Lab Testing For Lyme Disease Is Notoriously Tricky Even For Trained Doctors
Gold-standard Lyme disease tests are still murkymeaning a kit you buy online may be even less reliable.
Researchers determine the validity of most disease screening tests by looking at two factors.4 The first is sensitivity, which refers to how accurately a test identifies people who have the markers of a disease . The second is specificity, which refers to how well a test identifies people who dont have the markers of a disease .
In general the recommended lab tests for Lyme disease can lack both. There are a lot of false positives out there , and thats always been a problem, Raymond J. Dattwyler, MD, a professor of microbiology, immunology, and medicine at New York Medical College, tells SELF.
There are numerous reasons for potential inaccuracies. Some Western blot tests dont look for every type of protein band related to Lyme disease, for example, which could skew results, according to both Dr. Dattwyler and Samuel Shor, MD, FACP, former president of the International Lyme & Associated Diseases Society and clinical associate professor of health care sciences at George Washington University. Even if you take one that does, IgG and IgM antibodies may not develop until weeks after you become infected, so testing too soon can lead to false negatives, Dr. Shor says.
How Do I Know If I Have Lyme Disease
In order to tell if you have Lyme disease, you may need to get a Lyme disease blood test. However, many cases are diagnosed through a combination of your personal history, exposure to tick bites, physical examination, and symptoms.
According to MedlinePlus, Lyme diagnostic tests identify the presence of antibodies that your body produces in response to the disease. However, it can take a few weeks for these antibodies to show up in your blood. If you get tested before this happens, a test for Lyme disease can come back negative even if you do have the condition.
However, testing can be very useful if the clinical diagnosis for your condition is unclear. According to the Mayo Clinic, there are different types of tests used to diagnose Lyme disease, including:
- Enzyme-linked immunosorbent assay test
- Western blot test
According to the CDC, its currently recommended to get both of these Borrelia burgdorferi tests done to confirm a Lyme diagnosis. The ELISA test should be done first if the result is positive, a Western blot test is done to confirm the diagnosis. If the ELISA result is negative, no further testing is needed.
Its also recommended that all children aged 3 months to 18 years are screened for Lyme disease if they live in or have traveled to an area with a high risk for Lyme disease transmission.
Central Nervous System Lyme Disease
Central nervous system Lyme disease is diagnosed by 2-tiered testing using peripheral blood samples because all patients with this infectious manifestation should have mounted an adequate IgG response in the blood.
B cells migrate to and proliferate inside the central nervous system, leading to intrathecal production of anti-Borrelia antibodies. An index of cerebrospinal fluid to serum antibody greater than 1 is thus also indicative of neuroborreliosis. Thus, performing lumbar puncture to detect intrathecal production of antibodies may support the diagnosis of central nervous system Lyme disease however, it is not necessary.
Antibodies persist in the central nervous system for many years after appropriate antimicrobial treatment.
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How Do False Negatives Occur
When it comes to Lyme disease test accuracy, some people wonder why false negatives occasionally occur.
One key reason why is that both the EIA and Western blot tests are indirect tests. They measure the antibody response to the infection rather than directly checking for the genetic material of the bacteria. It can take several weeks for your body to produce enough antibodies for the tests to recognize them, which can sometimes yield false negative results if the tests are taken too soon after getting bitten by an infected tick.
Testing And Diagnosing Coinfections And Related Microbes
There are quite a few microbes spread by blood-sucking insects that have stealth characteristics similar to those of Borrelia burgdorferi some we know about, and others still waiting to be discovered.
They all have stealth characteristics and the ability to infect and thrive inside cells. They are masters of evading the immune system, and can be even harder to diagnose than borrelia. Symptoms profiles are similar to borrelia and related mostly to stimulation of cytokine cascades, not concentrations of microbes. Though they each have slightly different strategies, their motive is the same: complete a lifecycle stage within the host and move on.
The primary known players in chronic Lyme include mycoplasma, bartonella, and chlamydia species. The most well-known species of babesia, anaplasma, ehrlichia, and rickettsia are more apt to cause acute illness and less apt to be associated with chronic illness, but research is discovering lesser known and lesser virulent species of these microbes that are associated with chronic Lyme. Reactivation of herpes-type viruses is common in chronic Lyme.
Though testing is possible for some species of these microbes, when a natural route of recovery is chosen, extensive testing is not necessary and can actually be very misleading.
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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.
Can I Catch Lyme Disease From My Dog
Dogs are not a direct source of infection for people. Lyme disease cant be transmitted from one pet to another, nor from pets to humans, except through tick bites. However, a carrier tick could come into your house on your dogs fur and get on you.
If your dog is diagnosed with Lyme disease, you and any other pets have probably been in the same outdoor environment and may also be at risk, so it is a good idea to consult with your physician and veterinarian to see whether you should test other pets or family members.
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How Accurate Are Blood Tests For Lyme Disease
With about 30,000 people infected each year, Lyme disease causes a range of serious symptoms, including joint pain, chronic fatigue, facial paralysis, and in rare cases, even death. Because of these risks, anyone who is bitten by a deer tick should consider being tested for Lyme disease. Yet while lab tests are crucial for proper and perhaps life-saving treatment, they also have a low accuracy rate, leading many patients to become victims of a medical laboratory misdiagnosis.
Is There A Lyme Disease Test Kit
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.
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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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 the highly 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.
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.
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.
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First Its Important To Understand How A Doctor Should Test For Lyme Disease
Standard Lyme disease lab testing uses a two-tier system to analyze your blood for antibodies, which is recommended by the CDC. First, you take an enzyme-linked immunosorbent assay testalso known as enzyme immunoassays which aims to detect Immunoglobulin G and Immunoglobulin M in your blood, or antibodies that your immune system produces in response to the bacteria that cause Lyme, the Borrelia species.2
If you test positive for IgG and IgM antibodies, then the CDC also recommends taking a Western blot test. This test looks for bands, which are barcode-like lines of proteins in the blood that signify IgG and IgM antibodies.3 Alternatively, you may take another ELISA test to confirm the results of the first test.
Some at-home Lyme disease test manufacturers claim to use a similar process to laboratory tests. Others may test urine samples or tissue from your cheeks, which are not recommended testing methods for the identification of Lyme disease antibodies, according to the National Institute of Allergy and Infectious Diseases.
Pcr For B Burgdorferi
Short for Polymerase Chain Reaction, a PCR tests directly for borrelia DNA in the hosts blood, tissues, or urine. Historically, PCR has had limited accuracy, but improvements in technique are allowing PCR for microbial DNA to be the future of testing. At some point, it may be possible to define a persons entire microbiome.
For now, testing is available for the most common species of borrelia and many common species of coinfections with other stealth microbes. Testing is most accurate during acute infection, and much less accurate during chronic infection.
Again, the bottom line is that if you have many or most symptoms of chronic Lyme disease, then you are likely harboring at least one species of borrelia and several other species of stealth microbes no matter what the testing shows.
Many companies are offering microbial DNA testing, but a few are taking the lead. DNA Connexions tests DNA in either blood or urine specimens for three species of borrelia and several of the most common coinfections. Testing kits are available online.
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Can You Use A Serology Test To Diagnose The First Stage Of Lyme Disease
Serology antibody tests are generally more helpful for second and third stages of Lyme disease than first stage Lyme disease. Antibodies take weeks to develop, and if the initial presentation of Lyme disease is in the early stage those antibody tests may be falsely negative because the immune system has not yet had enough time to produce antibodies. If a physician is suspicious of Lyme disease but cannot make a diagnosis by the rash, then the antibody test in that first stage should be repeated 3 to 4 weeks later since a Lyme disease diagnosis can be missed with a false negative test in the first few weeks.
The Centers for Disease Control and Prevention recommends using a two-step testing process. If an ELISA test is positive, it is then followed by a Western blot test. However, this antibody-based testing system can produce some false positive results and high numbers of false negative results, particularly in early infection.
In addition, the immune response to borrelia is heterogeneous, and not all cases are captured by current antibody-based diagnostics. Antibody testing can also be a problem in patients with early disease who are treated with antibiotics. In these cases, a follow up antibody test done after treatment may be negative and never turn positive.
A negative antibody test does not necessarily rule out Lyme disease and should always be considered in the context of a full health history and clinical assessment.
Where Is Lyme Disease Found
In the United States, Lyme disease has been reported in every state, but over 95% of cases are from the Northeastern, Mid-Atlantic, and upper Midwestern states, with a small number of cases reported along the West Coast, especially Northern California. In Canada, Lyme-positive dogs are found mostly in southern Ontario and southern Manitoba, with a small number of cases in southern Quebec and the Maritime provinces.
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Lyme Disease Diagnosis And Testing Highlights
- LLMDS consider the specificity of the particular bands that test positive for a patient.
- Although the CDC requires 5 of 10 bands for IgG surveillance purposes, 2 of 5 bands have specificity of 93-96% and a sensitivity of 100%. .
- 56% of patients with Lyme disease test negative using the two-tiered testing system recommended by the CDC.
- The CDC case surveillance definition allows single-tier IgG immunoblot seropositivity using established criteria.
- The CDC states: This surveillance case definition was developed for national reporting of Lyme disease it is not intended to be used in clinical diagnosis.
- The College of American Pathologists found that ELISA tests do not have adequate sensitivity to be used for screening purposes.
- 52% of patients with chronic disease are negative by ELISA but positive by Western blot.
Lyme Disease Diagnostics Research
There is a great need to develop rapid, point-of-care tests to determine whether people are infected with Borrelia burgdorferi, the bacterium that causes Lyme disease. NIAID is committed to improving Lyme disease diagnostics by supporting innovative research projects.
Priorities include finding potential targetssubstances that new diagnostic tools might measure in patient samplesand improving the sensitivity and specificity of currently available diagnostic tests, thereby leading to more accurate results.
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How Is Lyme Disease Diagnosed
Though several types of tests do exist for the diagnosis of Lyme disease, the best tests for a Lyme disease diagnosis are blood tests, also known as serological tests. These tests are indirect, meaning they dont detect the infecting bacteria or its antigens but rather the antibodies an infected persons body produces in response to these antigens.
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.
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.
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