How To Test If You Have Lyme Disease

British Columbia Specific Information

Ticks are tiny bugs which feed on blood. For information on ticks, removing ticks, and how to avoid being bitten, see HealthLinkBC File #01 Tick Bites and Disease. You may also be interested in the HealthLinkBC File #96 Insect Repellent and DEET.

While most tick bites do not result in diseases, some can. Some of the diseases passed on by ticks include relapsing fever, tularemia, Rocky Mountain Spotted Fever , Q Fever and anaplasmosis. The most well-known is Lyme disease. For more information on Lyme Disease, visit BC Centre for Disease Control – Lyme Disease .

The Elisa And Western Blot Are Not Sensitive Enough

Another major limiting factor of the traditional ELISA and Western blot is the quality. These tests tend to use lysed BB cultures, and therefore, depending on the culture conditions, some antigens are over-expressed, and some are under-expressed. This, in turn, can affect the ability to detect antibodies from patients blood.

Whats more, if a patient tests too early after a tick bite, his or her body may not have produced enough antibodies to show up on a test with suboptimal sensitivity.

When A Lyme Diagnosis Is Simple

A person who notices a tick bite and gets a bullseye rash will typically get a Lyme disease diagnosis. Treatment can start right away without any testing.

Another straightforward example would be a person who has spent time outdoors in an area where Lyme disease is common. Lets say that person doesnt have a bullseye rash but has other possible symptoms of Lyme disease. Their doctor does a standard two-step blood test, and both are positive. In this case the person gets a Lyme disease diagnosis and starts treatment.

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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.

Can We Test Fluids Other Than Serum

Yes, CSF samples can be submitted from horses with neurological signs. The CSF sample needs to be submitted together with a serum sample from the same animal and taken at the same time. The relative increase of antibodies in CSF can indicate local production of antibodies in the CNS. Typically, one or two antibody values are increased more than 2-fold if B. burgdorferi contributes to the neurologic condition.

For other samples, contact the lab first .

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Investigation Of Suspected Neurological Lyme Disease

The diagnosis of neurological Lyme disease can only be confirmed by examination of the CSF and a paired serum sample. A definite diagnosis is based on the presence of a pleocytosis in the CSF, demonstration of intrathecal synthesis of specific antibodies to Borrelia species in CSF by comparison to serum and the presence of neurological symptoms. It is not possible to confirm intrathecal synthesis and hence definite neurological Lyme disease without a paired serum .

In 2018 RIPL introduced a service for the detection of intrathecal synthesis of Borrelia-specific antibodies which is summarised in this flow diagram. An accessible text version of this flowchart is available below.

Clinicians may ask for guidance on laboratory testing of CSF from RIPL if required.

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.

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Can Lyme Disease Go Away On Its Own

Although the signs and symptoms associated with Lyme disease may clear after a few weeks, without the help of antibiotics, treatment with antibiotics is crucial to avoid any potential damage in the future.

Lyme disease occurs in stages, so in order to avoid it progressing into the later stages, correct treatment is a must.

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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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How To Determine Where You Are

In my clinical experience, the best predictor of when treatment is done, or where you are in your treatment for Lyme or the coinfections is to follow the symptoms. If testing is negative, but you still have a lot of symptoms, then there is a good possibility, the germs are still active and require further treatment. For more information about how to determine to stop treatment see Finished? And How to Prevent Relapse.

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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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 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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Are There Any Risks To Lyme Disease Tests

There is very little risk to having a blood test or a lumbar puncture.

With 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.

With a CSF test, you may feel a little pinch or pressure when the needle is inserted. After the test, you may feel some pain or tenderness in your back where the needle was inserted.

You may also have some bleeding at the site or get a headache. The headache may last for several hours or up to a week or more, but your provider may suggest treatment to help relieve the pain.

If I Am Worried About Lyme Disease Who Can I Talk To

Lyme disease is being increasingly recognised as causing illness and hardship, if the diagnosis is missed. Over the last number of years, there has been a marked increase in awareness of the condition among GPs and hospital doctors in Ireland. Each of the HSEs Hospital Groups have a number of Infectious Disease Consultants who are expert in the diagnosis and management of Lyme disease. If you have been bitten by a tick or have other reasons to strongly suspect you may have Lyme disease, you should visit your GP for advice.

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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
• 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.

What Is An At

An at-home Lyme disease test will typically be a blood finger prick test.

If you have been exposed to the bacteria Borrelia that leads to the infection of Lyme disease, your body will have created one or two antibodies to fight it off. The test will look for the presence of both types of antibodies, known as immunoglobulin M and immunoglobulin G .

You will receive your test kit along with account information so that you can get your test results as soon as theyre ready. Follow the manufacturers instructions exactly as they are described.

Each test has different instructions, so its important to read the kits detailed information before getting started.

• swollen lymph nodes

Lyme disease that remains unnoticed or untreated can go on to progress to disseminated Lyme disease. With disseminated Lyme disease, symptoms can also include neurologic conditions, such as cranial nerve palsy and meningitis that mimics aseptic meningitis. Heart inflammation can also be a sign of Lyme disease.

You may want to get tested for Lyme disease if youre experiencing symptoms and you either:

• know you were bitten by a tick
• recently spent time in an area where ticks are common

However, if youre currently experiencing a bulls-eye rash, its best to go to a doctor rather than take an at-home test. Thats because the outlook for Lyme disease is best when treated early.

When choosing at-home Lyme disease tests to feature, we looked at:

• ease of directions

• Collection method: blood
• Results: 25 days

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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.

Lyme Disease Blood Test Results Fully Explained

The Lyme disease blood test is used to discover if someone who has the symptoms of a Borrelia burgdorferi infection actually has the bacteria in their bloodstream. Recent infections are much easier to detect and an IgM and IgG blood test will often be ordered as complimentary information gathering tools. This blood test does not always detect the presence of the disease, so patients that have persistent symptoms after having the test may be re-tested in a few weeks.

If any of these tests come back as positive, then other samples will be used to track the stage of the disease to determine if it has reached the chronic infection stage. At this point, a medical provider will order a Western blot test to confirm the presence of Lyme disease.

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An Early And Accurate Diagnosis Is Key

For patients and doctors, being aware of the many factors that can influence Lyme disease lab tests can better inform your perspective and reliance on the results. If Lyme disease test accuracy is a concern, doctors should consider multiple types of tests, a panel approach, to increase the chances of detecting the disease.

Additionally, they should always consider the patients Lyme disease test results in conjunction with their current or previously reported symptoms. Remember, Lyme disease causes symptoms such as fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes.

Finally, doctors should also consider risk factors that heighten someones probability of exposure to ticks or regions where Lyme disease and other tick-borne diseases are prevalent.

For more information on getting the proper diagnosis and treatment for your tick-borne disease, read the IGeneX blogs The Importance of Getting the Right Diagnosis and How to Find Doctors Who Can Help with Your Tick-Borne Disease.

Additional Resources

Is It Possible For Lyme Disease To Be Misdiagnosed As Amyotrophic Lateral Sclerosis Are There Similarities In Symptoms Between These Two Diseases

The question of a relationship between Lyme Disease and ALS first received significant academic attention when Dr. John Halperin who was then a neurologist at Stony Brook conducted a study in which he compared the frequency of blood test positivity to the agent of Lyme disease among patients with ALS to community controls. The results indicated a higher percentage of the ALS patients were seropositive for Lyme Disease. Since then, there have been isolated case reports both in the media and one or two in the academic literature indicating that a patient had been misdiagnosed with an ALS-like illness only later to be re-diagnosed and treated for Lyme disease with good clinical response. Although we suspect that there may be rare individuals who have symptoms similar to ALS but actually have proximal motor neuropathy caused by Lyme disease, the vast majority of patients with ALS are not thought to have Lyme disease as the cause of their serious disease. Clinical trials have been underway using antibiotics for ALS not because there is belief that ALS is caused by a microbe but because these antimicrobial agents have other properties as well, such as decreasing inflammation or decreasing glutamatergic excitotoxicity. The studies examining intravenous ceftriaxone as a treatment for ALS were not successful.

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Lyme Disease Frequently Asked Questions

If you have not done so already, remove the tick with fine-tipped tweezers.

The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in thehighly endemic areas of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why its so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.

If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so its important to be alert for any illness that follows a tick bite.

References:

Moody KD, Barthold SW, 1991. Relative infectivity of Borrelia burgdorferi in Lewis rats by various routes of inoculation.Am J Trop Med Hyg 44: 135-9.

There are no reports of Lyme disease being spread to infants through breast milk. If you are diagnosed with Lyme disease and are also breastfeeding, make sure that your doctor knows this so that he or she can prescribe an antibiotic thats safe for use when breastfeeding.