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Diagnostic Procedures For Lyme Disease

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Can Infection Be Spread Directly From One Dog To Another Dog Or From My Dog To My Family

Lyme Disease Tests For Diagnosis

Direct spread of Lyme disease from one dog to another dog has not been reported, even when infected and uninfected dogs have lived together for long periods.

Spread of Lyme disease from dogs to people has not been reported either, but people are equally at risk for Lyme disease if they are bitten by an infected tick.

Early Localized Lyme Disease

Early localized Lyme disease usually presents as an acute illness characterized by:

  • fever
  • headache
  • the presence of a single, localized skin lesion known as erythema migrans

Not all patients will present with an EM. Therefore, diagnosis should not be based solely on the presence of EM.

Most patients will present with EMs within 7 days of the initial tick bite. However, the incubation period can vary between 3 and 30 days.

The skin lesion is characteristically an annular erythematous lesion greater than 5 cm in diameter that:

  • slowly increases in size
  • is usually painless and non-pruritic

The lesion sometimes develops central clearing, but it can be more homogenously erythematous. In dark-skinned patients, the rash may appear more as a bruise.

Variations of an EM are highly suggestive of Lyme disease and can take the following forms:

  • blistering
  • blue-purple hues
  • a bull’s-eye appearance

A skin lesion called erythema migrans can develop into a bull’s-eye at the site of a tick bite. It is shown here on a patient’s upper arm.Footnote 1

A typical sign of early non-disseminated Lyme disease is an expanding rash called erythema migrans. This can take on the appearance of a bull’s eye.Footnote 1

Some Lyme disease skin lesions are uniformly red and do not appear with the classic ring.Footnote 1

Some patients present with a central blistering lesion, commonly mistaken as a spider bite. This is likely due to an inflammatory reaction to the pathogen induced by the tick.Footnote 1

  • fatigue

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.

Read Also: Lyme Disease And Neurological Problems

Polymerase Chain Reaction May Help In Some Situations

Molecular assays are not part of the standard evaluation and should be used only in conjunction with serologic testing. These tests have high specificity but lack consistent sensitivity.

That said, PCR testing may be useful:

  • In early infection, before antibody responses develop

  • In reinfection, when serologic tests are not reliable because the antibodies persist for many years after an infection in many patients

  • In endemic areas where serologic testing has high false-positive rates due to high baseline population seropositivity for anti-Borrelia antibodies caused by subclinical infection.

PCR assays that target plasmid-borne genes encoding outer surface proteins A and C and VisE are more sensitive than those that detect chromosomal 16s ribosomal ribonucleic acid genes, as plasmid-rich blebs are shed in larger concentrations than chromosomal DNA during active infection. However, these plasmid-contained genes persist in body tissues and fluids even after the infection is cleared, and their detection may not necessarily correlate with ongoing disease. Detection of chromosomal 16s rRNA genes is a better predictor of true organism viability.

The disadvantage of PCR is that a positive result does not always mean active infection, as the DNA of the dead microbe persists for several months even after successful treatment.

How Is Lyme Disease Diagnosed

Lyme Disease

Though several types of tests do exist for the diagnosis of Lyme disease, the best tests for a Lyme disease diagnosis are blood tests, also known as serological tests. These tests are indirect, meaning they dont detect the infecting bacteria or its antigens but rather the antibodies an infected persons body produces in response to these antigens.

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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.

Lyme Borreliosis: Disease Spectrum

Infection with B. burgdorferi sensu lato can result in dermatological, neurological, cardiac, and musculoskeletal disorders. The basic clinical spectra of the disease are similar worldwide, although differences in clinical manifestations between LB occurring in Europe and North America are well documented . Such differences are attributed to differences in B. burgdorferi sensu lato species causing LB on the two continents. Furthermore, differences in clinical presentations exist between regions of Europe, presumably due to differences in the rates of occurrence of infection caused by distinct B. burgdorferi sensu lato species .

Patients with B. burgdorferi sensu lato infection may experience one or more clinical syndromes of early or late LB. Usually, early infection consists of localized erythema migrans , which may be followed within days or weeks by clinical evidence of disseminated infection that may affect the skin, nervous system, heart, or joints and subsequently, within months, by late infection . Arthritis appears to be more frequent in North American patients , whereas lymphocytoma, acrodermatitis chronica atrophicans , and encephalomyelitis have been seen primarily in Europe .

While Lyme arthritis is the most common late manifestation of LB in North America, ACA appears to be the most common manifestation of late LB in Europe. As mentioned earlier, these differences are likely due to the different species causing LB in the two continents .

Read Also: Symptoms Of Lyme Flare Up

First Comes Igm Then Igg

The pathogenesis and the different stages of infection should inform laboratory testing in Lyme disease.

It is estimated that only 5% of infected ticks that bite people actually transmit their spirochetes to the human host. However, once infected, the patients innate immune system mounts a response that results in the classic erythema migrans rash at the bite site. A rash develops in only about 85% of patients who are infected and can appear at any time between 3 and 30 days, but most commonly after 7 days. Hence, a rash occurring within the first few hours of tick contact is not erythema migrans and does not indicate infection, but rather an early reaction to tick salivary antigens.

Antibody levels remain below the detection limits of currently available serologic tests in the first 7 days after exposure. Immunoglobulin M antibody titers peak between 8 and 14 days after tick contact, but IgM antibodies may never develop if the patient is started on early appropriate antimicrobial therapy.

If the infection is not treated, the spirochete may disseminate through the blood from the bite site to different tissues. Both cell-mediated and antibody-mediated immunity swing into action to kill the spirochetes at this stage. The IgM antibody response occurs in 1 to 2 weeks, followed by a robust IgG response in 2 to 4 weeks.

Because IgM can also cross-react with antigens other than those associated with B burgdorferi, the IgM test is less specific than the IgG test for Lyme disease.

Current Approach To Laboratory Testing For Lyme Disease

Making Sense of Lyme Disease Diagnostic Testing – Q& A

Serologic assays are the most frequently used and familiar tests for the laboratory diagnosis of Lyme disease. At present in the United States, all tests currently cleared for diagnostic use by the US Federal Drug Administration are serologic assays. The current guidelines for serologic testing were adopted in 1994 . The challenge to the 1994 Dearborn Conference participants was to develop testing and interpretive guidelines that would standardize serologic testing for diagnostic purposes. The guidelines are geared to assess exposure to B. burgdorferi through the patients antibody response to infection rather than direct detection of nucleic acid or protein from the microbe. The limitations of serologic testing and advances were recently reported in detail .

Recommended Reading: Which Ticks Give You Lyme Disease

Where Is Lyme Disease Found

In the United States, Lyme disease has been reported in every state, but over 95% of cases are from the Northeastern, Mid-Atlantic, and upper Midwestern states, with a small number of cases reported along the West Coast, especially Northern California. In Canada, Lyme-positive dogs are found mostly in southern Ontario and southern Manitoba, with a small number of cases in southern Quebec and the Maritime provinces.

Certain Infectious And Parasitic Diseasesincludes

  • diseases generally recognized as communicable or transmissible
    • certain localized infections – see body system-related chapters
    • carrier or suspected carrier of infectious disease
    • infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium
    • infectious and parasitic diseases specific to the perinatal period
    • influenza and other acute respiratory infections
    • code to identify resistance to antimicrobial drugs
    • 2016201720182019202020212022Non-Billable/Non-Specific Code

    Applicable To

  • Erythema chronicum migrans due to Borrelia burgdorferi
    • Erythema chronicum migrans
    • Lyme disease
  • Recurrent multisystemic infectious disease caused by a spirochete, borrelia burgdorferi, which is transmitted chiefly by ixodes ticks it is a disease with early and late cutaneous manifestations plus involvement of the nervous system, heart, eye, and joints in variable combinations.
    • 867 Other infectious and parasitic diseases diagnoses with mcc
    • 868 Other infectious and parasitic diseases diagnoses with cc
    • 869 Other infectious and parasitic diseases diagnoses without cc/mcc
    • : New code
    • 2017
    • 2016201720182019202020212022Billable/Specific Code

    Applicable To

      • 2016201720182019202020212022Billable/Specific Code

      Applicable To

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    Alleviate The Suffering Of Patients

    Lyme Diagnostics Ltd. is primarily focused on the more exact, routine diagnostics of Lyme disease, building on the innovative technologies developed by the diagnostic & therapeutic workgroup of the Lyme Borreliosis Foundation. We offer the results of 30 years of work by 8 medical professionals. Currently, our novel diagnostic methods are supplemented with laboratory-standard, widely-accepted diagnostic procedures, and carefully confirmed by clinical diagnosis. Our objective is that â after clinical testing â we will be able to offer one single screening method across Europe, and in North America.

    for GP’s

    Why It Is Done

    (PDF) Direct Diagnostic Tests for Lyme Disease

    A Lyme disease test is done to diagnose Lyme disease in people who have symptoms of Lyme disease. Symptoms may include:

    • An expanding red rash with a pale centre. This is sometimes called a “bull’s eye” rash.
    • Extreme tiredness.
    • Headache and stiff neck.
    • Muscle and joint pain.

    Symptoms of chronic Lyme disease infection include joint pain, stiffness, and problems with the heart, brain, or nerves.

    Testing is most accurate when you have risk factors for Lyme disease or symptoms of the disease.

    Recommended Reading: How Do You Treat Lyme Disease In Dogs

    Interpreting The Igm Western Blot Test: The 1

    If clinical symptoms and signs of Lyme disease have been present for more than 1 month, IgM reactivity alone should not be used to support the diagnosis, in view of the likelihood of a false-positive test result in this situation. This is called the 1-month rule in the diagnosis of Lyme disease.

    In early localized infection, Western blot is only half as sensitive as ELISA testing. Since the overall sensitivity of a 2-step algorithm is equal to that of its least sensitive component, 2-tiered testing is not useful in early disease.

    Although currently considered the most specific test for confirmation of Lyme disease, Western blot has limitations. It is technically and interpretively complex and is thus not universally available. The blots are scored by visual examination, compromising the reproducibility of the test, although densitometric blot analysis techniques and automated scanning and scoring attempt to address some of these limitations. Like the ELISA, Western blot can have false-positive results in healthy individuals without tick exposure, as nonspecific IgM immunoblots develop faint bands. This is because of cross-reaction between B burgdorferi antigens and antigens from other microorganisms. Around 50% of healthy adults show low-level serum IgG reactivity against the FlaB antigen, leading to false-positive results as well. In cases in which the Western blot result is indeterminate, other etiologies must be considered.

    Diagnosis Of Lyme Disease

    DANIEL L. DEPIETROPAOLO, M.D., Christiana Care Health Services, Wilmington, Delaware

    JOHN H. POWERS, M.D., National Institutes of Health, Bethesda, Maryland

    JAMES M. GILL, M.D., M.P.H., and ANDREW J. FOY, Christiana Care Health Services, Wilmington, Delaware

    Am Fam Physician. 2005 Jul 15 72:297-304.

    Patient information: See related handout about Lyme disease, written by the authors of this article.

    Lyme disease is a systemic illness resulting from infection with the spirochete Borrelia burgdorferi.1 According to the Centers for Disease Control and Prevention definition for reportable cases of Lyme disease, the annual number of cases increased from 7,943 in 1990 to 17,730 in 2000.2,3 The disease is most prevalent in children two to 15 years of age and in adults 30 to 59 years of age.3Figure 14 shows the endemicity of Lyme disease in areas of the United States.


    Physicians should assess the pretest probability of a patient with suspected Lyme disease on the basis of clinical signs and symptoms and the likelihood of exposure.

    A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 209 or.


    Figure 1.

    Figure 1.

    Recommended Reading: Can You Live With Lyme Disease

    Limitations Of Serologic Tests For Lyme Disease

    Currently available serologic tests have inherent limitations:

    • Antibodies against B burgdorferi take at least 1 week to develop

    • The background rate of seropositivity in endemic areas can be up to 4%, affecting the utility of a positive test result

    • Serologic tests cannot be used as tests of cure because antibodies can persist for months to years even after appropriate antimicrobial therapy and cure of disease thus, a positive serologic result could represent active infection or remote exposure

    • Antibodies can cross-react with related bacteria, including other borrelial or treponemal spirochetes

    • False-positive serologic test results can also occur in association with other medical conditions such as polyclonal gammopathies and systemic lupus erythematosus.

    Direct Methods For Detection Of B Burgdorferi

    Lyme Disease: Best Test for Diagnosis

    Laboratory tests for direct detection of B. burgdorferi are hampered by very low numbers of spirochetes in the majority of clinical samples. The lack of sensitive, relatively easy, fast, direct tests for the presence of B. burgdorferi is one of the main challenges in the laboratory diagnosis of Lyme disease. While direct tests for B. burgdorferi can sometimes be helpful, none are required for the diagnosis of the disease. The main direct test modalities used are culture and PCR. Histopathology has limited utility, being used mostly to exclude other diseases, and in the evaluation of suspected cases of borrelial lymphocytoma and acrodermatitis chronica atrophicans,. Detection of B. burgdorferi is difficult and time-consuming due to the extreme scarcity of organismsâ. Warthin-Starry and modified Dieterle silver stains, focus-floating microscopy, as well as direct and indirect immunofluorescence assays with anti-borrelial antibodies have been used, but can be difficult to interpret and require special expertise and careful use of controlsâ. At present, no antigen assays are recommended for the diagnosis of Lyme disease. A research test for detection of OspA has been used in cerebrospinal fluid. An assay to detect antigens in urine has been shown to be unreliable.

    Also Check: How To Know If I Have Lyme Disease

    Getting Tested For Lyme Disease

    Lyme disease testing is usually ordered by a doctor and is used when there are signs or symptoms consistent with Lyme disease.

    A blood sample can be drawn in a doctors office or other medical setting. If a test of cerebrospinal fluid is needed, an outpatient procedure called a lumbar puncture can be done in a hospital. Samples are then analyzed in a credentialed laboratory.

    What To Think About

    • It may be hard to tell if you have Lyme disease. False-positive and false-negative Lyme disease test results are common. Many people do not make antibodies to Lyme disease bacteria for up to 8 weeks after being infected.
    • Doctors often do not rely on test results alone when recommending treatment for a person who may have Lyme disease. Treatment is often based on a person’s symptoms, the time of year, having a tick bite, and other risk factors for Lyme disease.

    Read Also: Lyme Disease Breakthrough At Mayo Clinic

    Physicians Knowledge Of Ld Clinical Signs

    There were 495 people bitten by I. scapularis ticks that were infected with B. burgdorferi. The data on clinical information collected by a questionnaire administered to the GPs were available for 254 patients . Of these, 66 were diagnosed as having LD by their physician and these included 54 who were diagnosed with EM . Twenty-one persons were reported to have manifestations of disseminated clinical signs of LD by their GPs with seven cases of neurological involvement, ten cases of musculoskeletal involvement, two case of cardiac involvement and two with both neurological and musculoskeletal manifestations .

    Fig. 1

    Frequency of clinical manifestations reported by GPs for patients bitten by infected I. scapularis

    However, 27/43 of these 54 persons for which the information was available had skin lesions diagnosed as EM even though they occurred less than 5 days from the date of tick bite and as a result were likely hypersensitivity reactions and not EM . Indeed, 44% of EM lesions were diagnosed at the time of tick-removal while 9% of EM were diagnosed beyond 1 month post infection .

    Fig. 2

    Frequency of EM diagnoses in relation to time elapsed between diagnosis of EM and the date of tick removal. The black bar shows the frequency of reported EM cases that were considered to be misdiagnosed

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