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Lyme Borrelia Direct Detect – Nanotrap®
The next generation of Lyme + Co-Infection Diagnostics—designed to detect at every stage
Discover the Power of MosaicDX’s Lyme Borrelia Direct Detect profile that provides more sensitive direct detection for Lyme Borrelia infection at all stages of Lyme disease than standard methods. Identifies positive cases missed by conventional Two-Tiered Testing (TTT).
Up to 2x more sensitive than conventional antibody testing
Confirms cases missed by antibody testing
Easy at-home or in-office urine sample collection
More Sensitive and Reliable Direct Detection
100% sensitivity and 98% specificity in 24/24 patients with EM rash.
Urine
Turnaround Time: 2 - 3 Weeks
Turnaround times are estimates. Detailed order tracking is available in the MosaicDX Portal.
What patients might benefit from the Lyme Borrelia Direct Detect profile?
Patients presenting with flu-like symptoms, with or without Erythema migrans (EM) rash, and have lived or traveled to an area where Lyme disease is endemic.
Patients with chronic illness not improving, and past/present exposure to ticks, even with past treatment of Lyme, or Post-Treatment Lyme Disease Syndrome (PTLDS)
Headache
Fever / Sweats / Chills
Malaise
Fatigue or chronic fatigue
Muscle soreness
Sleeplessness
Localized or disseminated EM
Depression
Anorexia
Fibromyalgia
Joint pain
Neurological symptoms such as facial paralysis, blindness
Muscle/limb impairment or paralysis
Arthritis
Details
What is Lyme Borrelia?
Lyme Borrelia is the bacteria that causes Lyme disease, a tick-borne illness. Borrelia burgdorferi is the primary species responsible for infection in North America.
Why Test for Lyme Borrelia?
Lyme borreliosis infection can present many ways after exposure, and can cause both acute and chronic illness. It can be clinically diagnosed by a healthcare provider based on a patient’s medical history, current symptoms, and exposure risk. Laboratory test results are used to confirm or support diagnosis and can also be used post-treatment to monitor therapeutic interventions. The good news is that Lyme Disease is treatable and preventable, especially when detected early.
How Can Someone Be Exposed?
Humans and animals can be exposed to Borrelia bacteria if they live in or travel to Lyme-endemic areas. Exposure can occur both outdoors and indoors through contact with ticks, or through working with or living alongside animals that have been exposed to ticks. The primary vector for transmission is the bite of an infected blacklegged tick (deer tick).
When infected ticks detach from their host, such as deer or other animals, they may be unknowingly picked up by humans or their companion pets, becoming the next host for the infected tick. This can lead to the transmission of Borrelia and the subsequent development of Lyme disease.
How Does the Lyme Borrelia Nanotrap® Antigen Test Compare to Serology Tests?
The Nanotrap® Antigen Test is a direct detection test method that captures and concentrates OspA antigen to more accurately confirm Lyme disease diagnosis. Serology tests are indirect, detecting the presence of antibodies to Borrelia burgdorferi, only confirming prior exposure.
The Center for Disease Control (CDC) recommends using two-tier testing (TTT). This platform combines two test methods (ELISA and Western blot) aimed at detecting antibodies specific to Borrelia species. However, antibody (IgM and IgG) testing for Lyme borreliosis faces multiple challenges including:
Limited sensitivity in the absence of a robust immune response.
Delayed antibody response up to 4-6 weeks after transmission.
False positive diagnosis based on antibodies detected after an infection is actually cleared.
False positive test result due to antibody cross-reactivity with other microbes who share similar proteins.
Complicated and controversial interpretation of Western blot results with an important trade off between false positive and false negative risks depending on interpretation criteria.
The Nanotrap® test is targeting the OspA protein, which can be found on the surface of Borrelia species belonging to both major groups (sensu stricto and sensu lato). The test will only determine if OspA is present, not which Borrelia species was detected.
MosaicDX offers nine (9) individual tests and combinations of the most common Lyme and co-infections in North America, with options designed to meet every practitioner’s need.
Combinations and Complementary Test Recommendations
Ticks, fleas and other vectors can transmit multiple infections—not just Lyme disease. To help prioritize treatment, providers should consider additional Lyme and Co-infection tests to identify which pathogens are currently present.
Ticks are often called “nature’s dirty needle” because they can transmit multiple infections—not just Lyme disease. To help prioritize treatment, providers should consider additional direct detection tests to identify which pathogens are currently present.
Combining the Tickborne BBB Direct Detect dPCR with the Lyme Borrelia Nanotrap® urine antigen test for Lyme provides optimal coverage for the top flea and tick-borne infections at the genus level.
The exact timing for a Nanotrap test after tick bite in humans has not been directly assessed. However, the Nanotrap test can definitely be run upon the earliest onset of symptoms (with or without an EM rash), as Magni et al obtained positive Nanotrap results in 100% (24/24) patients with an EM rash AND in 6/6 (100%) early onset patients presenting with joint pain or neurologic symptoms, but without an EM rash. Also, in mouse studies, viable B. burgdorferi have been detected in the bladder/urine within 7-10 days of infection.
Mild (1+) to moderate proteinuria (2+) is not a problem, but large amounts of protein (3+) interfere with the Nanotrap assay.
Generally: Recommend that females do not submit samples while heavy menstruation, as large amounts of blood inhibit the test.
No, it shouldn’t. It actually might potentially help dislodge any bacteria stuck to the bladder wall by flushing them out into the urine (like with E. coli for a UTI).
No, but collecting on younger children can be a bit difficult. Collecting multiple samples within a 24-hour period is okay. IFA will be hard on kids under 2, due to how antibodies are developed in children.
No, urine specimens for Lyme + Co-infections tests should not be frozen.
40 mL of urine is the required minimum volume for the test.
See table below:
Lyme Borrelia Direct Detect – Nanotrap®
Urine
Bartonella IgG Detect – IFA
Serum
Tickborne BBB Direct Detect 1 day – dPCR
Blood x1
Tickborne BBB Direct Detect 3 day – dPCR
Blood x3
Lyme + Bartonella
Urine and Serum
Tickborne BBB Plus 1 day
Blood x1 + Serum x1
Tickborne BBB Plus 3 day
Blood x3 _ Serum x1
Lyme + Co-infections Comprehensive 1 day
Blood, Urine, Serum
Lyme + Co-infections Comprehensive 3 day
Blood x3, Urine x1, Serum x1
No, the Lyme + Co-infections tests are drop-ship only and will ship in a separate collection kit box because they have different collection needs.
USA practitioners with a USA address on their account, logged into the MosaicDX practitioner portal, ordering drop ship to USA addressed patient.
Getting tested with both direct and indirect detection methods provide a more comprehensive and accurate diagnosis, especially with infections and diseases that are difficult to detect.
Direct Detection:
Identifies the presence of the pathogen itself, such as with DNA, RNA, or proteins. Direct Detection can confirm that the pathogen (virus, bacteria, etc.) is currently present in your body. Best for acute infections, or cases where the pathogen is present in high enough quantities to be detected.
Indirect Detection:
Instead of identifying the presence of a pathogen, it looks for immune system responses that would happen when in the presence of the pathogen. Most commonly, indirect tests are used to measure the amount of antibodies in a sample. Antibodies are the proteins that the immune system typically produces to fight against antigens like bacteria or viruses. These tests can determine whether or not you have been exposed to a pathogen in the past, or even if your body is still fighting off an infection where it would be hard to detect the pathogen directly. Best for chronic or past infections in which pathogens are no longer detectable, but the immune response is.
Mosaic Diagnostics offers written interpretations within test reports and complimentary consultations with our clinical educators for qualified practitioners. To schedule a consultation, simply sign in to your MosaicDX account and book a consultation online.
We encourage all patients to discuss results with your practitioner.
Our Resources tab also contains educational materials that you may find useful, we also offer MosaicEDGE workshops for qualified practitioners to better understand the fundamentals of lab testing.
Visit the payment information page for an overview of payment options and procedures along with insurance coverage overview.
NOTE: Insurance coverage for testing is based on several factors such as the type of procedure, diagnosis, and insurance policy guidelines. Patients are encouraged to contact their insurance company to check for coverage and to provide the procedure codes (CPT codes) and diagnostic codes (ICD-10 codes). The CPT codes can be found on the billing information page, while ICD-10 codes are provided by the practitioner.
Different states have regulations that define the scope of practice for practitioners. It is the practitioner’s responsibility to abide by these rules. Check with your state board of health to determine any restrictions related to laboratory testing. Please note, Mosaic Diagnostics does not offer testing in New York.
Once you have opened your account, you have the options of ordering kits to stock in your office or drop-ship kits directly to your patients through your MosaicDX portal.
Watch our short tutorial videos on how to conveniently
International Lyme and Associated Diseases Society (ILADS). Lyme Disease Basics For Providers. https://www.ilads.org/research-literature/lyme-disease-basics-for-providers/. Accessed May 2025.
