Tuesday, August 16, 2022

How Is Lyme Disease Diagnosed In Humans

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Current Research On New Approaches

Understanding the Persistent Symptoms in Lyme Disease | Johns Hopkins Medicine

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:

Human Cases Of Lyme Disease In Canada

Between 2009 and 2019, provincial public health units have reported 10,150 human cases of Lyme disease across Canada.

Number of human reported Lyme disease cases from 2009 to 2019

Year
20192,634

Reported Lyme disease cases are from those who got the disease while in Canada or while abroad . The 2016 to 2019 Lyme disease cases are reported based on 2016 the Lyme disease case definition. There’s under-reporting because some cases are undetected or unreported.

All 10 provinces voluntarily provided data over the 11-year period. Territories haven’t reported any cases to the Public Health Agency of Canada since Lyme disease became nationally notifiable in 2009. This is because they haven’t had any Lyme disease cases.

Nationally notifiable diseases are infectious diseases identified by the federal, provincial and territorial governments as priorities for monitoring. Provinces and territories report annual notifiable disease data to the federal government. This helps the Public Health Agency of Canada monitor trends within provinces and across the country.

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.

Ideally, the CDC recommends standard two-tier testing to confirm the veracity of the Lyme disease test accuracy. Together, the ELISA and western blot tests are 99.9% accurate.

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Signs And Symptoms Of Lyme Disease

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Overview

Lyme disease is an underreported, under-researched, and often debilitating disease transmitted by spirochete bacteria. The spiral-shaped bacteria, Borrelia burgdorferi, are transmitted by blacklegged deer ticks. Lymes wide range of symptoms mimic those of many other ailments, making it difficult to diagnose .

The blacklegged ticks can also transmit other disease-causing bacteria, viruses, and parasites. These are known as coinfections . These ticks that transmit Lyme are increasing their geographical spread. As of 2016, they were found in about half the counties in 43 of 50 states in the United States .

Lyme is the fifth most reported of notifiable diseases in the United States, with an estimated 329,000 new cases found annually . Some studies estimate that there are as many as 1 million cases of Lyme in the United States every year .

Most people with Lyme who are treated right away with three weeks of antibiotics have a good prognosis.

But if youre not treated for weeks, months, or even years after infection, Lyme becomes more difficult to treat. Within days of the bite, the bacteria can move to your central nervous system, muscles and joints, eyes, and heart .

Here is a list of 13 common signs and symptoms of Lyme disease.

What Causes Lyme Disease

Ignore Lyme Disease Symptoms and You Could Risk Severe Complications ...

Lyme disease is caused by bacteria. In the United States, this is usually a bacterium called Borrelia burgdorferi. It spreads to humans through the bite of an infected tick. The ticks that spread it are blacklegged ticks . They are usually found in the:

  • Northeast
  • Upper Midwest
  • Pacific coast, especially northern California

These ticks can attach to any part your body. But they are often found in hard-to-see areas such as your groin, armpits, and scalp. Usually the tick must be attached to you for 36 to 48 hours or more to spread the bacterium to you.

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When Should I Get Checked For Lyme Disease

Generally, it is best to get tested for Lyme disease if you live where ticks are common or have recently visited such areas. Most certainly, you should get tested if you suspect that a tick has bitten you. It is important to talk to your doctor if you think you have any of the following early Lyme disease symptoms:

  • A rash resembling a bulls eye on the spot where youve been bitten
  • Fatigue
  • Headaches
  • Fever

Other symptoms dont show up immediately. Sometimes, it takes up to a few weeks or months after the tick bite to notice the following:

  • Swelling on the joints or severe joint pain
  • Tingling in the feet and hands
  • Dizziness
  • Shortness of breath

While it is okay get checked early, Lyme disease test results numbers are more authentic a few weeks after youve been bitten by a carrier-tick. Your body would have developed antibodies within that period, and that can make it easier to detect the disease.

Lyme Disease Risk Areas

Blacklegged ticks are spreading to new areas in Canada in part due to climate change. They can also spread by travelling on birds and deer. You can sometimes find blacklegged ticks in areas outside of where they’re known to live.

You’re most likely to encounter ticks during the spring, summer and fall. However, ticks can be active at any time of the year when the temperature is consistently above freezing. The best way to prevent Lyme disease is to protect yourself against tick bites. Always take precautions against tick bites when you’re in wooded or grassy areas.

Using data from active and passive tick monitoring, the Public Health Agency of Canada identifies areas where:

  • tick populations may be emerging
  • people are most at risk of getting Lyme disease

Check if you’re in a risk area. Enter the first 3 characters of your postal code or municipality in the filter field below.

Lyme disease risk areas, 2021

Municipality

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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.

The Chance Of Getting Lyme Disease

Testing for Lyme DiseaseWhat You Need to Know

Not all ticks in England carry the bacteria that causes Lyme disease.

But it’s still important to be aware of ticks and to safely remove them as soon as possible, just in case.

Ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern and northern England and the Scottish Highlands.

Ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They’re found all over the UK.

Ticks do not jump or fly. They attach to the skin of animals or humans that brush past them.

Once a tick bites into the skin, it feeds on blood for a few days before dropping off.

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Why Are Antibiotics The First Line Of Treatment For Lyme Disease

The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. Antibiotics go into the bacteria preferentially and either stop the multiplication of the bacteria or disrupt the cell wall of the bacteria and kill the bacteria . By stopping the growth or killing the bacteria the human host immune response is given a leg up to eradicate the residual infection. Without antibiotics, the infection in Lyme disease can evade the host immune system and more readily persist.

Transmission Symptoms And Treatment Options

Ticks often attach to hard-to-see areas such as the groin, armpits and scalp, and are difficult to identify due to their small size . For Lyme disease transmission, the tick must be attached for 36 to 48 hours.4 Early symptoms of Lyme disease may begin from 3 to 30 days after the tick bite and include fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes.6 Approximately 7080% of people will experience the erythema migrans rash which expands gradually over time sometimes forming the classic bulls-eye appearance. Later symptoms, days to months after the tick bite, include headaches, facial palsy, arthritis , joint and nerve pain, dizziness, and irregular heartbeat .6

Lyme disease can also feature neurological involvement. Neurological Lyme disease occurs as a secondary symptom of Lyme disease involving the peripheral or central nervous system and occurs in about 1015% of patients with untreated Lyme disease.7 The attack on the nervous system typically appears as radiculitis , which features cranial neuritis, facial paralysis and sensory disorders.8Less frequently, meningitis, myelitis, encephalitis and cerebral vasculitis occur.

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Future Perspectives On Lyme Disease Diagnosis

MTTT’s high performance has been demonstrated in various studies in the United States, Canada and Europe following FDA approval.22,23 In the United States, clinical testing labs have implemented the MTTT, and more manufacturers are offering solutions that are aligned with the MTTT. Some labs, on the other hand, continue to utilize STTT or both because some clinicians want to know what bands are positive in the immunoblots to gain more information about the disease, such as those antigens that are relevant to the detection of Lyme arthritis.12 Therefore, both CDC testing algorithms are projected to be used in the coming years.

If laboratories intend to perform alternative testing in addition to, or instead of, the testing established by the CDC, they must validate the new test with the relevant assay as a lab-developed test according to state and local guidelines. An example of alternate testing would be the use of immunoblots, as a second-tier test, containing extra and/or different antigens than those required by the CDC. A good example is the VlsE antigen, which stands for variable major protein-like sequence expressed. According to studies, adding the VlsE antigen, in an immunoblot to detect IgG, improves the sensitivity of Lyme disease testing in the early and late stages while retaining a high level of specificity.16,24-26

Table 1: Clinical symptoms and testing in early and convalescent phases of Lyme disease.

References

Is There A Lyme Disease Test Kit

5 Warning Signs of Lyme Disease to Never Ignore

Blood collection kits are available for at-home Lyme disease testing. Lyme disease test kits can cost as less as $20 and as much as $100 or more. Using a Lyme disease test kit is as simple as pricking your finger and smearing or collecting the blood onto the kit for testing.

However, testing for Lyme disease in a more controlled environment such as a lab or clinic is preferable as qualified healthcare professionals are likely to perform a more reliable test.

  • Center for Disease Control and Prevention . Data and surveillance. Retrieved from
  • Eugene D. S. . Lyme disease. N Engl J Med 2014 370:1724-1731. Retrieved from
  • Zeller J. L. . Lyme disease. JAMA. 2007 297:2664. Retrieved from
  • Center for Disease Control and Prevention . Diagnosis and testing. Retrieved from
  • Waddell L. A., et al. . The accuracy of diagnostic tests for Lyme disease in humans, a systematic review and meta-analysis of North American research. PLoS One. 2016 11: e0168613. Retrieved from

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    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.

    How Can A Tick Be Removed

    Removing ticks within 24-36 hours usually prevents infection. If you find a tick attached to your skin, make sure you remove it carefully as follows:

    • Use clean tweezers, grasp the head as close to the skin as possible and pull slowly straight out.
    • Afterwards, wash the bite site with soap and water or disinfect with alcohol hand sanitizer.
    • If mouthparts break off, remove them with tweezers or, if you are unable to remove them easily, leave it alone and let the skin heal.

    After removing the tick, the skin should be cleaned with soap and water or disinfected with alcohol or hand sanitizer. Wash your hands after removing the tick. Store the tick in a closed container if you are going to submit the tick for identification.

    For more information about removing ticks, including a photo, and for information about submitting ticks for identification, visit .

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    What Is The Outlook For Someone With Lyme Disease

    Most of the people who get Lyme disease and treated early will be fine.

    Post-Lyme Syndrome

    Even after proper treatment, some patients may experience lingering fatigue, achiness or headaches. This does not signify ongoing infection and will not respond to additional antibiotics. The majority of people in this group will have symptoms resolve over the next 1-6 months.

    Chronic Lyme Syndrome

    Chronic Lyme syndrome is a term used by some that includes the symptoms of Post-Lyme syndrome outlined above. This is a controversial topic with no accepted etiology and no proven cause or association.

    Can Lyme Disease Be Detected By A Blood Test

    Diagnosing and treating Lyme disease

    In a word: yes!

    A blood test does not only detect Lyme disease it is the most accurate and preferred test for diagnosing the disease. If a patient with Lyme disease shows signs that the central nervous system has been affected by the disease, western blot testing on the cerebrospinal fluid can be performed. If ordering from Walk-In Lab, a doctors note is not needed. Just pick your Lyme disease test and place your order online.

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    Lyme Disease Is A Complex Infection That Can Affect Various Systems In The Body Including The Joints Nervous System Heart And Skin Unfortunately Without An Expanding Ring

    Many symptoms of Lyme are similar to other illnesses, which complicates diagnosis. The Centers for Disease Control and Prevention recommends a two-step process when testing blood for evidence of antibodies against the Lyme bacterium. However, Lyme disease blood testing is fraught with problems, false negatives and false positives and, at best, should only be an adjunct to a clinical diagnosis of the disease.

    According to the CDC, the diagnosis should be based upon your symptoms, medical history, tick exposure, and geographical area . Blood tests should only be used to provide supporting evidence for the diagnosis.

    A new report published in Clinical Infectious Diseases acknowledges the need for better tests. Newer approaches in direct detection show promise and could help thousands of people with Lyme to get the treatment they need.

    What To Do If Bitten by a Tick

    After a suspected tick/insect bite, if you see a rash, even if its not at the site of the bite, you or your physician should take a picture of it, date it, and the doctor should place a copy of it in your medical records.

    Keep a Log

    It is important to keep a log, timing the start of the symptoms and keeping track of those that come and go over time. Fluctuating symptoms are hallmarks of Lyme disease. The log should also contain a record of when all medications are begun, ended, or have a dosage change.

    Diagnosing a Child Can Be Particularly Difficult
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    Symptoms Of Post Treatment Lyme Disease

    • Include severe fatigue, musculoskeletal pain, & cognitive problems
    • Can significantly impact patients health and quality of life
    • Can be debilitating and prolonged

    Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.

    The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.

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