Lyme + Co-infections Comprehensive 1 day

The next generation of Lyme + Co-Infection Diagnostics—designed to detect at every stage

Our most comprehensive Lyme and co-infection combination panel includes Tickborne BBB Direct Detect dPCR with the Lyme Borrelia Nanotrap® urine antigen test to provide optimal coverage for the top flea and tick-borne infections at the genus level. Bartonella IgG Detect IFA adds enhances diagnostic accuracy when combined with BBB Direct Detect species genus level digital PCR Bartonella results.

Tickborne BBB Direct Detect – dPCR (1 day or 3 day) and Lyme Borrelia Direct Detect – Nanotrap® and Bartonella IgG Detect – IFA

Tickborne BBB Direct Detect dPCR, confirms current infection by directly detecting genus-level DNA for a broad range of Bartonella, Borrelia, and Babesia species (spp) in whole blood. This approach ensures that positive cases of infection with less common species are not missed.

Lyme Borrelia Direct Detect – Nanotrap assesses the current presence of Lyme Borrelia infection in urine. Concentrations of Lyme Borrelia are so low in the blood that a blood draw is unlikely to capture the pathogen in the test tube. The Nanotrap® test is targeting the OspA protein, which can be found on the surface of Borrelia species.

Bartonella IgG Detect IFA confirms antibodies against the four most common species of infection: Bartonella henselae, Bartonella koehlerae, Bartonella quintana, and Bartonella vinsonii berkhoffii.

Combining direct and indirect testing methods–specifically for Bartonella infection–enhances diagnostic accuracy, especially for patients with complex clinical presentations. MosaicDX recommends maximizing diagnostic data by testing for both antibodies (indirect) and DNA evidence of infection (direct) for Bartonella, as each test method provides critical support. Tickborne BBB Direct Detect dPCR includes tests for Borrelia, Babesia and Bartonella at a genus level for all associated pathogens and Bartonella IgG Detect uses the IFA method to detect IgG to the top four Bartonella species affecting humans in North America.

We offer 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.

Blood, Serum, Urine
Practitioners:
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For Non-Practitioners:

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Sample Reports | Test Prep and Instructions
* Available in English

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) or co-infections.

Patients with chronic illness not improving, and past/present exposure to ticks, fleas, lice, spiders or companion animals.

  • Abdominal pain
  • Anorexia
  • Anxiety and depression
  • Arthritis
  • Bladder and pelvic pain
  • Body aches
  • Cardiovascular issues (endocarditis)
  • Carditis or heart block
  • Changes in bowel habits
  • Depression
  • Eye and vision problems (such as floaters, light sensitivity, and blurry vision)
  • Facial pain and tooth issues
  • Fatigue / chronic fatigue / profound fatigue
  • Fever
  • Fibromyalgia
  • Flu-like illness
  • Headaches
  • Joint pain
  • Localized or disseminated EM
  • Malaise
  • Muscle pain / soreness
  • Muscle/limb impairment or paralysis
  • Neurological manifestations
  • Neurological symptoms such as facial paralysis, blindness
  • Psychiatric symptoms (rage)
  • Rash “striae”
  • Seizures
  • Sleeplessness
  • Swollen lymph nodes in the head, neck, arms, and along the shins

Details

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. To help prioritize treatment, providers should consider additional Lyme and Co-infection tests to identify which pathogens are currently present.

Logo
Lyme Borrelia Direct Detect
Bartonella IgG Detect – IFA
Tickborne BBB Direct Detect
(1 or 3 day)

Methodology
Nanotrap®
Direct
Immuno-fluorescence (IFA)
Indirect
Digital PCR (dPCR)
Direct

Sample Type

Urine
Urine

Serum
Serum (yellow top)

Blood
Blood (lavender top)

INDIVIDUAL PROFILES

COMBINATION PROFILES

Analytes

Lyme Borrelia Direct Detect – Nanotrap®
Outer Surface Protein Antigen A (OspA)

Tickborne BBB Direct Detect – dPCR
Babesia spp. 1 day
Bartonella spp. 1 day
Borrelia spp. 1 day
Bartonella spp. Culture dPCR 1 day

Bartonella IgG Detect – IFA
Bartonella henselae
Bartonella koehlerae
Bartonella quintana
Bartonella vinsonii berkhoffii

Sample Reports

Lyme + Co-infections Comprehensive 1 day – Sample Test Report (Sample Report)

Test Prep and Instructions

Lyme + Co-infections Collection Instructions

Explore our Lyme + Co-infections Comprehensive 1 day Resources

View All Resources
Sample Test Reports

Lyme + Co-infections Comprehensive 1 day – Sample Test Report

Read More
Webinars

Untangling the Web: A Functional Medicine Approach to Lyme & Mold

Read More
Brochures

Tickborne BBB Direct Detect dPCR – Practitioner Brochure

Read More

Frequently Asked Questions

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 

The Tickborne BBB Direct Detect dPCR may be performed on a single blood sample or on a series of three blood samples drawn every other day within a 5- to 8-day period. The 3-Day Draw is similar to the 1-Day Draw, except for the number of samples and the days they are drawn (i.e., Day 1, Day 3, Day 5).

Note: A 3-Day Draw cannot be performed if all three samples are collected on the same day. Samples must be drawn on different days.

Bartonella species invade the endothelial cells lining the vascular system, cycling in and out of the blood over 5 to 8 days. They evade the immune response in the bloodstream by hiding in erythrocytes and other cell types. Research suggests that a serial testing approach, which we call a 3-Day—or Triple Draw—may increase the odds of a positive dPCR result.

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. 

Don’t panic. Most of the materials inside the kit are still usable. The expiration date on the kit or at least one of the included tubes has expired. Please check the individual tubes before using them. If a tube is past it’s date, then they can be swapped out for standard SST tubes (yellow top, tiger top) and EDTA tubes (lavender top) as long as those tubes have not expired. Any expired tubes will be rejected per CLIA regulations. 

Yes, a licensed medical practitioner (Licensed Physicians (MD, DO), NPs, PAs, and NDs with active NPI numbers) from an eligible state is required to order testing from Mosaic. 

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.

  1. Visit AnyLabTest Now to find a location near you.
    1. Schedule an appointment online, call for assistance, or just show up for your lab test — no appointment necessary.
    2. Bring the following to your appointment:
      1. Payment for specimen collection and processing fee.
      2. Test collection kit
      3. Included gel pack (freeze ahead of time)
      4. Collection instructions
      5. Test Requisition Form with doctor’s signature
      6. UPS return bag (included in the test kit)
  2. Alpha Phlebotomy Group offers three options
    1. In Home Collections – where the phlebotomist comes to you. Fees include per collection rates and mileage.
    2. Collection Draw Site Locations – where APG provides you with a location that is familiar with MosaicDX orders. Prices for collections vary by phlebotomist.
    3. Mobile Event Collections for Groups – Have a group of 20 blood collections? Create a blood draw corporate or wellness event. Events require a minimum of 6 draws per hour otherwise additional hourly fees may apply along with specific pricing per participant.
  3. Los Angeles and Orange County Areas: Contact Mobile Phlebotomy Service
    1. They will complete the blood draw directly from your home. Call 909-985-5562 to make an appointment. Standard hours of operation are 6:00 a.m. to 3:00 p.m.
  4. Kansas City Metro Areas: Contact Test Smartly Labs.
    1. Collection hours are Monday through Friday 9:00 a.m. to 5:00 p.m. at all four of the TSL Kansas City area locations. Call 816-800-9699 to set up your appointment.

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  

Already have a kit? Watch this video on how to place an order for your patient using a kit from your inventory.   

Have a question? We've got answers.

Our team of experts can help you find exactly what you need. Contact us now and let's get started.

Contact Us

Clinical References

  1. Maggi, R.G., Calchi, A.C., Moore, C.O. et al. Human Babesia odocoilei and Bartonella spp. co-infections in the Americas. Parasites Vectors 17, 302 (2024). https://doi.org/10.1186/s13071-024-06385-4. 
  1. Hildebrand, J., Buńkowska-Gawlik, K. & Perec-Matysiak, A. Co-occurrence of Babesia microti, Bartonella spp., Borrelia burgdorferi s.l. and Anaplasma phagocytophilum in rodents from Lower Silesia, Poland. Parasites Vectors 7 (Suppl 1), O4 (2014). https://doi.org/10.1186/1756-3305-7-S1-O4. 
  1. Breitschwardt E. The Evolving Biomedical Importance of Bartonella Species Infections. Pathogens. Special Issue. Bacterial Pathogens. ISSN 2076-0817. Accessed May 2025. 
  1. Infectious Disease Society of America 2020 Guideline on Diagnosis and Management of Babesiosis. Clinical Infectious Diseases, Volume 72, Issue 2, 15 January 2021, Pages e49-e64, https://doi.org/10.1093/cid/ciaa1216. 

  1. Spach, David. UpToDate. Biology of Bartonella Species. Accessed 05/2025. 
  1. Breitschwerdt E. Bartonellosis: One Health Perspectives for an Emerging Infectious Disease. ILAR Journal, Volume 55, Issue 1, 2014, Pages 46–58, https://doi.org/10.1093/ilar/ilu015 
  1. Bush J, Robveille C, Maggi R, et al. Bush, J.C., Robveille, C., Maggi, R.G. et al. Neurobartonelloses: emerging from obscurity! Parasites Vectors 17, 416 (2024). https://doi.org/10.1186/s13071-024-06491-3 
  1. Maggi, R.G., et al. (2005). Bartonella spp. bacteremia in patients with neurological and neurocognitive dysfunction. Journal of Clinical Microbiology, 43(9), 4818-4822. 
  1. Breitschwerdt, E.B., et al. (2008). Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerging Infectious Diseases, 14(5), 653-660. 
  1. Breitschwerdt E, Atkins C, Brown T, et al. Bartonella vinsonii subsp. Berkhoffi and Related Members of the Alpha Subdivision of the Proteobacteria in Dogs with Cardiac Arrhythmias, Endocarditis, or Myocarditis. Journal of Clinical Microbiology. Nov 1999, Vol 37 No 11: 3618-26. 
  1. Cheslock M, and Embers M. Human Bartonellosis: An Underappreciated Public Health Problem? Tropical Medicine and Infectious Disease Review April 2019. 
  1. Boaz A, Graidy M, Efrat G, et al. Bartonella Koehlerae, a New Cat-Associated Agent of Culture-Negative Human Endocarditis. Journal of Clinical Microbiology, Aug. 2004, v42 No 8: 3462–3468. 
  1. Project Lyme. What is Bartonella. Accessed May 2025. 
  1. Centers for Disease Control and Prevention. About Bartonella Henselae. Accessed May 2025. 
  1. Galaxy Diagnostics. What is Bartonellosis. Accessed May 2025. 

  1. Shapiro, Eugene. Borrelia burgdorferi (Lyme Disease). Pediatr Rev (2014) 35 (12): 500–509. https://doi.org/10.1542/pir.35-12-500 
  1. Pfeifle A, Duvall, R, Tamming L, et al. Borrelia burgdorferi Strain-Specific Differences in Mouse Infectivity and Pathology. Pathogens 2025, 14(4), 352; https://doi.org/10.3390/pathogens14040352. 
  1. Centers for Disease Control and Prevention. Comparison of Lyme Disease in the United States and Europe. Emerging Infectious Diseases. Vol. 27, Number 8—August 2021 
  1. Wilcox J, Mankoff S, Stricker J. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ. 2014; 2:e322. PMID: 24749006 PMCID: PMC3976119. 
  1. Sellati, T, and Barberio D. Mechanisms of Dysregulated Antibody Response in Lyme Disease. Front Cell Infect Microbiol. 2020 Oct 7;10:567252. doi: 10.3389/fcimb.2020.567252. 
  1. Magni R, Espina B, Shah K, et al. Application of Nanotrap technology for high sensitivity measurement of urinary outer surface protein A carboxyl-terminus domain in early stage Lyme borreliosis. J Transl Med. 2015 Nov 4;13:346. doi: 10.1186/s12967-015-0701-z. 
    Aucott, J, Rebman A, et al. Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Qual Life Res. 2012 Feb 1;22(1):75–84. doi: 10.1007/s11136-012-0126-6
  2. 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.
  3. Centers for Disease Control and Prevention (CDC). How Lyme Disease Spreads. https://www.cdc.gov/lyme/causes/index.html. Accessed May 2025.
  4. Melski JW. Lyme borreliosis. Semin Cutan Med Surg. 2000 Mar;19(1):10-8. doi: 10.1053/sd.2000.7373. PMID: 10834603.
  5. Kurokawa, C., Lynn, G.E., Pedra, J.H.F. et al. Interactions between Borrelia burgdorferi and ticks. Nat Rev Microbiol 18, 587–600 (2020). https://doi.org/10.1038/s41579-020-0400-5.
  6. Infectious Disease Society of America (IDSA). AAN/ACR/IDSA 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clinical Infectious Diseases, Volume 72, Issue 1, 1 January 2021, Pages e1-e48, https://doi.org/10.1093/cid/ciaa1215
  7. Cameron D, Johnson L, Maloney E. International Lyme and Associated Diseases Society (ILADS). Evidence Assessments and Guideline Recommendations in Lyme Disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease. https://www.ilads.org/patient-care/ilads-treatment-guidelines/. Accessed May 2025.