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Lyme Disease How To Get Tested

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What If Your Lyme Disease Test Is Positive

Testing for Lyme DiseaseWhat You Need to Know

Its important to note that a positive result doesnt mean you have a diagnosis of Lyme disease. The tests will show that antibodies are present in your blood, but a physician will need to order another type of test before you get an official diagnosis.

If someone gets a positive at-home test, definitely see your doctor, says Dr. Puja Uppal, a board certified family medicine physician and the chief medical officer at Think Healthy.

A physician will likely order both an enzyme-linked immunosorbent assay and a Western blot test, which check for antibodies specific to Borrelia burgdorferi. They will consider the results of both these tests, along with your symptoms, to make an accurate diagnosis.

Notice To Readersrecommendations For Test Performance And Interpretation From Thesecond National Conference On Serologic Diagnosis Of Lyme Disease

The Association of State and Territorial Public HealthLaboratory Directors, CDC, the Food and Drug Administration, theNational Institutes of Health, the Council of State and TerritorialEpidemiologists, and the National Committee for Clinical LaboratoryStandards cosponsored the Second National Conference on SerologicDiagnosis of Lyme Disease held October 27-29, 1994. Conferencerecommendations were grouped into four categories: 1) serologictest performance and interpretation, 2) quality-assurancepractices, 3) new test evaluation and clearance, and 4)communication of developments in Lyme disease testing. Thisreport presents recommendations for serologic test performance andinterpretation, which included substantial changes in therecommended tests and their interpretation for the serodiagnosis ofLD.

It was recommended that an IgM immunoblot be consideredpositive if two of the following three bands are present: 24 kDa * , 39 kDa , and 41 kDa . It was furtherrecommended that an that IgG immunoblot be considered positive iffive of the following 10 bands are present: 18 kDa, 21 kDa *,28 kDa, 30 kDa, 39 kDa , 41 kDa , 45 kDa, 58 kDa , 66 kDa, and 93 kDa .

The details of both plenary sessions and the work groupdeliberations are included in the publication of the proceedings,which is available from the Association of State and TerritorialPublic Health Laboratory Directors telephone 822-5227.

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. 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 is introducing a service for the detection of intrathecal synthesis of Borrelia-specific antibodies which is summarised in this flow diagram.

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

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Alternative Diagnostic Tests Not Available At Ripl

Tests used in the NHS and PHE to identify Lyme disease are well characterised, standardised, and are highly reproducible between laboratories. They are the methods of choice recommended in the 2018 NICE Lyme disease guideline, following an extensive review of the evidence and literature. International external quality assurance schemes are in place to ensure consistency between different centres offering these tests.

Several private laboratories in Europe and the USA offer an alternative type of test called an ELISpot to diagnose Lyme disease. This looks for different markers in blood samples compared to conventional validated Lyme disease serology tests. The laboratories using these tests in the diagnosis of Lyme disease do not publish their methods, and have not produced any peer reviewed publications on their clinical value.

This makes it very difficult to verify their results, especially as there are no national or international EQA schemes for Lyme disease ELISpot tests and therefore no independent verification of performance between laboratories. Without independent evidence it is impossible to determine the validity of results produced using these alternative tests.

RIPL cannot interpret the results of alternative diagnostic tests.

The Most Common Lyme Disease Blood Tests

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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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Other Diagnostic Tests For Lyme Disease

Some laboratories offer Lyme disease testing using urine or other body fluids. These tests are not approved by FDA because they have not been proven to be accurate. For example, one study of urine-based polymerase chain reaction assays for Lyme disease diagnosis showed that with currently available tools, urine cannot be used to accurately diagnose Lyme disease. Another study by NIAID-supported scientists showed that the Lyme Urinary Antigen Test was unreliable and resulted in excessive numbers of false positives. In the same study, researchers confirmed that an ELISA followed by a Western blot test was nearly 100 percent reliable in diagnosing Lyme disease. With the availability of so many Lyme disease tests, including non-commercial tests developed by individual facilities, it is impossible to address the accuracy of each one. The development of new, rapid, clearly validated diagnostic tests continues to be a need.

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Late Lyme Disease Symptoms

  • Have you had any of the following symptoms typical of late or chronic Lyme disease?
  • Fatigue
  • Psychiatric
  • Yes
  • No
  • Unsure
  • New onset fatigue, widespread pain, sleep disturbance, and cognitive impairment are common symptoms of late Lyme disease. Many symptoms of late or chronic Lyme disease are non-specific and common among diseases. What sets Lyme patients apart is the severity of symptoms and the degree of functional impairment. Patients report pain at the severity of post-operative patients, fatigue at the level of patients with multiple sclerosis, and functional impairment comparable to those with congestive heart failure. Most patients with chronic Lyme disease report one or more of the following symptoms as severe or very severe: fatigue , sleep impairment , joint pain , muscle aches , other pain , depression , cognitive impairment , neuropathy , headaches and heart-related issues . Chronic Lyme patients generally report more than one symptom and average three severe or very severe symptoms.
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    What To Do If You Find A Tick

    If you see a tick, try to remove it from your childs body. If the tick was on the body for less than 36 hours, it may help prevent infection.

    To safely remove a tick:

    • Use fine-tipped tweezers to grasp the tick at its head or mouth, close to the skin.
    • Pull firmly on the tick until it releases the skin. Try to ease out any parts that get stuck in the skin.
    • Wash the bite area with rubbing alcohol or soap and water and apply an antiseptic lotion or cream.

    Lyme Disease Signs And Symptoms

    Officials harvest ticks, test for Lyme disease in Sacramento area

    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:

    • rash
    • 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
    • fatigue
    • 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.

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    When You May Need To See A Specialist

    Though a family physician or general practitioner should be able to order the diagnostic tests for Lyme disease, there are some situations in which you may need to see a specialist. For example, untreated or misdiagnosed Lyme can develop into chronic Lyme disease, which can then lead to complications such as arthritic or neurological symptoms. In these cases, patients may need to see the following types of specialists:

    • Rheumatologist Chronic joint problems from Lyme disease may need the care of a physician who specializes in rheumatology.
    • Neurologist Chronic Lyme can be associated with debilitating neurological symptoms that must be treated by a specialist.
    • Infectious disease specialist Again, even though this isnt always necessary, it can be helpful if your symptoms dont go away or become more complex.
    • Cardiologist In the event that you develop the rare but dangerous complication known as Lyme carditis, you may need to see a cardiologist and even be fitted with a temporary pacemaker.

    However, its important to remember that seeing a specialist for symptoms related to Lyme disease without treating Lyme disease is costly and dangerous. In other words, a rheumatologist or neurologist will not be able to treat your Lyme if no diagnosis has been made. They can simply help treat symptoms that result from chronic or untreated Lyme.

    To treat Lyme disease, you must get an accurate diagnosis and be prescribed antibiotics.

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    Submitting Ticks To A Provincial Public Health Laboratory

    If possible, send any ticks that you have removed to a public health laboratory in your area. However, tick identification and testing is not done in all provinces of Canada.The following provinces accept submissions:

    Contact your local public health authority for details on:

    • the tick identification and testing program available in your area
    • how to submit a tick for testing

    The public health laboratory will:

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    Diagnosis Of Lyme Disease

    The diagnosis of Lyme disease can be made clinically or in conjunction with laboratory test results. When the skin rash is typical and when a patient has been exposed to an environment where blacklegged ticks are known to be established, the diagnosis can be made on clinical grounds alone. In parts of Canada where adventitious, unestablished populations of blacklegged or western blacklegged ticks have been noted, a clinical diagnosis is more challenging. When the rash is atypical or occurs in circumstances in which exposure to the appropriate vector tick species was unlikely, diagnosis is based on the demonstration of a serological response to B burgdorferi. Immunoglobulin M antibodies are usually detectable within weeks of the onset of symptoms however, a significant proportion of patients with EM may not have detectable antibody at the time of initial presentation . Furthermore, when patients are treated very early in the course of illness, antibodies may not develop. When an initial antibody determination is negative, it is suggested that a second serum specimen be collected four weeks later.

    Current evidence suggests that commercially available enzyme immunoassays used for the purpose of screening are sufficiently sensitive .

    Antigen detection has also been used in both spinal fluid and urine. As with NAT, antigen tests cannot be recommended unless their sensitivity and specificity significantly improve .

    Positive C6 Elisa On Serum

    Natural Strategies to Overcome Lyme Disease

    RIPL will automatically proceed to do IgM and IgG immunoblot tests after a positive or indeterminate ELISA test and will provide an overall interpretation of the ELISA and immunoblot in the light of the clinical details provided on the request form.

    Please provide clinical details to allow the interpretation of serological results. These are needed for interpretation because antibody levels from a protective humoral immune response to Borrelia species may persist indefinitely in patients who have had Lyme disease in the past. After successful treatment of Lyme disease antibody concentrations may slowly fall over time.

    Borrelia species are notifiable organisms. The numbers of positive results from laboratory confirmed cases in RIPL are reported to PHE and analysed for inclusion in PHE Health Protection Reports as part of Lyme disease epidemiology and surveillance.

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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.

    Lyme Disease Surveillance In Canada

    Lyme disease became a national notifiable disease in December 2009.

    Canada continues to monitor the evolving geographic distribution and prevalence of infected ticks and cases of Lyme disease. Therefore, you must report clinically diagnosed or laboratory-confirmed cases to your provincial or territorial public health authorities.

    Health professionals in Canada play a critical role in identifying and reporting cases of Lyme disease. See the surveillance section for more information on surveillance in Canada.

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    What Happens During Lyme Disease Testing

    Lyme disease testing is usually done with your blood or cerebrospinal fluid.

    For a Lyme disease blood test:

    • A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

    If you have symptoms of Lyme disease affecting your nervous system, such as neck stiffness and numbness in hands or feet, you may need a test of cerebrospinal fluid . CSF is a clear liquid found in your brain and spinal cord. During this test, your CSF will be collected through a procedure called a lumbar puncture, also known as a spinal tap. During the procedure:

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    How To Get A Tick Tested For Lyme Disease

    Rapid test for Lyme disease

    How to get a tick tested for lyme diseasePeople who have removed a tick sometimes wonder if they should have it tested for evidence of infection. Although some commercial groups offer testing, in general this is not recommended because: Laboratories that conduct tick testing are not required to have the high standards of quality control used by clinical diagnostic laboratories.

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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.

    Submission And Collection Notes

    If European Lyme disease testing is required: enter ‘European Lyme disease’ under Test Description of the and provide travel history including location of travel and dates.

    European Lyme is referred to the National Microbiology Laboratory in Winnipeg.

    Indicate the following on the :

    • date of onset
    • exposure

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    Diagnosis Testing And Treatment

    You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon how long youve been infected. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.

    Several weeks after infection, FDA cleared tests have very good sensitivity.

    It is possible for someone who was infected with Lyme disease to test negative because:

  • Some people who receive antibiotics early in disease may not have a fully developed antibody response or may only develop an antibody response at levels too low to be detected by the test.
  • Antibodies against Lyme disease bacteria usually take a few weeks to develop, so tests performed before this time may be negative even if the person is infected. In this case, if the person is retested a few weeks later, they should have a positive test if they have Lyme disease. It is not until 4 to 6 weeks have passed that the test is likely to be positive. This does not mean that the test is bad, only that it needs to be used correctly.
  • If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately.

  • Telford SR, Wormser GP. Bartonella transmission by ticks not established.Emerg Infect Dis. 2010 Mar 16 379-84.
    • Report being bitten by a tick, or
    • Live in, or have recently visited, a tick-infested area.

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