wears long pants and long-sleeved shirts when in wooded areas or when doing yard work, or has ever been bitten by a tick.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

Infection

  • Administer prescribed antibiotics and other medications to treat symptoms.
  • Minimize future exposure to ticks by staying out of the woods in spring and summer and staying toward the center of the trail when hiking.
  • Do not sit on the ground in leafy/grassy wooded areas.
  • Wear long-sleeved shirts, tuck pants into socks, tuck shirt into pants, and wear light-colored clothing to make attached ticks more visible.
  • Use a bug repellant with DEET.
  • Complete frequent self-checks for ticks.
  • Do a full body check after being outdoors in endemic areas, and check pets for ticks.

Clinical Judgement

  • Consider ways to emphasize the necessity of wearing light-colored clothing that covers extremities when in areas infested by ticks.

Follow-Up and Desired Outcomes

  • Acknowledges information on Lyme disease can be found at the Centers for Disease Control and Prevention, https://www.cdc.gov/lyme/index.html and https://www.cdc.gov /mmwr/volumes/68/wr/mm6832a4.htm?s_cid=mm6832a4_w
  • Understands the importance of reporting continued signs and symptoms of the infection.
  • Understands the importance of taking the prescribed antibiotic to treat infection, including that repeated antibiotic treatments that may be necessary.
  • Aware that Lyme disease is a notifiable infectious disease and positive findings must be reported to local health department officials.