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Borrelia Antibody (CSF)

Does this test have other names?

Lyme disease test (CSF)

What is this test?

This test looks for Borrelia antibodies in your cerebrospinal fluid (CSF). Borrelia burgdorferi bacteria cause Lyme disease.

The bacteria are spread to humans through the bite of an infected tick.

If not treated, Lyme disease can cause meningitis, or an infection of the tissues covering the brain and spinal cord. It can also cause liver and heart problems; facial palsy, or the inability to control facial muscles; and other complications that may show up months or even years later. These include ongoing pain and tiredness, arthritis, and problems with memory and concentration. Lyme disease is the most common tick-borne condition in the U.S.

This test measures the level of antibodies to the Borrelia bacteria in your CSF to see if Lyme disease has spread to your central nervous system.

Why do I need this test?

You may have this test to find out whether Lyme disease has affected your central nervous system. Early signs that Lyme disease has affected the nervous system include:

  • Meningitis, an infection of the brain's protective membranes

  • Facial palsy

  • Nerve inflammation that causes pain

  • Weakness

  • Numbness or difficulty controlling muscles in some part of your body 

It's important to catch Lyme disease early because it can cause arthritis, heart and liver problems, ongoing pain and fatigue, and chronic problems with memory and concentration. Antibiotic treatment is effective in treating all stages of the disease.

You may also have this test to check for other tickborne illnesses.

What other tests might I have along with this test?

Your doctor may also order these tests:

  • Blood test to check for Borrelia antibodies

  • Other CSF tests, including cell count and protein and glucose levels

  • CSF gram stain and bacterial cultures to rule out other disease-causing germs

  • Nerve conduction studies to look for damage to the peripheral nervous system

  • CXCL13

  • Electrophysiologic testing of peripheral nerve function

  • Imaging tests

What do my test results mean?

Many things may affect your lab test results. These include the method each lab uses to do the test. Even if your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your health care provider.

Some Borrelia antibodies in the blood are likely to spread to your CSF, so finding them in your CSF does not necessarily mean you have central nervous system Lyme disease. A higher level of antibodies to Lyme disease in your CSF than in your blood means that the antibodies may be multiplying there and that the disease has spread to your central nervous system.

You will likely be diagnosed with central nervous system Lyme disease if your test results show most or all of these conditions:

  • You have higher counts of lymphocytes and/or monocytes in your CSF. These are both types of white blood cells that may mean you have an acute infection.

  • Your CSF protein concentration is 200 to 300 milligrams per deciliter (mg/dL).  

  • You have a higher level of Borrelia antibodies in your CSF than in your blood after adjusting your blood and CSF antibody tests so that both have an equal concentration of IgG antibodies.

A negative result means that no Borrelia antibodies were found. But a negative result of this test alone doesn't rule out the possibility of nervous system Lyme disease. A diagnosis is usually made after looking at the results of several types of tests.

How is this test done?

This test requires a sample of cerebrospinal fluid, which is taken through a lumbar puncture in your lower back. During this procedure, you either sit up and lean forward or lie down on your side. A health care provider inserts a needle into your spine and draws out a sample of fluid.

Does this test pose any risks?

It's rare to develop complications after having this test. But potential risks include:

  • Headache

  • Infection

  • Bleeding

  • Cerebral herniation

  • Nerve pain or numbness

  • Back pain

Talk with your provider about the risks before the test. Be sure to tell your provider if you've had a seizure, increased pressure in your eyes, or other health problems. 

What might affect my test results?

Other factors aren't likely to affect your results.

How do I get ready for this test?

You don't need to prepare for this test. But be sure your doctor knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don't need a prescription and any illicit drugs you may use.