Lyme Diagnosis and Testing
The importance of Diagnosing Lyme and other Tick Borne Illnesses is so Important for getting the appropriate treatment and recovery. Early Diagnosis gives the potential for fast and complete recovery. If undiagnosed, Lyme and Tick Illnesses can move deeper into the body and wreak havoc on many systems leading to Chronic Disease. That doesn’t mean it isn’t curable. But it takes longer to heal and may cause a lot of pain and suffering. Therefore, I am a huge fan of yearly Lyme Screens in my patients that spend time in areas that are known to have Ticks.
Lyme disease is a clinical diagnosis—based on your medical history, symptoms and exposure to ticks. Because the typical Lyme disease diagnostic tests are so insensitive, a negative test result does not mean you don’t have Lyme. There are many reasons why someone who actually has Lyme may have a negative test result. There may not have been time for antibodies to develop; the immune system may be suppressed; or the person may be infected with a strain the test doesn’t measure.
Lyme disease is known to inhibit the immune system and 20-30% of patients have falsely negative antibody tests.
What should I talk to my doctor about if I’m worried about Lyme?
Make sure you talk to your doctor about:
- Where you live, your activities, and travel (exposure risks)
- Any symptoms and signs you have experienced, even if you’re not sure they’re connected to Lyme
- Any pre-existing conditions you have
- Any allergies you have
- Any medication intolerances you may have
- If you’ve just been bitten, discuss preventative antibiotic treatment
- If you have the tick you were bitten by, discuss testing it for pathogens
How can I tell if I have Lyme disease?
Lyme disease should be clinically diagnosed. This means a medical professional must evaluate your symptoms, physical findings, exposure risk, and any test results to determine whether you have the disease. No single factor or test result is enough to determine whether you do or do not have Lyme or other tick-borne illnesses.
What should a medical professional consider in diagnosing Lyme?
- Tick bite and exposure risk. A patient who recalls a tick bite should tell their medical provider. However, just because a you don’t recall a tick bite doesn’t mean you don’t have Lyme. Many patients with Lyme disease do not recall a tick bite. Tell your doctor about your activities, and where you live and have traveled.
- Rash. A classic indicator of Lyme disease is the presence of a rash -- erythema migrans (EM), which is often called a bull’s-eye rash. However, most erythema migrans do not have a bull’s-eye appearance, and many patients do not recall any rash at all. It is important to consider Lyme as a diagnosis if other factors warrant it, even if a rash does not appear or is not recalled.
- Other infections sometimes cause a rash. Borrelia miyamotoi and B. mayonii also cause an EM-like rash. Anaplasma and Ehrlichia occasionally cause a diffuse pink to red, spotty rash. Bartonella has been associated with “vasculitic rashes” that can resemble stretch marks or scattered red lesions on various parts of the body. Other tick borne infectors, like spotted fever rickettsiae, also cause rashes, but are transmitted by different ticks.
- Other Symptoms. Lyme disease has been called the “great imitator.” Borrelia burgdorferi can infect multiple organs and tissues, producing a wide range of symptoms. Lyme can mimic rheumatologic and neurologic conditions, as well as chronic fatigue syndrome, fibromyalgia, and many difficult-to-diagnose multi-system illnesses. Patients with longer lasting cases of Lyme disease may be misdiagnosed with somatoform disorders.
- Testing. No testing is necessary when a patient has an EM rash and a story that fits with Lyme disease. Testing at this early time is unlikely to give a positive result because it takes time to develop antibodies to the infection. Current tests sometimes fail to identify patients who do in fact have Lyme disease if testing is done too early or too late in the illness. A negative test result alone is not sufficient to definitively rule out Lyme disease as the cause of your symptoms.
Why isn’t a test result enough to tell me if I have Lyme?
One of the biggest challenges of fighting Lyme disease is providing patients with accurate diagnostic tests. Without access to the best tests for Lyme disease, it’s impossible to diagnose this treatable disease in a timely manner. When the disease isn’t caught in time, it can spread throughout the body and cause chronic health problems that could otherwise be avoided with earlier detection and treatment.
Lyme Disease Testing
The most common Lyme disease tests are indirect ones. They measure the patient’s antibody response to the infection, not the infection itself. The two most-used antibody tests are the enzyme-linked immunosorbent assay (ELISA) and the Western blot. The CDC recommends that doctors first order an ELISA to screen for Lyme disease and then confirm Lyme disease with a Western blot.
During the first four-to-six weeks of Lyme infection, these Lyme disease tests are unreliable because most people have not yet developed the antibody response that the test measures. Even later in the illness, the two-tiered testing is highly insensitive missing roughly half of those who have Lyme disease.
Lyme Disease Test – Two-tier Testing
Two-tiered Lyme disease testing uses two tests. The first is a screening test that should detect anyone who might have the disease. Tests that do this well have are regarded as having high sensitivity. This test is followed by a second test that is intended to make sure that only people with the disease are diagnosed. Tests that do this well have high specificity.
Lyme Disease Test – Western Blot
Labs performing a Western blot use electricity to separate proteins called antigens into bands. The read-out from the Western blot looks like a bar code. The lab compares the pattern produced by running the test with your blood to a template pattern representing known cases of Lyme disease. If your blot has bands in the right places, and the right number of bands, it is positive.
The CDC requires 5 out of 10 bands for a positive test result. However, because some bands on the Western blot are more significant than others your doctor may decide you have Lyme disease even if your Western blot does not have the number of bands or specific bands recommended by the CDC.
Different laboratories use different methods and criteria for interpreting the test, so you can have a positive test result from one lab and a negative test result from another.
When testing for Lyme, should other tests be performed?
Evaluating other possible causes of a patient’s illness is important. After conducting a thorough history and exam, your doctor may determine that you need to be tested for diseases that mimic Lyme disease.
The limitations of the ELISA and Western blot
- Traditional Lyme disease tests are not specific enough. Lyme disease is caused by the spiral-shaped bacteria Borrelia. There are multiple species and strains of Lyme borreliae (Lb). Therefore, tests must be targeted to these multiple species and strains in order to be able to detect them. If a patient is infected with a species or strain of Lyme borreliae that their test can’t detect, they will get a false-negative test result and thus risk missing their diagnosis.
- The ELISA and Western blot are not sensitive enough. Another major limiting factor of the traditional ELISA and Western blot is the quality. These tests tend to use lysed BB cultures, and therefore, depending on the culture conditions, some antigens are over-expressed, and some are under-expressed. This, in turn, can affect the ability to detect antibodies from patients’ blood. What’s more, if a patient tests too early after a tick bite, his or her body may not have produced enough antibodies to show up on a test with suboptimal sensitivity.
IGeneX Lyme ImmunoBlot Test
IGeneX has developed a serological test that increases specificity without sacrificing sensitivity that has changed how to test for Lyme disease. It uses specifically created recombinant proteins from multiple species and strains of Lyme borreliae and reduces inconsistencies in reading and interpreting the test bands.
More species detected – The Lyme ImmunoBlot tests for more species of Lyme borreliae than the traditional ELISA and Western blot tests, reducing the risks of false negatives due to the inability to detect antibodies to a certain strain or species of Lb. The test includes all Borrelia-specific antigens relevant in North America and Europe, not just B. burgdorferi B31 or 297.
The result is a single test that replaces at least 8 Western blots.
More accurate testing – The ImmunoBlot uses specific recombinant proteins that are sprayed in precise amounts onto specific locations on the membrane strip, allowing for greater control of the quantity and location of the antigens. This makes reading the bands much more accurate and consistent.
Earlier detection – The ImmunoBlot can detect infections at multiple stages of illness, letting you catch (and treat) infections earlier.
The IgM and IgG ImmunoBlots’ superior specificity and sensitivity make them the best Lyme disease test available.
What about co-infection testing?
When a patient is being treated for Lyme disease without success or is exhibiting additional symptoms that are not typically seen in Lyme disease, their health care provider should consider testing for Babesia, Anaplasma, Ehrlichia, and Bartonella (other infections that are often seen with Lyme). Left undiagnosed and untreated, these co-infections can not only cause symptoms of their own, their continued presence can prevent successful treatment of Lyme disease.
The International Lyme and Associated Disease Society Position on Diagnosis and Testing
Lyme disease is a clinical diagnosis based on the history and physical findings, and supported by appropriate laboratory tests when they are indicated. These elements must be considered in the context of the individual patient’s full story and with consideration of other diagnoses that may explain or confound the patient’s diagnosis.
The Importance of Diagnosing Lyme and other Tick Borne Infections both Clinically and with Labs is essential for determining the appropriate treatments.