How Is Lyme Disease Diagnosed
An EM rash is a sure sign of Lyme disease, so your doctor can diagnose and treat you without the need for laboratory tests.
An EM rash, often shaped like a bullseye , is a sure sign of Lyme disease. If you develop an EM rash, you should be diagnosed & treated for Lyme disease without the need for further lab tests. EM rashes are not as obvious on darker skin .
For all other cases, your doctor should consider whether your symptoms and risk factors point to a Lyme disease diagnosis. For example:
Were you bitten by a tick?
Did you spend time outdoors in an area where Lyme disease is common?
Recent travel: Lyme disease may be common where you were, even if it is unusual where you live.
Your current symptoms and how long have they been present.
Your full medical history, including previous unexplained symptoms that may help lead to an accurate diagnosis whether that ends up being Lyme or another condition.
How Can The Lyme Multiplex Assay Be Compared To Other Serological Lyme Assays
Researchers at the Animal Health Diagnostic Center at Cornell University have compared the former ELISA/Western blot procedure and the commonly used C6-based assays with the Canine Lyme Multiplex Assay9. Lyme Multiplex Assay OspF and C6 results highly correlate for the identification of infected or non-infected dogs. Antibodies to OspF and C6 provide robust markers of infection in dogs. However, the multiplex assay provides additional information on the dogs infection stage and vaccination status.
Positive C6 Elisa On Serum
RIPL will automatically proceed to do IgM and IgG immunoblot tests after a positive or indeterminate ELISA test and will provide an overall interpretation of the ELISA and immunoblot in the light of the clinical details provided on the request form.
Please provide clinical details to allow the interpretation of serological results. These are needed for interpretation because antibody levels from a protective humoral immune response to Borrelia species may persist indefinitely in patients who have had Lyme disease in the past. After successful treatment of Lyme disease antibody concentrations may slowly fall over time.
Borrelia species are notifiable organisms. The numbers of positive results from laboratory confirmed cases in RIPL are reported to PHE and analysed for inclusion in PHE Health Protection Reports as part of Lyme disease epidemiology and surveillance.
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Lyme Disease Signs And Symptoms
According to the NHS, Lyme disease can cause symptoms such as:
- A circular skin rash around an area where a tick was attached
- Flu-like symptoms, such as fever, chills, and sweats
- Neck stiffness which can last for weeks
If Lyme disease is left untreated, it can spread and cause complications in different parts of the body, such as the heart, joints, and nervous system.
Ticks generally attach to their hosts and feed on blood slowly over a period of several days, giving them enough time to transmit the disease if they arent caught and removed. Ticks infected with Lyme disease can carry other diseases as well, such as anaplasmosis and ehrlichiosis.
Current Research On New Approaches
NIAID actively supports research on Lyme disease diagnostics. Small businesses and public/private partnerships often submit applications for new research projects. NIAID grantees also work directly with CDC scientists to evaluate and compare the effectiveness of currently used diagnostic methods.
Working with CDC, NIAID plays a major role in encouraging the development of new approaches to improve Lyme disease diagnosis in people with tick-borne co-infections such as anaplasmosis or babesiosis. New diagnostic tests are also needed to distinguish between people with B. burgdorferi infection and those whose immune responses stemming solely from past Lyme disease vaccination. Although Lyme disease vaccines for humans are no longer available in the United States, the discontinued LYMErix vaccine used between 1998 and 2002 was based on a specific part of B. burgdorferi called outer surface protein A . In response to the vaccines, immunized individuals developed antibodies for OspA. Because the conventional ELISA measures OspA antibodies to determine if someone has Lyme disease, the test does not provide accurate results for immunized individuals. People who received the vaccination will test positive whether or not they are actually infected with B. burgdorferi.
NIAID is supporting research on a variety of approaches to improve the diagnosis of Lyme disease:
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What Is A Lyme Disease Blood Test
A Lyme disease blood test is used to determine if you have contracted Borrelia burgdorferi , the bacterium that causes Lyme disease. Lyme disease tests are conducted with a routine blood draw.
While there are other species of Borrelia that cause Lyme disease, B. burgdorferi is the most common cause in the United States. Most antibody tests in the United States only test for B. burgdorferi, but other species-specific tests are available depending on a persons travel history.
Lyme disease is transmitted to humans through ticks that are infected with Borrelia.
- shortness of breath
Lyme disease can be difficult to diagnose. Ticks are very small, and the bites are not always noticeable. Symptoms of the disease can vary from person to person. Not everyone experiences the classic bulls-eye rash pattern around a tick bite.
It should be noted that testing is not always required to make a diagnosis. For people with a classic bulls-eye rash living in a high risk area, testing is not recommended for diagnosis.
Your doctor will use the results of a Lyme disease antibody test, along with the report of your symptoms, to confirm a diagnosis.
Antibodies are proteins your body makes in response to foreign or harmful substances called antigens. Common antigens include:
Your body produces antibodies if you have contracted B. burgdorferi. These Lyme disease-specific antibodies will be present in your blood, and your test will be positive if you have the bacterial infection.
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.
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The Earlier In The Course Of Tick Borne Disease That The Treatment Is Started The Better For The Patient And The Worse For The Microbes
Early detection, however, can be difficult. Lyme IS the most prevalent tick borne disease in the states and it is increasing in incidence year to year. Yet the Center for Disease Control estimates only 10% of the cases of Lyme disease are reported annually. This is because only 50% to 68% of patients have a clear bulls-eye rash. Only 26% ever see the tick that gives them Lyme disease. Most people do not know that a flu in the late spring, summer or early fall can be a sign of Lyme disease. Most doctors do not know that Lyme exists anywhere but the northeast part of the United States. So early treatment is a challenge. I try during tick season in Northern California to have short appointments to check out a tick bite or erythema migrans rash, in order to effect early treatment.
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How Do They Test For Lyme Disease
Lyme disease is best tested using two different blood testing methods. These are:
- The Enzyme-linked Immunosorbent Assay test: In a nutshell, this test will look for signs that your body is trying to fight off Lyme disease by producing antibodies. However, the ELISA test may come back negative even when a person is infected by the Borrelia burgdorferi bacteria. False-negatives can occur during the early stages of the disease, where the infected persons body has not produced enough antibodies to fight off the B. burgdorferi bacteria. For this reason, reliable diagnosis is not usually based only on the ELISA test results.
- Western Blot test: Heres a simple way to explain the western blot test without getting into all the nitty-gritty details of what it does and how it does it. Put simply, it separates the blood proteins and detects antibodies to the bacteria causing the Lyme disease. Usually, when an ELISA test comes back positive, a western blot test is performed to confirm the diagnosis.
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You Do Not Usually Need Tests To Show That You Have Lyme Disease
In most cases, theres a clear sign of Lyme diseasea painless, spreading rash that often grows to look like a bulls eye. If you have this rash, and you recently had a tick bite or were in an area known for Lyme disease, you dont need a test. Instead, your doctor can just start treating you with antibiotics, as appropriate.
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.
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Lyme Serum Repository For Validation Of Novel Diagnostic Tests
When developing new tests or assessing their performance, researchers must have access to well-characterized positive and negative controls. Moreover, it is essential to include samples from patients with diseases that have overlapping clinical features and that are known to be serologically cross-reactive because sensitivity and specificity are heavily dependent on the types of patient samples used. However, collecting and characterizing a wide variety of clinical samples for this purpose can be challenging, costly, and time-consuming.
To improve availability of serum sample sets to evaluate novel diagnostic tests, the Centers for Disease Control and Prevention and the National Institutes of Health have developed a repository of well-characterized serum samples from patients with Lyme disease . The repository includes samples from patients with various stages of Lyme disease patients with cross-reactive conditions, such as multiple sclerosis and infectious mononucleosis and healthy controls from both disease-endemic and nondisease-endemic areas. Panels of serum, along with accompanying clinical and laboratory testing results, are now available to researchers for validation of novel diagnostic testing.
Enzyme Immune Assay Testing:
This test detects antibodies to the different kinds of bacteria that are known to cause symptoms of Lyme disease. Different strains of Borrelia are found in the USA and Europe but the tests are designed to detect all of the Borrelia that cause symptoms.
The EIA is the first test performed as it is designed to be very sensitive . If the EIA test is negative for Lyme disease, this can be relied upon to exclude Lyme disease in the patient, especially if the sample is taken when symptoms have been present for several weeks.
The disadvantage of the EIA is because it is very sensitive it can give false positive results. This means that the EIA test is reacting with something else present in the blood sample which is not related to Lyme disease. False positive EIA results can happen when there are infections with other bacteria or viruses, or in certain inflammatory /automimmune conditions. This is why a positive EIA test should be confirmed by a second test the Western Blot.
In Ireland, 2.5% of over 4,800 people who were tested by the National Virus Reference Laboratory in a single year had a positive Lyme test result. In Europe, between 3- 5% of the general population show evidence of infection with Borrelia bacteria at some point in their lifetime while a study in Ireland previously found that the background rate of infection in the Irish population was 3.4%.
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Lyme Disease Test: How To Check For Lyme Disease
- Dr. Andrea Pinto Lopezon September 28, 2022
Vector-borne diseases are infectious diseases which are spread through a type of insects called arthropods. These insects include ticks, mosquitoes, fleas, and triatomine bugs. If you live in certain areas of the United States, its very likely that youve heard about Lyme disease in the past. This disease is relatively common in some locations of the country. It can cause a wide range of symptoms that range in severity, but how do you check for Lyme disease?
Keep reading to find out the answers to all your questions about Lyme disease detection now.
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.
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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
- 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.
Timing Of Testingwindow Period
As with all serologic tests, clinicians must consider the timing of a patients illness when ordering and interpreting Lyme disease tests . Serologic analysis has low sensitivity during the first few weeks of infection while the antibody response is still developing . This period is known as the window period and is common to all serologic tests. Patients with illnesses suspicious for early Lyme disease but lacking typical EM can present a diagnostic dilemma because serologic test results might be negative at this point . In these cases, treatment can be administered at the discretion of the clinician, but serologic analysis is necessary to confirm the diagnosis .
Clinical approach to diagnosis of early Lyme disease, United States. *See Figure 1. Given the gradual geographic expansion of Lyme disease, testing may be warranted for patients with signs and symptoms of Lyme disease who were exposed in areas that border known disease-endemic regions. For a more detailed discussion of symptoms as they relate to pretest probability, see section on exposure and pretest probability. §For recommended 2-tiered testing protocol, see Figure 2. STARI, Southern tickassociated rash illness EM, erythema migrans.
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Why It Is Done
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.