Cdc Supports The Development Of New Tests
New tests may be developed as alternatives to one or both steps of the two-step process. Before CDC will recommend new tests, they must be cleared by the Food and Drug Administration . For more details, see: Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease.
The Test Isnt Designed To Detect The Exact Disease
A number of Lyme disease lab tests are designed to identify only a few species of the Borrelia bacteria that can cause Lyme disease. In the United States, for example, many tests are only designed to detect Borrelia burgdorferi, leaving out many other species that are less common yet still known to cause the disease in humans, including the recently discovered B. mayonii.
In fact, a recent internal study showed exactly how easily tests could miss infections from species other than B. burgdorferi. IGeneX researchers tested 43 samples all positive on IGeneX Lyme ImmunoBlot tests using the more limited Western blots prepared from the following species of Borrelia:
- burgdorferi B31
- spielmanii
- valensiana
When only a B. burgdorferi B31 Western Blot was performed, only 14 of the 43 Lyme ImmunoBlot-positive samples were Western-Blot-positive. In other words, the B. burgdoferi Western Blot missed 29 of the 43 infections. However, when all eight Western Blots were performed, the remaining twenty-nine samples were detected.
This inability of many lab tests to cast a wide enough net of detection could result in false-negative results for patients infected with different strains of disease-causing Borrelia.
What Do The Test Results Mean
Because there are three tests that are typically conducted for the Lyme disease blood test, then results can vary based on the combination of test results received. When all three tests are positive, then Lyme disease is likely. These other result combinations are usually interpreted in the following ways.
Positive IgM, Negative IgG, Negative Western Blot.This usually indicates that the Lyme disease infection is in its early stages or that the blood test has produced a false positive result.
Negative IgM, Positive IgG, Positive Western Blot.This is usually interpreted as having a late-stage Lyme disease infection. It may also be an indication that someone had a previous infection that has been removed from the body.
All results negative.This is usually interpreted as there not being any infection present and that the symptoms are being caused by another issue. In some specific instances, however, it can also be seen as the antibody levels being too low to detect.
Once Lyme disease is confirmed, there will almost always be detectable levels of the bacteria which causes the disease in the IgG antibodies in their blood. This will mean that their IgG blood test results will have a standard deviation in what is considered as normal because of the presence of the disease, even if it has been effectively cured.
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How Is Lyme Disease Diagnosed
In general, if a patient attends their doctor with erythema migrans the doctor will be able to diagnose Lyme disease from this distinctive rash. Lyme blood tests are not necessary and at this stage of early infection tests may be negative. This is because blood tests for Lyme work by detecting antibodies to the Borrelia bacteria in the persons bloodstream, and the body takes 2-4 weeks to produce these antibodies.
Antibodies are produced by the bodys immune system when it detects harmful substances, such as bacteria. People have a wide variety of antibodies each type of antibody is different and defends the body against a specific kind of infection. A person with Lyme disease will develop antibodies that recognise different parts of the Borrelia bacteria. However it can take about 2-4 weeks for this to happen. If a blood sample is taken at this early stage and is negative, then retesting in 2-4 weeks may be useful.
For Lyme disease at a later stage the persons immune system will have had time to develop antibodies which can be detected by laboratory tests. The current advice is that the diagnosis of Lyme disease should be made only after careful review of the patients symptoms as well as the laboratory tests results and tick bite history. This is because many of the symptoms of these later stages of Lyme disease can be due to other illnesses or factors.
What Do The Results Mean
The Centers for Disease Control and Prevention recommends a two-test process of your sample:
- If your first test result is negative for Lyme disease, you don’t need any more testing.
- If your first result is positive for Lyme disease, your blood will get a second test.
- If both results are positive for Lyme disease and you also have symptoms of infection, you probably have Lyme disease.
Positive results don’t always mean a Lyme disease diagnosis. In some cases, you can have a positive result but not have an infection. Positive results may also mean you have an autoimmune disease, such as lupus or rheumatoid arthritis.
If your lumbar puncture results are positive, it may mean you have Lyme disease, but you might need more tests to confirm a diagnosis.
If your health care provider thinks you have Lyme disease, he or she will prescribe antibiotic treatment. Most people who are treated with antibiotics in the early stage of disease will make a complete recovery.
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Is There Any Relationship Between Sleep Apnea And Lyme Disease
We do not know of any evidence that Lyme disease causes sleep apnea, although sleep apnea has been associated with other encephalitic disorders. Sleep apnea may look like Lyme disease. For example, patients with sleep apnea may be difficult to arouse when asleep, will have excessive daytime sleepiness, and may complain of insomnia. They may have morning headaches, inattentiveness, and a decline in school or work performance. Hypertension may also occur. One can have sleep apnea without being obese. The problem can occur in children as well as adults. The diagnosis is made at a sleep lab after special tests of respiratory function and all-night polygraphic sleep monitoring. Patients with central sleep apnea may have lesions in the medulla with ninth and 10th cranial nerve palsies with trouble swallowing or speaking. Patients with obstructive sleep apnea tend to be overweight and to have large tonsils. These patients may snore and then have 10-30 second periods at night when breathing appears to stop. Patients will then take a deep snorting breath and then return to sleep, unaware of what just happened. Treatment is determined by the severity of the symptoms and the type. In central apnea, medroxyprogesterone and protriptyline can be helpful. Weight loss and surgical correction are the treatments for the obstructive type. Patients may experience enormous relief after the surgery. Symptoms previously incorrectly attributed to Lyme disease may now resolve completely.
Notes On Serological Tests
For patients with illness lasting over a month, only IgG testing should be performed . A positive IgM test alone is not sufficient to diagnose current disease in these patients.
Due to antibody persistence, a positive serological test cannot distinguish between active and past infection.
Serological tests:
- should not be done as a test of cure
- cannot be used to measure treatment response
The EIA test:
- may yield false-positive results when used as a stand-alone test
- may cross-react with antibodies to commensal or pathogenic spirochetes
- there may be some viral infections for certain autoimmune diseases
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How To Prevent Dogs From Having Ticks
While it is healthy to bring your dog out often to play, keeping them indoors most of the time is still the best way to avoid ticks. After a fun walk outside, thoroughly check them for any signs of ticks or itching as the longer a tick stays attached to your dog, the higher risk of developing a disease.
Ticks attach to grass, shrubs, etc. and latch on to nearby animals so it would be best to maintain a clean environment to avoid harboring ticks.
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Are You The Ticks 2nd Meal
A tick that is partially fed may be able to transmit diseases faster, Eisen explains.
Partially fed ticks able to re-attach could result from detachment from dead animals or possibly by host grooming.
Researchers have shown that infected I. scapularis nymph ticks which had been previously attached to a host for 24 48 hours, then removed and placed onto a new host, can effectively transmit B. burgdorferi spirochete within 24 hours of their re-attachment, Eisen writes.
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Molecular Testing For Detection Of Borrelia Species Bacterial Dna
PCR is available for Borrelia species DNA detection but is of limited value in routine testing for Lyme disease because the organism is only present in blood during the early stages of the disease and is predominantly restricted to the affected tissues.
Diagnostic molecular testing for Borrelia species DNA is available on request for relevant specimen types. Please call RIPL to discuss individual cases.
Lyme Disease Is Remarkably Difficult To Diagnose
The problem with Lyme disease is that the bacteria can create a hard shell around themselves when inactive so that the blood tests are unable to detect them. This is especially true when the disease has reached the chronic stage. The timing of the symptoms is often used by a medical provider to establish a time line to a tick bite or exposure to a high-risk region where the disease is commonly transmitted.
Because the ticks that can spread Lyme disease are often the size of a pinhead, the ticks might not even be notice. A bulls-eye rash at the bite location is a trademark symptom of Lyme disease, but only about half of the people who are infected with the bacteria develop the rash. Once the disease reaches the chronic stage, chronic arthritis, joint pain, and neurological symptoms begin to appear, sometimes several months after the infection.
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How Long Does It Take To Show Signs Of Lyme Disease
Lyme disease is characterized by various symptoms. The discomforts are very varied and affect many organs. If a person becomes infected with the Borrelia burgdorferi bacterium by means of a tick bite, a reddish and annular lesion on the skin may appear after several days or weeks this would be the first manifestation.
In the first month of exposure to the tick, which in most cases the patient does not remember, early localized infection occurs, which is usually manifested by nonspecific flu-like symptoms and the appearance of migratory erythema, which is a papule or macula that extends painlessly to take the form of a target with the clearer center. Since a quarter of patients do not have migratory erythema, it is not uncommon for this first stage to go unnoticed and doctors receive a patient with symptoms of an early disseminated infection , after weeks or months of exposure. This stage could be initiated, for example, as a general condition with intense discomfort, diffuse pains, headache, asthenia or new cutaneous symptoms: annular lesions smaller than migratory erythema, or the rare presence of lymphocytoma cutis .
Considering the inconstancy and clinical variability of borreliosis in this phase, it has been called the great imitator.
In any case, and if we exclude the almost constant fatigue/lethargy, it seems that the most relevant and frequent presentation symptoms are neurological, followed by the musculoskeletal and dermatological signs.
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New Test Diagnoses Lyme Disease Within 15 Minutes
- Date:
- Columbia University School of Engineering and Applied Science
- Summary:
- Current testing for Lyme disease, called the standard 2-tiered approach or the STT, involves running two complex assays to detect antibodies against the bacterium, and requires experienced personnel in a lab, and a few hours to carry out and interpret. Biomedical engineers have developed a rapid microfluidic test that can detect Lyme disease with similar performance as the STT in a much shorter time — 15 minutes.
Some 300,000 people in the U.S. are diagnosed with Lyme disease every year. Caused by Borrelia burgdorferi and transmitted by the bite of infected Ixodes ticks, the disease if left untreated can cause serious neurologic, cardiac, and/or rheumatologic complications.
Current testing for Lyme disease, called the standard 2-tiered approach or the STT, involves running two complex assays to detect antibodies against the bacterium, and requires experienced personnel in a lab, and a few hours to carry out and interpret. A team led by Sam Sia, professor of biomedical engineering at Columbia Engineering, has developed a rapid microfluidic test that can detect Lyme disease with similar performance as the STT in a much shorter time — 15 minutes.
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Are There Any Risks To Lyme Disease Tests
There is very little risk to having a blood test or a lumbar puncture. If you had a blood test, you may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. If you had a lumbar puncture, you may have pain or tenderness in your back where the needle was inserted. You may also get a headache after the procedure.
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Microbiologist Elli Theel, who directs the Infectious Diseases Serology Laboratory at Mayo Clinic, calls the 2015 study incredibly promising. The sensitivity they showed just in early Lyme disease patients was very high, the highest Ive actually seen, she said.
In an upcoming publication, the researchers also showed that metabolomics can differentiate Lyme from a similar tick-borne disease called southern tick-associated rash illness . The disease causes similar symptoms as Lyme, including a bullseye rash, and occurs in overlapping geographic regions. Currently there is no laboratory test to diagnose STARI, and little is known about how the disease progresses and how to treat it, something Molins hopes will change with better testing.
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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.
How Do I Remove A Tick From My Dog
Check your pet immediately after it has been in a tick-infected area. The deer tick is a small tick and only about pinhead size in juvenile stage, but is a little more obvious in the adult phase and after feeding. If you find a tick moving on your pet, the tick has not fed. Remove the tick promptly and place it in rubbing alcohol or crush it between two solid surfaces. If you find a tick attached to your pet, grasp the tick with fine tweezers or your finger nails near the dogs skin and firmly pull it straight out. There are also tools available called Tick Twister® or Tick Key® which can be useful. However, take care to use them cautiously as twisting or jerking the tick may cause the mouth parts to break off and remain in the skin. See your veterinarian if you are unsure or unable to remove the tick from your dog.
Make sure you protect your fingers from exposure by using a tissue or a disposable glove.You may need another person to help restrain your dog. Removing the tick quickly is important since the disease does not appear to be transmitted until the tick has fed for approximately 12 hours. If you crush the tick, do not get the ticks contents, including blood, on your skin.
Note: The bacterium that causes Lyme disease can pass through a wound or cut in your skin.
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How To Test For Lyme Disease
Wondering how to get tested for Lyme disease? The Centers for Disease Control and Prevention suggests a two-step testing process to check for a Lyme disease infection, both of which involve antibody testing , typically done on the same blood sample.
If the first step in the process returns a negative test result, then the second step is not necessary. However, if the first step yields a positive result, the second test is recommended as confirmation of a Lyme disease diagnosis. The Everlywell Lyme Disease Test follows this recommended protocol from the CDC, so it includes the two-step testing process.
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Negative C6 Elisa On Serum
Early clinical Lyme disease in the form of erythema migrans with associated history of a tick bite should be treated empirically. There is no need for testing unless there are further symptoms.
A negative ELISA result in the early stages of Lyme disease does not exclude infection. If acute Lyme disease is suspected but serology results are negative, we recommend that the test is repeated in 4-6 weeks with a fresh sample to look for seroconversion.
In patients with long term symptoms a negative ELISA test usually excludes Lyme disease as a cause of these symptoms. Information on differential diagnosis for patients with persistent symptoms and negative Lyme disease serology results is available.
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