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.
Could You Have Lyme Disease And Not Even Know It
The scary truth about this sneaky illness.
After you get home from a glorious summer hike, you probably do a few things: post photos of the great outdoors to Instagram, take a quick shower, and chow down on some post-workout snacks. But if checking yourself for ticks isn’t a part of that routine, you might be leaving yourself open to Lyme disease. “It happens frequently that people have Lyme disease and don’t know it,” says Andrea Gaito, M.D., a rheumatologist with a private practice in Basking Ridge, New Jersey.
Lyme disease is a bacterial infection transmitted by tick bites, especially those from deer ticks. Approximately 70 percent of deer ticks are infected, says Gaito. And those of you in New York, New Jersey, and Pennsylvania should be on high-alert: Your states have the highest rates of Lyme disease, which is much more manageable when caught early on, says Gaito.
It sounds pretty scary, but there are ways to figure out if you’ve got Lyme disease before it really has its hooks in youor even prevent it in the first place. Here’s what to look out for.
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Is There A Blood Test For Lyme Disease
If your doctor suspects that you have Lyme disease, they may order two blood tests. These will look for signs that your body is trying to fight it off. The results are most precise a few weeks after youâve been infected.
These tests are:
ELISA test. This test canât check for the bacteria that causes Lyme disease. It can only look for your immune systemâs response to it.
Once Borrelia burgdorferi gets into your blood, your body begins to make special proteins called antibodies to fight it off. The ELISA test checks for those antibodies.
Although itâs the most common way to check for Lyme disease, the ELISA test isnât perfect. It can sometimes give false âpositiveâ results. On the other hand, if you have it done too soon after youâve been infected, your body may not have developed enough antibodies for the test to detect them. This will give you a ânegativeâ result even though you do have Lyme disease.
Western blot test. Whether your ELISA test comes back positive or negative, your doctor will need to do this blood test, too.
A Western blot uses electricity to split certain proteins in your blood into patterns. This is then compared to the pattern of people known to have Lyme disease.
At least five band matches means that you have Lyme disease. Still, not all labs have the same standards. Thereâs a chance that you could get a âpositiveâ result from one and a ânegativeâ result from another.
- Alzheimerâs disease
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What Blacklegged Ticks Look Like
Blacklegged ticks are small and hard to see. They attach themselves to humans and animals and feed on their blood. They can range in size depending on how long they have been feeding.
You can find out if its a blacklegged tick by:
- calling your local public health unit or checking their website
- submitting a photo of the tick to etick.ca
Adult female blacklegged tick at various stages of feeding. Photo: Government of Canada
How To Avoid Getting A Tick Bite
You might be at risk if you live, work in, or visit a wooded area, or an area with tall grasses and bushes .
You may also be at risk if you are involved in outdoor activities such as hiking, camping and gardening.
You may be bitten by a tick and not even know it.
Heres what you can do to avoid getting a tick bite.
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How Do I Know If I Have Lyme Disease
Lyme disease is an illness caused by a tick bite–specifically, the bite of the black legged tick or deer tick. Some of these ticks carry a bacteria called Borrelia burgdorferi. The tick transfers the bacteria to a persons bloodstream through the bite. The tick must be attached for at least 24 hours before this can happen.
Over time, untreated Lyme disease can cause serious problems with the heart, joints, nervous system, and memory. Youre most likely to get infected during spring and summer. So before you rush outside to enjoy the warmth of the sun, take some time to review Lyme disease symptoms and when you should see your health care provider.
Lyme Disease: What to Look For
If you become ill within a few weeks of a known tick bite, see your health care provider right away. And even when you arent sure if youve been bitten by a tick–but have the symptoms of Lyme disease and have been in the great outdoors–you should check in with your provider. Immature deer ticks cause most infections they are very tiny and many people are bitten without being aware of it.
Shortly after infection, Lyme disease can cause:
- Muscle and joint pain
- Swollen lymph nodes
- A bulls-eye-shaped rash at the site of the bite, which can appear within a few days or up to a month after the bite
How Is Lyme Disease Diagnosed?
Building Knowledge, Enhancing Care
Can Lyme Disease Be Prevented
If youre travelling to an area where ticks are common, especially in spring or summer:
- wear long sleeves, long pants and long socks
- use insect repellent containing DEET
- check your body carefully and regularly
Remove ticks as soon as possible.
It is important to kill the tick first to prevent more saliva from being forced into the wound. Kill the tick with a product that quickly freezes it, such as a spray used to treat warts. Then gently remove it with tweezers when it is dead. This method will also lower your chances of developing an allergy to ticks. If you are allergic to ticks, you need the tick to be removed by a doctor.
Read more about preventing and treating insect bites.
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Treating Pain Causes By Lyme Disease
When Lyme disease is the cause of pain and arthritis, the primary goal is to remove the bacteria that started a cascade of reactions that contributed to the pain. Just as importantly, the fire of inflammation that has been lit needs to be treated. This inflammation is present with active infections, but can also persist after the infections are successfully treated.
The foundation for reducing systemic inflammation in the body is to avoid foods that are inflammatory. The foods that most commonly create inflammation are gluten, cow dairy, and sugar. If food allergy testing has been performed, the reactive foods should also be avoided. People with other conditions such as SIBO or MCAS may also need to follow a specific diet. Any food that creates inflammation adds to the level of inflammation already being produced by infections.
Herbal Treatment for Pain
The herb turmeric is one of the most effective treatments for reducing the pro-inflammatory cytokines produced by the immune system in response to tick-borne infections. This reduction in inflammation leads to a reduction in muscle and joint pain, and joint swelling.
Low-dose immunotherapy is a promising therapy that works to improve the immune response in Lyme disease
LDI uses very dilute doses of bacterial antigens to help down-regulate the inflammation produced by bacteria. This treatment has provided remarkable benefits for many people who suffer from pain and neuropathy from Lyme disease and associated infections.
Where Blacklegged Ticks Live
We continue to track where infected and uninfected blacklegged ticks are being found.
Public Health Ontarios Lyme disease page has a map that shows areas in Ontario where they estimate you are more likely to find blacklegged ticks.
Blacklegged ticks are spreading to new areas of the province because of climate change. They can also spread by traveling on birds and deer. While the probability is low, it is possible to find an infected tick almost anywhere in Ontario.
Ticks are most active in spring and summer, but can be found at any time of the year when the temperature is above freezing.
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Current Problems With Lyme Disease Diagnosis & Patient Care
- Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial.
- The rash is not always present or easily recognized
- Misdiagnosis and delayed diagnosis can make Lyme disease more difficult to treat and lead to prolonged and debilitating illness
- Early symptoms can be mistaken for a summer flu
- Lyme disease can involve several parts of the body, including joints, connective tissue, heart, brain, and nerves, and produce different symptoms at different times.
- Antibody testing done after early treatment may be negative and never turn positive for some cases
- Borrelia burgdorferi can evade our protective immune system and trigger immune system dysfunction.
- No reliable blood test is presently available to measure treatment success, necessitating close clinical follow up and improved physician education.
- Presently there is no vaccine to prevent Lyme disease available to humans.
Seek Medical Care Early To Prevent Lyme Disease From Progressing
Its easy to get bit by a tick and not know it. Most people dont feel a tick on their skin or the bite. Checking your skin for ticks after spending time outdoors can help you find a tick and remove it.
Removing a tick can prevent Lyme disease. A tick must be attached to your skin for at least 36 hours to infect you with the bacteria that cause Lyme disease.
Its not always possible to find a tick, so its important to pay close attention to your skin. If you notice any signs of Lyme disease or develop a rash, get medical care right away. Ticks can cause other serious diseases, such as Rocky Mountain spotted fever.
Related AAD resources
ImagesImage 1: Centers for Disease Control and Prevention, Public Health Image Library, Last accessed May 11, 2017.
Images 2, 3, and 7: Used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2011 64:619-36.
Image 6: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
ReferencesBhate C and Schwartz RA.
Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol. 2011 64:619-36.
Lyme disease: Part II. Management and prevention. J Am Acad Dermatol 2011 64:639-53.
Centers for Disease Control and Prevention:
Signs and symptoms of untreated Lyme disease. Page last updated October 26, 2016. Last accessed May 2, 2018.
Lyme disease: transmission. Page lasted updated March 4, 2015. Last accessed May 2, 2018.
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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.
Other Causes Of Lyme Disease Symptoms
Sometimes people think they have the symptoms of Lyme disease, but it is a different disease caused by ticks. Diseases caused by tick bites that are known in Australia are:
- Queensland tick typhus
- Q fever
- mammalian meat allergy
Sometimes there is no known diagnosis for symptoms such as fatigue, disordered thinking, disturbances of the senses, joint pain and headaches. These symptoms are real and can be very debilitating. In this case, you doctor will work with you to manage the symptoms and improve your quality of life.
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Lyme Disease Test Two
Two-tiered Lyme disease testing uses two tests. The first is a screening test that should detect anyone who might have the disease. Tests that do this well have are regarded as having high sensitivity. This test is followed by a second test that is intended to make sure that only people with the disease are diagnosed. Tests that do this well have high specificity.
HIV/AIDS is diagnosed with tests that are both highly sensitive and highly specific. They are accurate more than 99% of the time. In Lyme disease, the second test is highly specific. So there are few false positives. Unfortunately, the screening test is highly insensitive and fails to accurately identify patients who have Lyme disease. The two-tiered test system misses roughly 54% of patients.
Because of this, LDo recommends the patients and physicians skip the ELISA and go straight to the Western blot.
What About Tests
The commonly used ELISA test is not a reliable indicator for many Lyme patients .
The Western blot test tends to be more sensitive, but it still misses 20 percent or more of Lyme cases .
At-home testing is also available. You can buy a test kit online from LetsGetChecked here.
If you dont have the initial Lyme rash, diagnosis is usually based on your symptoms and your potential exposure to blacklegged ticks. The doctor will rule out other possible diseases that may cause the same symptoms.
Lyme diagnosis is usually based on your symptoms.
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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.
How Do You Know If Your Lyme Disease Is Treated And Finished
Patients ask me this question all the time. We diagnose the disease, we treat with antibiotics, or herbs, or homeopathics. We feel better. We stop the treatment. And either we continue to feel better, or we relapse and have to start all over again.
Is there no way to test whether the spirochete is gone?
The Lyme disease.org website has an excellent article ondiagnosis of Lyme disease.
The National Geographic website has a good description of the deer tick, and thehistory of Lyme disease.
Standard Lyme testing includes the following:
- ELISA or IFA test
- If that test is positive, then a Western Blot test is run
- If 5 out of the 10 possible Lyme bands are positive, you are diagnosed with Lyme disease
- If fewer than 5 of the 10 possible bands are positive, you are diagnosed as negative.
Not all the bands which appear on a Western blot are specific to Lyme disease even though one ofthose non-specific bands is required by the CDC for diagnosis.
Two of the bands which are specific to Lyme disease are not on the CDC list of bands required to be positive.
How much sense does that make?
For more detailed information about the IFA and Western blot testing, check out theIGeneX website.
There is another test that can give us an idea whether the Lyme disease is actually gone out of our systems. This is an inflammatory marker, so it tells us whether there is continued inflammation or whether that inflammation is no longer present.
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Lyme Disease Signs And Symptoms
Most symptoms of Lyme disease in humans usually appear between three and 30 days after a bite from an infected blacklegged tick.
You should contact your local public health unit or speak to a health care professional right away if you have been somewhere that ticks might live and experience any of the following symptoms:
- a bulls-eye rash (a red patch on the skin that is usually round or oval and more than 5 cm that spreads outwards and is getting bigger
- a bruise-like rash
- another type of unusual rash
- muscle aches and joint pains
- swollen lymph nodes
- spasms, numbness or tingling
- facial paralysis
If not treated, Lyme disease can make you feel tired and weak and, if it gets really bad, it can even harm your heart, nerves, liver and joints. Symptoms from untreated Lyme disease can last years and include recurring arthritis and neurological problems, numbness, paralysis and, in very rare cases, death.
What Causes Lyme Disease
People get Lyme disease when they are bitten by an infected tick. Ticks live in areas with a lot of plant life, such as wooded areas or fields. They sit near the top of grassy plants and low bushes. They wait there for people or animals to brush up against them. Ticks can crawl on your clothes or body for up to several hours or more before attaching to the skin.
Ticks can attach to any part of your body. They are usually found in hard-to-see areas, including the armpits, groin, or scalp. An infected tick needs to be attached to your skin for 36 to 48 hours before it passes the bacteria on to you.
People who spend time in outdoor areas where ticks are common are at higher risk of getting tick-borne diseases.
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