Laboratory Tests That Are Not Recommended
Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established. Examples of unvalidated tests include:
- Capture assays for antigens in urine
- Culture, immunofluorescence staining, or cell sorting of cell wall-deficient or cystic forms of B. burgdorferi
- Lymphocyte transformation tests
- In-house criteria for interpretation of immunoblots
- Measurements of antibodies in joint fluid
- IgM or IgG tests without a previous ELISA/EIA/IFA
When You May Need To See A Specialist
Though a family physician or general practitioner should be able to order the diagnostic tests for Lyme disease, there are some situations in which you may need to see a specialist. For example, untreated or misdiagnosed Lyme can develop into chronic Lyme disease, which can then lead to complications such as arthritic or neurological symptoms. In these cases, patients may need to see the following types of specialists:
- Rheumatologist Chronic joint problems from Lyme disease may need the care of a physician who specializes in rheumatology.
- Neurologist Chronic Lyme can be associated with debilitating neurological symptoms that must be treated by a specialist.
- Infectious disease specialist Again, even though this isnt always necessary, it can be helpful if your symptoms dont go away or become more complex.
- Cardiologist In the event that you develop the rare but dangerous complication known as Lyme carditis, you may need to see a cardiologist and even be fitted with a temporary pacemaker.
However, its important to remember that seeing a specialist for symptoms related to Lyme disease without treating Lyme disease is costly and dangerous. In other words, a rheumatologist or neurologist will not be able to treat your Lyme if no diagnosis has been made. They can simply help treat symptoms that result from chronic or untreated Lyme.
To treat Lyme disease, you must get an accurate diagnosis and be prescribed antibiotics.
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Do All Ticks Carry Lyme Disease
Most people who get tick bites do not get Lyme disease. Not all ticks are infected, and the risk for contracting the disease increases the longer the tick is attached to the body. Within one to four weeks of being bitten by an infected tick, most people will experience some symptoms of Lyme disease.
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Lyme Disease Laboratory Tests Available At Ripl
The primary service provided by RIPL is serological testing using well-characterised and validated screening and confirmatory tests in accordance with the NICE Lyme disease guideline.
RIPL participates in regular external quality assurance exercises as an independent measure of its performance.
Details of prices and turnaround times for Lyme testing are provided in Appendix 1 of the RIPL user manual.
What Is Lyme Disease How Does My Dog Get Infected
Lyme disease is an infectious disease caused by bacteria called Borrelia. The bacteria are most commonly carried by the deer tick . Infection occurs when a dog is bitten by an infected tick. It appears that the disease is not transmitted until the tick has fed for approximately 12 hours. The tick itself becomes infected by feeding on infected mice, birds, deer, and other animals.
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What Abnormal Results Mean
A positive ELISA result is abnormal. This means antibodies were seen in your blood sample. But, this does not confirm a diagnosis of Lyme disease. A positive ELISA result must be followed up with a Western blot test. Only a positive Western blot test can confirm the diagnosis of Lyme disease.
For many people, the ELISA test remains positive, even after they have been treated for Lyme disease and no longer have symptoms.
A positive ELISA test may also occur with certain diseases not related to Lyme disease, such as rheumatoid arthritis.
What Do Testing Kits Typically Include
Depending on the method of collection, testing kits may include:
- a device to collect the blood, urine, or saliva sample
- instructions
- a container to ship the sample back to the lab
- a shipping label
Some kits come with a bandage, wipes, and a biohazard bag. Kits may contain extras such as Styrofoam holders, labels, or tubes with varying solutions inside.
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Other Lyme Disease Tests
Three other tests that may be used to diagnose Lyme disease are polymerase chain reaction , antigen detection and culture testing. They are called direct tests because they detect the bacteria, not just your immune response to it.
PCR multiplies a key portion of DNA from the Lyme bacteria so that it can be detected. While PCR is highly accurate when the Lyme DNA is detected, it produces many false negatives. This is because the Lyme bacteria are sparse and may not be in the sample tested.
Antigen detection tests look for a unique Lyme protein in fluid . Sometimes people whose indirect tests are negative are positive on this test.
Culture is the gold standard test for identifying bacteria. The lab takes a sample of blood or other fluid from the patient and attempts to grow Lyme spirochetes in a special medium.
Although culture tests are generally accepted as proof of infection, the CDC has advised caution on the only commercially available culture test developed by Advanced Laboratory Services. LDo recognizes that the test is new and requires further validation in other studies. However, we believe that informed patients should be able to choose the test if they prefer. Choice is particularly important given the low quality of Lyme disease tests generally.
The Blood Tests Can Have False Positives
The blood tests can trigger false positives, suggesting that you have the disease when you really dont. This can happen in up to one out of four tests.
This can lead to unnecessary treatment with antibiotics. These drugs are usually safe, but they sometimes cause side effects, such as nausea, vomiting, diarrhea, and increased sensitivity of the skin to sunlight. In rare cases, they can even cause dangerous allergic reactions.
Using too many antibiotics can also lead to the growth of drug-resistant bacteria. This means that bacteria in your body may get stronger and more difficult to treat with antibiotics in the future.
A false positive can also lead to more unneeded blood tests, urine tests, X-rays, and doctor visits.
If you have a false positive, you may not get treated for the real cause of your pain. For example, rheumatoid arthritis is a disease that causes joint pain. It can lead to permanent and severe joint damage if you do not start taking the right medicines as early as possible.
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What Are The 3 Stages Of Lyme Disease
Although Lyme disease is commonly divided into three stages early localized, early disseminated, and late disseminated symptoms can overlap. Some people will also present in a later stage of disease without having symptoms of earlier disease.
Where Can I Get A Tick Tested For Lyme Disease
Where can i get a tick tested for lyme diseasePeople can have an impaired immune system from an overactive and underactive immune response. A strong immune system responds appropriately to the challenge a weak immune.
Diagnosing and treating a tick-borne disease can be highly complex. Having a doctor who is trained and experienced in caring for patients with these illnesses can help ensure that you achieve the best possible health outcome. Luckily, there is a growing number of Lyme disease experts who can provide diagnostic testing and proper treatment for Lyme and other tick-borne.
People who have removed a tick sometimes wonder if they should have it tested for evidence of infection. Although some commercial groups offer testing, in general this is not recommended because: Laboratories that conduct tick testing are not required to have the high standards of quality control used by clinical diagnostic laboratories.
If no clinical signs of Lyme disease are observed, different approaches can be tried: A different antibiotic can be used, treatment time can be extended, or the animal is not treated again but its antibody status is monitored every 6-12 months .
Lyme disease cant be transmitted from one pet to another, nor from pets to humans, except through tick bites. However, a carrier tick could come into your house on your dogs fur and get on you.
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How Can I Tell If Treatment Is Working
If joint lameness is the presenting sign, improvement may be noted after 3-5 days starting antibiotics. A dog’s response to therapy can be assessed by repeating the QC6 test six months after treatment is complete. Dogs that start with a moderate to high QC6 value typically show a 50% reduction or more in the QC6 at six months, indicating that treatment has been successful. Dogs that have a lower initial QC6 value may not show such dramatic reductions in the QC6 at six months, although the value should still be lower than the starting point if treatment has been successful.
A persistently high QC6 suggests treatment may not have been complete or that the dog became reinfected after treatment was stopped.
The Most Common Lyme Disease Blood Tests
The two most common diagnostic tests for Lyme disease are the enzyme-linked immunosorbent assay and the Western blot. These Lyme disease tests allow physicians to visualize the reaction between antibodies in an infected persons blood to specific antigens or parts of the bacteria that cause Lyme disease.
In the case of the Western blot, for example, antigens are separated by size and then transferred onto a membrane strip. When an antibody reacts with an antigen on the strip, that band will turn dark purple. For test results to be positive, a specific combination of bands on the membrane strip must be present.
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How Is It Diagnosed
If youâve been outside in an area where ticks are known to live, you should tell your doctor. Theyâll also want to know about the symptoms youâre having. These details are crucial to making a diagnosis of Lyme disease.
Early symptoms that usually occur within the first month after a tick bite can include:
- Rash at the site of the tick bite that may look like a âbullâs-eyeâ
- Racing heart
- Problems with your short-term memory
Symptoms that come and go are common with Lyme disease. They will also depend on the stage of the disease.
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.
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What Is The Most Accurate Test For Lyme Disease
These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include: Enzyme-linked immunosorbent assay test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi.
Letsgetchecked Lyme Infection Test
LetsGetCheckeds kit tests for Borellia IgG and IgM antibodies through a fingerprick collection. The website states people should receive the test 57 days after ordering.
The company requires individuals to activate the kit, so they can collect the sample and send it back using the prepaid shipping label. They can then access their results on their online account within 25 days.
In addition, LetsGetCheckeds laboratories have a certification, meaning they are compliant with federal certifications.
This Lyme disease test costs $119 and comes with free shipping.
Pros and cons
The LetsGetChecked Lyme Infection Test features the following advantages:
- There is a nursing team available to discuss results.
- The company offers free shipping.
- People can pay through a health savings account or a flexible spending account .
However, the company also has some disadvantages. Firstly, its single-test kits can be expensive. Additionally, shipping is not available to all countries.
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Testing For Lyme Disease: Follow The Steps
Barbara J.B. Johnson, PhD
Hello, I am Dr. Barbara Johnson. I am a microbiologist with the Centers for Disease Control and Prevention, and I am pleased to speak with you today as part of the on Medscape about serologic testing for Lyme disease. Serology is currently the only type of diagnostic test for Lyme disease approved by the US Food and Drug Administration.
Serologic tests are designed to detect antibodies that the immune system makes in response to an infectious organism, in this case the spirochete Borrelia burgdorferi. Before testing a patient for Lyme disease, it is important to consider the likelihood that a patient is infected. Factors to consider are:
-
Symptoms: Does the patient have signs and symptoms consistent with the disease?
-
Geography: Has the patient been in an area where the disease occurs?
-
Behaviors: Does the patient have risk factors for exposure to ticks?
When testing for antibodies for Lyme disease, CDC recommends a 2-step testing process. In the first step, serum is tested using a highly sensitive but inadequately specific quantitative assay, most commonly an enzyme immunoassay, such as an ELISA. If this first test is negative, no further testing is indicated. If the first test is positive or indeterminate , a second-step test should be performed.
Two important caveats:
For more information about Lyme disease, the geographic areas of risk, and appropriate laboratory testing procedures, please consult the CDC Website list below. Thank you.
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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How Is Lyme Disease Diagnosed
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.
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.
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What To Do If You Find A Tick
If you see a tick, try to remove it from your childs body. If the tick was on the body for less than 36 hours, it may help prevent infection.
To safely remove a tick:
- Use fine-tipped tweezers to grasp the tick at its head or mouth, close to the skin.
- Pull firmly on the tick until it releases the skin. Try to ease out any parts that get stuck in the skin.
- Wash the bite area with rubbing alcohol or soap and water and apply an antiseptic lotion or cream.
Access To Lyme Disease Testing Services
This guidance on the laboratory diagnosis of Lyme disease is intended for healthcare professionals in the UK. Patients concerned about possible Lyme infection should consult an appropriate healthcare professional, for example their GP, in the first instance.
Health professionals wishing to discuss a possible case or ascertain local arrangements for testing should contact a local Infection specialist .
NHS testing for Lyme disease is available through local service providers and the Rare and Imported Pathogens Laboratory at PHE Porton where ISO15189 accredited confirmatory testing is also provided. RIPL is also introducing a testing service for neurological Lyme disease.
RIPL provides medical and laboratory specialist services to the NHS and other healthcare providers, covering advice and diagnosis of a wide range of unusual bacterial and viral infections, including Lyme disease.
RIPL continuously updates its methods and will make further information on Lyme disease diagnostic testing available as it arises.
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Notice To Readersrecommendations For Test Performance And Interpretation From Thesecond National Conference On Serologic Diagnosis Of Lyme Disease
The Association of State and Territorial Public HealthLaboratory Directors, CDC, the Food and Drug Administration, theNational Institutes of Health, the Council of State and TerritorialEpidemiologists, and the National Committee for Clinical LaboratoryStandards cosponsored the Second National Conference on SerologicDiagnosis of Lyme Disease held October 27-29, 1994. Conferencerecommendations were grouped into four categories: 1) serologictest performance and interpretation, 2) quality-assurancepractices, 3) new test evaluation and clearance, and 4)communication of developments in Lyme disease testing. Thisreport presents recommendations for serologic test performance andinterpretation, which included substantial changes in therecommended tests and their interpretation for the serodiagnosis ofLD.
It was recommended that an IgM immunoblot be consideredpositive if two of the following three bands are present: 24 kDa * , 39 kDa , and 41 kDa . It was furtherrecommended that an that IgG immunoblot be considered positive iffive of the following 10 bands are present: 18 kDa, 21 kDa *,28 kDa, 30 kDa, 39 kDa , 41 kDa , 45 kDa, 58 kDa , 66 kDa, and 93 kDa .
The details of both plenary sessions and the work groupdeliberations are included in the publication of the proceedings,which is available from the Association of State and TerritorialPublic Health Laboratory Directors telephone 822-5227.