Diagnostic testing of CSF for Lyme disease of the central nervous system in the United States

TestAdvantage(s)Concerns or disadvantages
CultureProof of active infection.Delay in time to positivity; false positive results have been reported; testing is very
insensitive and not routinely offered by clinical laboratories.
NAATProof of active infection.False positives may occur and insufficient sensitivity to exclude the diagnosis.
CXCL13Often elevated in patients with CNSLD.Insufficient specificity to distinguish CNSLD from other neuroinflammatory
syndromes; also, CXCL13 levels can rapidly fall below the cutoff threshold if
antibiotic therapy is initiated prior to CSF collection; not routinely available
through U.S. laboratories.
Enzyme immunoassayNoneMay be positive due to passive antibody diffusion from blood.
ImmunoblotNoneMay be positive due to passive antibody diffusion from blood and lack of interpretive
criteria for evaluation of CSF.
Intrathecal antibody detectionOften positive; positivity may precede serum antibody positivity.Poorly standardized; positive results do not prove active infection.