Diagnosis Testing And Treatment
You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon how long youve been infected. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.
Several weeks after infection, FDA cleared tests have very good sensitivity.
It is possible for someone who was infected with Lyme disease to test negative because:
If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately.
- Report being bitten by a tick, or
- Live in, or have recently visited, a tick-infested area.
What Are The Stages Of Lyme Infection
There are three stages:
- Early localized Lyme: Flu-like symptoms like fever, chills, headache, swollen lymph nodes, sore throat, and a rash that looks like a bull’s-eye or is round and red and at least 2 inches long
- Early disseminated Lyme: Flu-like symptoms like pain, weakness, or numbness in your arms and legs, changes in your vision, heart palpitations and chest pain, a rash , and a type of facial paralysis known as Bellâs palsy
- Late disseminated Lyme: This can happen weeks, months, or years after the tick bite. Symptoms might include arthritis, severe fatigue and headaches, dizziness, trouble sleeping, and confusion.
About 10% of people treated for Lyme infection donât shake the disease. They may go on to have three core symptoms: joint or muscle pain, fatigue, and short-term memory loss or confusion. This is called post-treatment Lyme disease syndrome. It can be hard to diagnose because it has the same symptoms as other diseases. Plus, there isn’t a blood test to confirm it.
Experts arenât sure why Lyme symptoms donât always go away. One theory is that your body keeps fighting the infection even after the bacteria are gone, like an autoimmune disorder.
What Are Lyme Disease Symptoms
Lyme disease can cause a slew of different symptoms, according to the Centers for Disease Control and Prevention , and you may experience different signs of the illness depending on how long its been since you were infected. These are the most common symptoms that can surface anywhere from three to 30 days after a tick bite, the CDC says:
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Fever
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Shooting pains, numbness, or tingling in the hands or feet
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Lyme Disease Can Be Diagnosed By ‘bull’s Eye’ Rash Alone
Lyme disease can be diagnosed by the rash alone, new advice for the NHS says.
People with the “bull’s eye” circular rash do not need a blood test and should be treated immediately to avoid complications, the National Institute for Health and Care Excellence says.
Waiting for lab results is unnecessary and can cause delays in patients being prescribed the antibiotics they need.
Lyme disease is spread by tick bites and can be debilitating.
A blood tests can check for it but may not give a positive result until eight weeks after the patient is bitten.
Prof Gillian Leng, deputy chief executive and director of health and social care at the National Institute for Health and Care Excellence , said for most people with Lyme disease, a course of antibiotics would be an effective treatment, “so it is important we diagnose and treat people as soon as possible”.
“A person with Lyme disease may present with a wide range of symptoms, so we have clear advice for professionals about the use of lab tests for diagnosis and the most appropriate antibiotic treatments,” she said.
“If a characteristic bull’s eye rash is present, healthcare professionals should feel confident in diagnosing Lyme disease.”
Lyme disease can be difficult to diagnose. It has similar symptoms to other conditions and there is not always an obvious rash. The rash can also appear in a number of different ways, as these images from the NICE guidance show.
Symptoms can also include:
How To Avoid Getting A Tick Bite
You might be at risk if you live, work in, or visit a wooded area, or an area with tall grasses and bushes .
You may also be at risk if you are involved in outdoor activities such as hiking, camping and gardening.
You may be bitten by a tick and not even know it.
Heres what you can do to avoid getting a tick bite.
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Other Diagnostic Tests For Lyme Disease
Some laboratories offer Lyme disease testing using urine or other body fluids. These tests are not approved by FDA because they have not been proven to be accurate. For example, one study of urine-based polymerase chain reaction assays for Lyme disease diagnosis showed that with currently available tools, urine cannot be used to accurately diagnose Lyme disease. Another study by NIAID-supported scientists showed that the Lyme Urinary Antigen Test was unreliable and resulted in excessive numbers of false positives. In the same study, researchers confirmed that an ELISA followed by a Western blot test was nearly 100 percent reliable in diagnosing Lyme disease. With the availability of so many Lyme disease tests, including non-commercial tests developed by individual facilities, it is impossible to address the accuracy of each one. The development of new, rapid, clearly validated diagnostic tests continues to be a need.
Why Lyme Is Tough To Diagnose
- Lyme symptoms are similar to other illnesses, so misdiagnosis is common.
- Many Canadian doctors are unfamiliar with Lyme, so they dont test for it or administer the wrong tests.
- Only a handful of blood tests effectively detect Lyme bacteria, so the infection is often missed.
Dont get discouraged if you get a negative diagnosis. Seek out second, and even third, opinions if you must!
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Does The Time Of Year Matter In The Diagnosis Of Lyme Disease
Since Lyme disease is a tick-borne infection, the seasonality of the disease is linked tightly to the life cycle and behavior of ticks. May, June, July, and early August are the biggest risk months for acquiring first stage Lyme disease in the US. This is the feeding time for nymph and adolescent ticks which are difficult to see. A viral-like illness in those early summer months might be Lyme disease. There is also some transmission of Lyme disease via adult ticks in the fall and winter and throughout the year anytime the temperature is above 40 degrees, but to a lesser degree.
The risk of acute Lyme disease is more of a year-round risk in more temperate regions such as northern California and the pacific northwest. Later stage Lyme disease, however, can manifest at any time.
Who Gets Lyme Disease
Anyone bitten by an infected deer tick can get Lyme disease. Most U.S. cases of Lyme disease happen in Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. But Lyme disease is found in other parts of the U.S., Europe, Asia, and Australia too.
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What Should I Do If I Am Bitten By A Tick
If you experience a tick bite, the best way to remove it is by taking the following steps:
- Tug gently but firmly with blunt tweezers near the “head” of the tick at the level of your skin until it releases its hold on the skin.
- Avoid crushing the tick’s body or handling the tick with bare fingers as you could exposure yourself to the bacteria in the tick.
- Wash the bite area thoroughly with soap and water.
- DO NOT use kerosene, petroleum jelly , or hot cigarette butts to remove the tick.
- DO NOT squeeze the tick’s body with your fingers or tweezers.
Current Problems With Lyme Disease Diagnosis & Patient Care
- Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial.
- The rash is not always present or easily recognized
- Misdiagnosis and delayed diagnosis can make Lyme disease more difficult to treat and lead to prolonged and debilitating illness
- Early symptoms can be mistaken for a summer flu
- Lyme disease can involve several parts of the body, including joints, connective tissue, heart, brain, and nerves, and produce different symptoms at different times.
- Antibody testing done after early treatment may be negative and never turn positive for some cases
- Borrelia burgdorferi can evade our protective immune system and trigger immune system dysfunction.
- No reliable blood test is presently available to measure treatment success, necessitating close clinical follow up and improved physician education.
- Presently there is no vaccine to prevent Lyme disease available to humans.
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Key Points To Remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
History And Physical Examination
The clinical diagnosis of Lyme disease can be straightforward in patients with a history of tick exposure and the characteristic finding of an erythema migrans rash.12 The CDC has defined erythema migrans rash as an expanding red macule or papule that must reach at least 5 cm in size .11 According to the Infectious Diseases Society of America guidelines, erythema migrans rash is the only clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.20 Although one study concluded that primary care physicians in a Lyme diseaseendemic area of France correctly identified erythema migrans in 72 percent of patients,22 the study was limited by lack of complete clinical information for the participants.
A number of conditions resemble erythema migrans however, the rapid and prolonged expansion of an erythematous lesion is unique to erythema migrans.11 Lesions most often occur at anatomic sites that are unusual for cellulitis and other conditions that mimic erythema migrans therefore, a complete skin examination should be performed before excluding erythema migrans.20
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Symptoms To Help You Identify Lyme Disease And When To Talk To Your Doctor
If you like to spend time outdoors in the summer, youre probably aware of the importance of checking yourself for ticks afterward. And, if you live in certain parts of the country, Lyme disease is very likely on your radar.
But knowing you could get Lyme disease from a tick bite and actually being aware of which symptoms to look out for are two different things. So, what are the Lyme disease symptoms to look for? Heres what you need to know.
How To Prevent Post
While you may not be able to prevent post-treatment Lyme disease syndrome, you can take precautions to prevent coming into direct contact with infected ticks. The following practices can reduce your likelihood of getting Lyme disease and developing persistent symptoms.
If a tick bites you, contact your doctor. You should be observed for 30 days for signs of Lyme disease. You should also learn the signs of early Lyme disease and seek prompt treatment if you think youre infected. Early antibiotic intervention may reduce your risk of developing chronic symptoms.
The signs of early Lyme disease can occur from 3 to 30 days after a bite from an infected tick. Look for:
- a red, expanding bulls-eye rash at the site of the tick bite
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Lyme Disease Surveillance In Canada
Lyme disease became a national notifiable disease in December 2009.
Canada continues to monitor the evolving geographic distribution and prevalence of infected ticks and cases of Lyme disease. Therefore, you must report clinically diagnosed or laboratory-confirmed cases to your provincial or territorial public health authorities.
Health professionals in Canada play a critical role in identifying and reporting cases of Lyme disease. See the surveillance section for more information on surveillance in Canada.
Consult the national case definition for additional information.
Considerations While On Treatment
Antibiotics can wipe out beneficial intestinal flora, leading to a wide variety of additional health problems. It is important to take probiotics while on antibiotics to maintain a healthy balance of gut bacteria. Furthermore, antibiotics may interact with other drugs, supplements or food. The National Institutes of Healths MedLinePlus website gives information about drug interactions.
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When Should You See A Doctor If You Think You Have Lyme
The rash is a pretty good indication that you may have been bitten. Take a photo of the rash and see your doctor. At this stage, treatment with antibiotics will probably work.
If you don’t have the rash but have symptoms like fatigue, fever, and headache but no respiratory symptoms like a cough, you may want to talk to your doctor.
Persistent Symptoms Following Treatment
In most cases, timely treatment according to the appropriate regimen described in the chart above is effective. However, some Lyme disease patients have persistent symptoms following treatment. Research continues into the causes and methods of treatment.
There is no definitive evidence that persistent symptoms represent ongoing infection. Post-infectious inflammation due to damage from the infectious process may respond to anti-inflammatory drugs.
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Stage : Early Disseminated Lyme Disease
Early disseminated Lyme disease occurs several weeks to months after the tick bite.
Youll have a general feeling of being unwell, and a rash may appear in areas other than the tick bite.
This stage of the disease is primarily characterized by evidence of systemic infection, which means infection has spread throughout the body, including to other organs.
Symptoms can include:
- disturbances in heart rhythm, which can be caused by Lyme carditis
- neurologic conditions, such as numbness, tingling, facial and cranial nerve palsies, and meningitis
The symptoms of stages 1 and 2 can overlap.
Treatment For Other Forms Of Lyme Disease
People with other forms of disseminated Lyme disease may require longer courses of antibiotics or intravenous treatment with antibiotics such as ceftriaxone. For more information about treating other forms of Lyme disease, see:
The National Institutes of Health has funded several studies on the treatment of Lyme disease that show most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue and myalgia can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome , although it is also sometimes called chronic Lyme disease. For details on research into chronic Lyme disease and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.
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What Do The Results Mean
The Centers for Disease Control and Prevention recommends a two-test process of your sample:
- If your first test result is negative for Lyme disease, you don’t need any more testing.
- If your first result is positive for Lyme disease, your blood will get a second test.
- If both results are positive for Lyme disease and you also have symptoms of infection, you probably have Lyme disease.
Positive results don’t always mean a Lyme disease diagnosis. In some cases, you can have a positive result but not have an infection. Positive results may also mean you have an autoimmune disease, such as lupus or rheumatoid arthritis.
If your lumbar puncture results are positive, it may mean you have Lyme disease, but you might need more tests to confirm a diagnosis.
If your health care provider thinks you have Lyme disease, he or she will prescribe antibiotic treatment. Most people who are treated with antibiotics in the early stage of disease will make a complete recovery.
How Can You Tell If You Have Lyme Disease Or Something Else
Lyme disease can be tricky to diagnose, given that the symptoms can mimic those of other illnesses, says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. If you have the classic rash, you can probably assume you have Lyme disease, Dr. Russo says. But not all symptoms are classic and Lyme disease can mimic a variety of other things.
Still, your doctor can order blood tests, including an enzyme-linked immunosorbent assay test to look for antibodies to B. burgdorferi in your blood, the Mayo Clinic says. Another blood test, called a Western blot test, is usually given to confirm the diagnosis, per the Mayo Clinic.
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