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.
Medical Considerations in Lyme Diagnosis:
Tick bite and exposure risk. A patient who recalls a tick bite should tell their medical provider. 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.
Lyme 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. 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.
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.
Two Tier Tests:
The first is a screening test that should detect anyone who might have the disease. 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. 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.
Limitations of Current Lyme Testing:
1. Traditional Lyme disease tests are not specific enough.
2. The ELISA and Western blot are not sensitive enough.
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 IgM and IgG ImmunoBlots’ superior specificity and sensitivity make them the best Lyme disease test available.
Importance of Testing for Co-Infection
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).