Understanding Of Lab Tests Results
Please visit the page about lyme disease on the site associated with The American Association for Clinical Chemistry for better understanding of tests. There you will find the most detailed and full information regarding lab tests. In “common questions” tab you will find answers on the most common questions.
In addition, you can use a special form to ask the question. It is useful, if there is no answer on your question on the web site. A laboratory scientist will answer your question. It is a part of voluntary service provided by the American Society for Clinical Laboratory Science.
Newer Immunoblot Using Synthetic Proteins From Igenex: Grade A
In an immunoblot using synthetic proteins grown in bacteria through recombinant dna, only the protein regions specific for Lyme on protein 31, 41, and 93 are grown. This decreases the chances of a false positive testing which I outlined above in the western blot section. In this method, like the western blot above, attention is still paid to certain Lyme specific proteins.
IGenex goes one step further in its new Lyme Immunoblot test and uses 8 different strains of Lyme proteins. These include: B. burgdorferi B31, B. burgdorferi 297, B. californiensis, B. mayonii, B. spielmanii, B. afzelii, B. garinii and B. valaisiana.
Using internal validation standards, an IGM Immunoblot is positive if there are antibodies attached to 2 of the following four proteins: 23, 31, 39, and 41. The IGG Immunoblot is positive if there are antibodies attached to 2 of the following 6 proteins: 23, 31, 34, 39, and 41.
Based on internal validation studies, IGenex reports the tests has a sensitivity of 90.9% and a specificity of 98%. This means this is by far the best test at finding Lyme with a very limited chance of false positives.
Grade: A-. The only reason I do not give this test an A grade is that it still misses 9% of Lyme. This can occur for a variety of reasons including immune suppression making it difficult to make antibodies or due to Lyme hiding where the immune system cannot see the germ.
So When Do You Need Blood Tests For Lyme Disease
In some cases, you can have Lyme disease without the rash. Or you may not see the rash before it goes away on its own.
In these cases, your doctor should ask you about your medical history and do a thorough physical exam. Your doctor should look for these signs that you might have Lyme disease:
- You were in an area with ticks and Lyme disease.
- You also have fever or redness, warmth, and swelling in one or a few joints at a time usually the knees, shoulders, or wrists.
Other symptoms can occur later on. Talk to your doctor about testing and treatment choices.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
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Who Should Get Testing
Testing is usually indicated if a person has symptoms of Lyme disease and a known or possible exposure to ticks that can carry the Borrelia bacteria. However, because it takes time for antibodies to develop, the timing of testing is important to consider.
Lyme disease symptoms depend on the extent of the bacterial infection. Three phases are used to describe the infection:
It is important to understand these phases because testing is not equally valuable in each stage. With early localized disease and erythema migrans, blood testing is generally not helpful because antibodies have not had enough time to develop.
Because of similar concerns about potential false positive results, random screening for Lyme disease in people without symptoms is not recommended even in areas that are known to have ticks that can carry the Borrelia bacteria.
What Is The Most Accurate Test For Lyme Disease
Lyme disease is more common than many people think. Figures from the Center for Disease Control suggest that roughly 300,000 Lyme disease cases occur every year in the US.
The numbers are alarming, but it gets worse as finding accurate diagnostic tests can be challenging. Although the disease is treatable, it is nearly impossible to tackle it effectively if it is not diagnosed accurately and early enough.
Late detection can lead to severe health problems such as arthritis, heart blockage, and inability to concentrate, among other problems.
Given the prevalence and seeming elusiveness of the disease, some of the logical questions concerned persons would ask are: what is the most accurate test for Lyme disease? And when should I get checked for Lyme disease? This article will proffer answers to these and many other related questions. But first, a little background would be in order.
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There Are Many Types Of Lyme Tests
There are a variety of tests that can help diagnose Lyme disease by finding evidence of Lyme infection. These include ELISA, IFA, PCR, immunoblot done as a western blot, the new immunoblot with synthetic proteins, Elispot, and blood culture. Although these tests are helpful aids they are far from perfect. In this article I review each of these tests and give them a grade. With these grades in mind, I describe the way I use these tests to help decide if someone has Lyme disease.
At the end of the article I tell you what I think the best Lyme test is and why.
As you read about the tests, note that a test does not diagnose a disease. In my Seattle practice I, I did not treat a test I treated a person. Tests can be wrong. To make a diagnosis consider
- the risks of getting the infection like having a known tick bite, or a history of hiking where there are a lot of ticks that carry Lyme like in Minnesota, or a number of other risk factors,
- the symptoms,
- physical exam findings, and
- whether there is supportive testing.
Note that I said supportive testing. So the result of testing is only one part to consider in making a diagnosis. See How to Diagnose Chronic Lyme Disease. More Than A Test. for more information about this complex issue.
Lyme Disease Western Blot Test
The Lyme Disease Western Blot test is typically used as a confirmatory test for people who have had positive results from previous Lyme Disease testing. The immunoblot test is also known as a Lyme Disease Line Blot test. This test looks for the presence of both IgG and IgM antigen bands to confirm both recent and previous exposure. The detection of multiple bands is required for a positive result. The CDC does not recommend the Western Blot test as a front-line screening as some conditions other than Lyme Disease may cause a false positive.
Lyme Disease is caused by infection with the bacteria Borrelia burgdorferi. It is most commonly spread by the Deer Tick or Black Legged Tick and is the most common tick-borne illness in the United States and Europe. Lyme disease can be difficult to diagnose because the symptoms are often similar to other afflictions. While some people will display a distinctive “bulls-eye” rash around the site of the bite, others may experience common flu-like symptoms such as fever, chills, fatigue, and headache. The ticks which spread the disease are typically very small and many people do not even realize they have been bitten. If left untreated, Lyme Disease can cause joint pain, numbness in the arms and legs, facial paralysis, Meningitis, heart problems, or memory problems.
Turnaround time for the Lyme Disease Western Blot test is typically 2-5 business days.
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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 . 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 cant detect, they will get a false-negative test result and thus risk missing their diagnosis. This can be costly and dangerous.
Many ELISA and Western blot Lyme disease tests are only equipped to detect one strain of one species of Borrelia: Borrelia burgdorferi B31 . This means that those tests are missing infections caused by other strains and/or species of Lyme borreliae.
In one internal study designed to test the validity of the IGeneX ImmunoBlot against traditional Western blot tests, a total of 132 patients were tested by both Lyme Western blots and Lyme IB. 43 patients were seropositive on the ImmunoBlot, and 14 were positive on standard Western blots prepared from a mixture of two species for Bb ss B31 and 297. Thus 29 of the 43 patients tested negative on Western blots i.e., the Western blot totally missed their infections with strains other than Bb ss B31 and 297.
With such limited tests, patients infected with non-B31 species and strains e.g., B. mayonii, B. californiensis, or European species are at risk of receiving false negatives and missing the chance to treat their diseases.
High Endemicity Screening Of A Child
A healthy child from an area of high endemicity receives an annual physical. The mother notes that the child enjoys playing in the backyard, which is adjacent to a heavily wooded area.
Serologic testing should not be ordered because the child is asymptomatic. A false-positive test result would expose the child unnecessarily to the risks of treatment. In this scenario, the probability that a positive test represents true infection is less than 25 percent.
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What Is Lyme Disease
Lyme disease is a bacterial infection caused by the bacteria Borrelia burgdorferi. It is spread to humans through the bite of a carrier black-legged tick or deer tick. The disease causes flu-like symptoms and rashes.
While most people with Lyme disease can recover completely, provided they get early diagnosis and treatment, the symptoms can reoccur in some people later in the future. For this reason, it is important to test for Lyme disease years later, especially if you have developed syndromes after the disease was treated.
Avoid Unnecessary And Unscientific Testing
As part of the admirable Choosing Wisely campaign to reduce unnecessary tests and treatments, the American College of Rheumatology warns:
Dont test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.
The CDC , French Society of Internal Medicine, and other experts around the world have expressed similar sentiments to the ACR.
Experts also warn against unvalidated testing . Quackwatch and Science-Based Medicine both provide accessible explanations about the differences between validated and unvalidated tests.
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Testing And Diagnosing Coinfections And Related Microbes
There are quite a few microbes spread by blood-sucking insects that have stealth characteristics similar to those of Borrelia burgdorferi some we know about, and others still waiting to be discovered.
They all have stealth characteristics and the ability to infect and thrive inside cells. They are masters of evading the immune system, and can be even harder to diagnose than borrelia. Symptoms profiles are similar to borrelia and related mostly to stimulation of cytokine cascades, not concentrations of microbes. Though they each have slightly different strategies, their motive is the same: complete a lifecycle stage within the host and move on.
The primary known players in chronic Lyme include mycoplasma, bartonella, and chlamydia species. The most well-known species of babesia, anaplasma, ehrlichia, and rickettsia are more apt to cause acute illness and less apt to be associated with chronic illness, but research is discovering lesser known and lesser virulent species of these microbes that are associated with chronic Lyme. Reactivation of herpes-type viruses is common in chronic Lyme.
Though testing is possible for some species of these microbes, when a natural route of recovery is chosen, extensive testing is not necessary and can actually be very misleading.
The Role Of Lyme Disease Tests
The purpose of the most common type of Lyme disease testing is to determine whether you have developed antibodies as a result of past exposure to the Borrelia bacteria that cause Lyme disease. Antibodies are proteins created by the immune system that target specific threats like bacteria and viruses.
Blood testing alone cannot determine whether you have Lyme disease. Instead, testing can provide helpful information that your doctor can consider along with other factors, such as any symptoms youve had and whether youve been exposed to ticks that can carry Borrelia, to determine if a diagnosis of Lyme disease is appropriate.
Beyond blood testing, it is possible to analyze fluid from the central nervous system for signs of the Borrelia bacteria.
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What Happens During Lyme Disease Testing
Lyme disease testing is usually done with your blood or cerebrospinal fluid.
For a Lyme disease blood test:
- A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
If you have symptoms of Lyme disease affecting your nervous system, such as neck stiffness and numbness in hands or feet, you may need a test of cerebrospinal fluid . CSF is a clear liquid found in your brain and spinal cord. During this test, your CSF will be collected through a procedure called a lumbar puncture, also known as a spinal tap. During the procedure:
Common Types Of Testing For Microbes
Testing is getting better, and there are a variety of different ways to test, but none of them are anywhere near 100% accurate. Testing is mostly useful for diagnosing acute illness. This is especially true when symptoms of illness suggest infection with a higher virulence microbe that might respond to acute treatment with antibiotics. New innovations may gradually improve testing for chronic illness associated with stealth microbes.
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How Much Does The Lyme Disease Test Cost
Lyme disease test cost ranges between $91 and $159 in different labs and facilities across the U.S. No prior appointment is required. Compare the price, order your test online and visit the nearest lab during lab business hours. Complete the procedure and get the results in your email in 2 to 3 business days. Doctor consultation is also available for further treatment or any kind of medical advice.
The following table shows the Lyme test cost at 3 of our partner laboratories network located across the U.S.
Serologic Testing For Lyme Disease
William G. Finn, MDMedical Director, Warde Medical Laboratory
We frequently receive calls regarding recommendations for Lyme disease testing. Due to recent minor changes to our Lyme disease test menu, we are taking this opportunity to clarify recommended approaches for the serologic evaluation of patients suspected to have Lyme disease.
Lyme disease is the clinical syndrome caused by infection with the bacterial spirochete Borrelia burgdorferi. Infection by B. burgdorferi is transmitted via the North American deer tick . In its initial phase, Lyme disease typically is characterized by a distinct pattern of rash known as erythema migrans .
The incubation period between initial exposure and onset of EM varies considerably, but typically is about one to two weeks. In the acute phase of infection, the rash may be accompanied by systemic symptoms such as fever, joint and muscle pain, generalized weakness or fatigue, and enlarged lymph nodes. If left untreated, Lyme disease may progress beyond the initial localized cutaneous phase into disseminated phases of disease.
|muscle and joint pain, headache, fatigue Regional||fatigue|
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Catch It Early And Treat It
While its tempting to wait for symptoms, studies show the longer you wait, the harder itll be to get rid of the bug. Think of the Borrelia burdorferi as a burrowing little critter who likes to hide. The more time you give it, the longer itll take to hunt it down.
As months go by, the cork-screw shape bacteria will worm its way from bloodstream to joints and bones and even nerves.
Most horses that are infected, dont show it, said Dr. Sandra Bushmich, CVMDL director, who noted that Western Blot detects antibodies about a month after the suspected infection If you treat it right then, you have a pretty good chance of getting rid of the infection.
When youre finished with treatment, you still may not be out of the woods. Some vets recommended retesting. Bushmichs lab stores
Consider using Ranger Ready, which contains picaridin and can be used on horses AND humans
results so clients can monitor recovery, response to treatment, and potential reinfection.
Flaherty, of Maine Equine Associates, doesnt retest.
Even though you wont see improvement with antibody levels, the horse will be better after treatment, said Flaherty. Owners get confused by the lack of correlation between numbers and symptoms.
Reilly just does another in-stall SNAP test to check horses response to treatment.