Interpreting Your Lyme Test Not That Easy
I have been writing to you about my involvement with Lyme disease and other tick borne illnesses for over six months. Through the letters one can see the vast involvement and damage these disorders can cause and can present in many different ways often mimicking other conditions. In my practice, I primarily see patients who have been undiagnosed for month or even years, often not receiving any treatment or not being treated appropriately.
Part of the frustration in the Lyme community is the fact that there is no one good test that is accurate. The test that we have now is up to 50-70% inaccurate in some instances. Intern, if you test negative for Lyme disease on regular blood work it doesnt mean you dont have Lyme. In fact, recently the state of Maryland signed a bill into law that requires health care providers warn patients in writing that Lyme disease testing can be problematic and standard laboratory tests often result in false negative and false positive results.
So what do we do? Well, my suggestion is educating yourself which is the reason for this News Letter.
The issue: a patient may falsely test negative for ELISA and so the bands will never be run/reported, or patients may test positive for a number of bands but not enough to meet the CDC/IDSA guidelines delineated above.
Take away points:
Be well this Holiday Season!
Elena Frid MD
The Role Of Lyme Disease Tests
The purpose of the most common type of Lyme disease testing is to determine whether you have developed antibodies as a result of past exposure to the Borrelia bacteria that cause Lyme disease. Antibodies are proteins created by the immune system that target specific threats like bacteria and viruses.
Blood testing alone cannot determine whether you have Lyme disease. Instead, testing can provide helpful information that your doctor can consider along with other factors, such as any symptoms youve had and whether youve been exposed to ticks that can carry Borrelia, to determine if a diagnosis of Lyme disease is appropriate.
Beyond blood testing, it is possible to analyze fluid from the central nervous system for signs of the Borrelia bacteria.
Tbrf Western Blot Igm
Tick-borne relapsing fever is caused by Borrelia species: B. duttoni, B. hermsii, and B. parkerii. Recently, B. miyamotoi has been added to the list. TBRF is a complex and progressively systemic illness which tends to mimic other diseases including Lyme disease. Therefore, determination of specific antibodies is helpful in the diagnosis of TBRF. The Relapsing Fever IgM Western Blot detects RF specific antibodies in human serum. IGeneX interpretation is based on internal validation studies.
Positive:Antibodies against two or more TBRF antigens are detected. This suggests exposure to Relapsing Fever Borrelia.
Negative:Antibodies against less than two TBRF antigens detected.
Disclaimer:This test was developed and its performance characteristics determined by IGeneX, Inc. It has not been cleared or approved by the FDA. The FDA has determined that such approval is not necessary. The test is used for clinical purposes and should not be regarded as investigational or for research. IGeneX, Inc. is licensed by CMS and NYS to perform high complexity clinical laboratory testing.
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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.
What Do My Test Results Mean
If both tests come back positive, that means you have had Lyme disease at some point in time.
If either or both of your tests come back negative, your doctor may still diagnose Lyme disease, particularly if you recently developed Lyme-like symptoms, regardless of your test results. But, if your doctor does not diagnose you with Lyme disease, you can ask to be re-tested in a few weeks. If you do have Lyme disease, your body may build up sufficient antibodies by that point to be detected by a blood test.
Two-step blood testing for later stages of Lyme disease is more accurate than for early infection because your body should have had sufficient time to produce the antibodies detected by diagnostic tests.
Interpreting the Western blot test
The Western blot test looks at whether you have an immune response the production of IgM or IgG antibodies to specific proteins on the Lyme disease bacteria. IgM antibodies are usually made by your body when the infection is new and recent, while IgG antibodies are usually made some weeks later. When the IgM or IgG antibodies combine with specific proteins from the Lyme disease bacteria, this produces dark spots, or bands on the Western blot test strip.
The CDC considers a Western blot test to be positive for Lyme disease if at least two of three IgM bands are positive within 30 days of symptom onset, or five of 10 IgG bands are positive at any time.
If your Western blot test comes back negative, ask your doctor:
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Antibody Test Quick Facts
- The timing of the test is crucial. It takes 4-6 weeks for the body to develop enough antibodies to show up on a test, so if you test too early, you could get a false negative.
- Most antibody tests are blood tests. Also known as serological tests, they require that a patient have a small sample of blood taken, and they detect antibodies in the patients serum or plasma.
- Not every test is able to detect every type of Lyme Borrelia. In fact, most tests like those recommended by the CDC are only designed to detect one or two species of Borrelia, even though at least 18 distinct types of Lyme-causing Borrelia are active in North America. This is a major cause of mis- and missed diagnoses.
Getting Tested For Lyme Disease
Lyme disease testing is usually ordered by a doctor and is used when there are signs or symptoms consistent with Lyme disease.
A blood sample can be drawn in a doctors office or other medical setting. If a test of cerebrospinal fluid is needed, an outpatient procedure called a lumbar puncture can be done in a hospital. Samples are then analyzed in a credentialed laboratory.
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How To Read Lyme Test Results
This article was medically reviewed by Sarah Gehrke, RN, MS and by wikiHow staff writer, Jennifer Mueller, JD. Sarah Gehrke is a Registered Nurse and Licensed Massage Therapist in Texas. Sarah has over 10 years of experience teaching and practicing phlebotomy and intravenous therapy using physical, psychological, and emotional support. She received her Massage Therapist License from the Amarillo Massage Therapy Institute in 2008 and a M.S. in Nursing from the University of Phoenix in 2013.There are 13 references cited in this article, which can be found at the bottom of the page. This article has been viewed 19,480 times.
If you’ve been bitten by a tick, it’s normal to feel nervous that you might have contracted Lyme disease. There is a two-step process recommended by the CDC to test for Lyme. The process tests your blood for evidence of antibodies your body produces to resist spirochete bacteria, which causes Lyme disease.XResearch source Your health care provider will first review your symptoms. Depending on your condition, you’ll be given an initial screening. The more detailed “Western blot” test will be done if the initial screening indicates a positive result.XTrustworthy SourceCenters for Disease Control and PreventionMain public health institute for the US, run by the Dept. of Health and Human ServicesGo to source
Bartonella Species Igg Western Blot
Bartonellosis is caused by Bartonella species, e.g. B. elizabethae, B. vinsonii, B. henselae, and B. quintana. Bartonellosis is a complex and progressively systemic illness which tends to mimic other diseases and is most likely known to be a co-infection with Lyme disease. Therefore, determination of specific antibodies is helpful in the diagnosis of Bartonellosis. The Bartonella IgG Western Blot panel detects specific antibodies in human serum to B. elizabethae, B. vinsonii, B. henselae, and B. quintana. IGeneX interpretation is based on internal validation studies.
Interpretation:Positive: Presence of 2 or more specific antibodies to Bartonella antigen detected. If positive, species is determined.Indeterminate: Presence of one specific antibody to Bartonella antigen detected.Negative: No specific antibody to Bartonella antigen detected.
Disclaimer: This test was developed and its performance characteristics determined by IGeneX, Inc. It has not been cleared or approved by the FDA. The FDA has determined that such approval is not necessary. The test is used for clinical purposes and should not be regarded as investigational or for research. IGeneX, Inc. is licensed by CMS and NYS to perform high complexity clinical laboratory testing.
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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.
Treatment And Treatment Follow
For treatment options and recommendations for infected dogs with or without clinical signs of Lyme disease, we refer to the ACVIM small animal consensus statement on Lyme disease in dogs3.
In addition to improvement of clinical signs, the evaluation of treatment success is performed based on declining antibody values to B. burgdorferi. The evaluation requires a pre- and post-treatment sample. Successful antibiotic treatment decreases the bacterial load. The lower or missing antigenic stimulus causes the immune system to produce fewer antibodies which leads to a decrease in serum antibody values. The decline of antibodies is slower than the bacterial clearance caused by the antibiotic treatment. After successful treatment, IgG antibodies to B. burgdorferi decline according to their half-life of around twenty-one days. A decrease of a positive antibody value by at least 50% of the original value in the time frames mentioned below is considered an indicator of treatment success. After successful treatment, antibodies will continue to drop without further treatment and will become negative over time if no re-infection occurs. The best timing for follow-up testing depends on the stage of infection. For example:
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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.
How Do You Read Lyme Disease Test Results
A positive result on both initial and confirmatory tests means that your signs and symptoms are likely caused by Lyme disease. A positive result for IgM antibody but negative results for IgG and Western blot may mean that you have a very recent infection or a positive when you do not have Lyme disease .
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What Is Lyme Disease
Lyme disease is an illness caused by infection with a bacteria that is spread through the bite of certain kinds of ticks. Symptoms can affect the skin where the bite occurred or elsewhere on the skin and may progress to affect other parts of the body. A family of bacteria, known as Borrelia, causes Lyme disease.
Why Do I Need A Lyme Disease Test
You may need a test if you have symptoms of infection and were exposed or possibly exposed to ticks that carry the bacteria that causes Lyme disease. The first symptoms of Lyme disease usually show up between 3 and 30 days after the tick bite.
Early signs and symptoms may include:
- A reddish round skin rash that slowly gets bigger over several days. It usually doesn’t itch or hurt, but it may be warm. As it gets better, it may look like a bull’s-eye , but not always.
- Muscle and joint aches
- Swollen lymph nodes
Later signs and symptoms of Lyme disease usually affect your joints and nervous system. They include:
- Severe headaches and neck stiffness
- Rashes on other parts of your body
- Arthritis with severe joint pain and swelling, especially in the knees
- Pain that comes and goes in your muscles, joints, bones, and tendons
- Shooting pains, numbness, or tingling in your hands or feet
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Lyme Titer Blood Tests Are Not Used For Screening
The immunoblot process is not an effective screening tool for the presence of Lyme disease because there are so many different variables that may be present. Some people may not have increased reactivity to a Lyme titer blood test for up to 6 months after the initial infection period passes. Although certain serums can be detected as early as 14 days after the onset of the disease, this may be enough time to have the disease transition from an acute infection to a chronic infection.
Individuals who have early stage Lyme disease often do not have enough antibodies present for a positive test result to be generated. In those who have a suppressed immune system for any reason may have test results that are difficult to interpret. Women who are pregnant may also have conflicting results from the general population.
In addition to the false negative results, a false positive result can occur in individuals who have received blood products within the past year, either from transfusions, because of surgery, or for other reasons. Certain diseases, the flu, and multiple sclerosis may also generate false positive results that send medical providers down an inaccurate treatment path.
Can Infection Be Spread Directly From One Dog To Another Dog Or From My Dog To My Family
Direct spread of Lyme disease from one dog to another dog has not been reported, even when infected and uninfected dogs have lived together for long periods.
Spread of Lyme disease from dogs to people has not been reported either, but people are equally at risk for Lyme disease if they are bitten by an infected tick.
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How Does The Canine Lyme Multiplex Assay Work
The Canine Lyme Multiplex Assay was developed at the Animal Health Diagnostic Center at Cornell University. It detects antibodies to three B. burgdorferi antigens in canine serum . The test is based on fluorescent beads and allows the simultaneous measurement of antibodies to all three B. burgdorferi antigens in a single sample10,11.
Figure 2:B. burgdorferi
Interpretation Of Lyme Multiplex Results910
The Lyme Multiplex Assay is a fully quantitative test. It results in a numeric antibody value for each of the three B. burgdorferi antigens tested. An interpretation of each value is submitted with the test report. In addition, the antibody profile gives an advanced interpretation on the infection and vaccination status of the dog. Antibodies to OspA serve as markers for vaccination and those to OspC and OspF as markers for infection . In infected dogs, quantitative antibody values can then be used to follow-up on treatment success.
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