national lyme borreliosis testing laboratory user manual
Contents
1. number 2 Where the CHI number is not available a third point of identification e g address must be provided In addition please ensure the request form includes Name and location of sender or details of where the final report should be sent if different Specimen type Date and time of collection Associated clinical information Specimens that do not conform to the minimum data set will NOT be processed by the laboratory The department will reject soecimens that present a Health amp Safety hazard to staff e g leaking specimens contamination of specimen containers external surfaces inappropriate and insufficient specimens Specimen transportation Samples must be appropriately packaged and transported in accordance with current regulations If unsure of the current regulations please contact the laboratory for advice Please ensure that packages contain sufficient absorbent material to contain all liquid Please ensure request forms are placed between the plastic container and cardboard outer and not with the sample inside the plastic container Samples should be sent to the laboratory via Royal Mail or DX courier to the address shown in section 2 1 or using other appropriate transport within NHS Highland view on 25 Feb 2016 lyM Page 5 of 6 2015 15 54 Printed 26 Feb 20 dex MQ022 rsion 1 2 Inde Ver rs guide Lyme borreliosis NHS eee ee Highland 8 0 Charges Samples2. received from referring laboratories and private patients are subject to charge prices are reviewed annually and are available on request 9 0 Results and turn around times Serology Within 10 working days PCR Within 7 working days Urgent requests Please contact the laboratory Results are returned by Royal Mail to the address on the request form or electronically where available 10 0 Treatment 10 1 Early Lyme borreliosis e Oral doxycycline 100mg 2 x daily for 14 21 days or oral amoxicillin 500mg 3 x daily for 14 21 days Erythromycin may be considered in penicillin allergic children e IV Ceftriaxone if severe 10 2 Late Lyme borreliosis e Arthritis Oral doxycycline 100mg 2 x daily for 28 days or amoxicillin 500mg 3 x daily for 28 days Persistent arthritis may require repeat oral antibiotic course or IV antibiotics e Neuroborreliosis IV Ceftriaxone Penicillin e Skin and other late forms of disease require specialist advice 11 0 Prevention When visiting areas inhabited by ticks long trousers should be tucked into socks and long sleeves worn An insect repellent may also be used Regular checks should be made and any ticks removed within 24 hrs 12 0 References The epidemiology prevention investigation and treatment of Lyme borreliosis in United Kingdom patients a position statement by the British Infection Association J Inf 2011 62 329 339 Page 6 of 6
3. Lyme borreliosis users guide Version 1 2 Index MQ022 Printed 26 Feb 2015 15 54 NHS S Highland NATIONAL LYME BORRELIOSIS TESTING LABORATORY USER MANUAL t ASM Microb Libraryorg Welson Lyme borreliosis users guide Version 1 2 Index MQ022 Printed 26 Feb 2015 15 54 Authorised on 25 Feb 2015 Authorised by Roger Evans Document Unique Reference 1027 52773489 Due for review on 25 Feb 2016 Author s Sally Mavin Page 1 of 6 CONTENTS Section Page 1 Introduction 3 2 Contact details and key personnel 3 3 Opening hours 3 4 Service provided 4 4 1 Samples 4 4 2 Laboratory tests 4 4 3 Specialist advice 4 5 Clinical Information 4 6 Specimen and request form labelling 5 7 Specimen transportation 5 8 Charges 6 9 Results and turn around times 6 10 Treatment 6 11 Prevention 6 12 References 6 Page 2 of 6 ers guide Version 1 2 Lyme borreliosis us NHS wee oe Highland 1 0 Introduction The National Lyme borreliosis testing laboratory provides a specialist diagnostic service for Scottish Health Boards and other users by request The laboratory is located within the Microbiology Department Raigmore Hospital Inverness The department is accredited by Clinical Pathology Accreditation UK Ltd Lyme borreliosis formerly Lyme disease is caused by the spirochaete Borrelia burgdorferi and is endemic in Scotland 2 0 Contact details and ke
4. by serum sample PCR Skin biopsies CSF 200ul after discussion with laboratory joint fluid 200uI Laboratory tests Enzyme Immunoassay EIA IgG Immunoblot for confirmation of EIA PCR PCR samples must be accompanied by serum sample Specialist advice The laboratory can be contacted as above in 2 1 for clinical enquiries regarding Lyme borreliosis as well as advice regarding specialist testing Clinical Information This is vitally important in deciding how to test a sample Please give specific symptoms and signs and details of any tick bite exposure In accordance with the BIA position statement on Lyme borreliosis we do not test samples without clinical details provided or asymptomatic patients with tick bite Likewise we no longer test samples if clinical details are tick bite and erythema migrans EM These patients should be treated accordingly Early Lyme borreliosis Onset of symptoms 3 32 days following a tick bite Erythema migrans EM rash is diagnostic but rash may be atypical Tender muscles joints pyrexia and lymphadenopathy can also occur Meningitis encephalitis are rare NB For patients with suspected early Lyme borreliosis a negative result does not exclude the possibility of Borrelia burgdorferi infection Failure to detect antibodies may be the result of Sample collection prior to antibody development Inhibition of antibody development due to antibiotic treatment Failure of some patients to
5. produce antibodies If a negative report is issued on a patient with a clinical history consistent with early Lyme disease a further sample should be requested 6 8 weeks after onset Late Lyme borreliosis Weeks to months after tick exposure Multiple or single system involvement of skin joints heart brain or peripheral nerves Lyme borreliosis users guide Version 1 2 Index MQ022 Printed 26 Feb 2015 15 54 Authorised on 25 Feb 2015 Authorised by Roger Evans Document Unique Reference 1027 52773489 Due for review on 25 Feb 2016 Author s Sally Mavin Page 4 of 6 6 0 6 1 6 2 6 3 6 4 7 0 7 1 7 2 7 3 7 4 7 5 NHS wee oe Highland Specimen and request form labelling For the safety of patients and staff the NHS Highland Area Laboratory Service operates a strict specimen acceptance policy full copy is available on request Specimens may be submitted either using a referring laboratory s own request form or with a letter However both the request form or letter and sample must be labelled with a minimum of three pieces of information to allow unequivocal identification of the patient MINIMUM DATA SET Request form Sample Patient s surname Patient s surname Patient s forename s Patient s forename s CHI number CHI number Date of birth not Date of birth not age age 1 Or accepted coded identifier e g soundex code NaSH
6. y personnel 2 1 Address Postal address DX address National Lyme borreliosis testing laboratory DX6180102 90IV Microbiology Department Zone 3 Raigmore Hospital Old Perth Road Inverness IV2 3UJ 2 2 Telephone Fax email General laboratory enquiries 09 00 17 30 01463 704206 704207 direct Monday to Friday Clinical enquiries 01463 704206 704207 direct 09 00 17 00 Monday to Friday Fax 01463 705648 email nhshighland microbiology nhs net 2 3 Key personnel Designation Name Telephone Clinical Lead Dr Emma Watson 01463 705431 Consultant Clinical Scientist Dr Roger Evans 01463 705889 Clinical Scientist S Mavin 01463 705889 Microbiology Service Manager Dr David Ashburn 01463 704108 3 0 Opening hours 3 1 Core Hours are Monday Friday 9 00am to 5 30pm The department does not operate an out of hours service for Lyme borreliosis Lyme borreliosis users guide Version 1 2 Index MQ022 Printed 26 Feb 2015 15 54 Authorised on 25 Feb 2015 Authorised by Roger Evans Document Unique Reference 1027 52773489 Due for review on 25 Feb 2016 Author s Sally Mavin Page 3 of 6 Lyme borreliosis users guide Version 1 2 Index MQ022 Printed 26 Feb 2015 15 54 4 0 4 1 5 0 5 1 5 2 NHS wey oe Highland Service provided Samples Serology Clotted blood 10ml serum 500ul CSF 200ul CSF samples must be accompanied
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