The Best Test For Lyme Disease
Lyme disease is a tick-borne illness spread by Lyme borreliaebacteria which includes, but is not limited to, Borrelia burgdorferi sensu stricto. The Centers for Disease Control and Prevention estimate that there are 400,000 cases of Lyme disease annually, making Lyme a serious public health concern that only stands to grow as the spread of ticks affects disease endemicity and seasonality.
One of the biggest challenges of fighting Lyme disease is providing patients with accurate diagnostic tests. Without access to the best tests for Lyme disease, its impossible to diagnose this treatable disease in a timely manner. When the disease isnt caught in time, it can spread throughout the body and cause chronic health problems that could otherwise be avoided with earlier detection and treatment.
Viral Hepatitis Infection A
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Question 6 Can Serologic Testing Detect Lyme Disease Immediately After Infection
No, not immediately. Lyme disease develops in stages: the early stage, which is divided into early localized infection, early disseminated, and then a late disseminated infection.1 Spirochetemia occurs early, with widespread dissemination through tissue and body fluids. However, antibodies usually take at least 2 weeks to develop, so patients may be seronegative within 2 weeks of a suspected tick bite.1-3 The sensitivity of serologic testing increases markedly with the progression of B burgdorferi infection from early to late Lyme disease.
Identification of Borrelia species DNA in the blood by polymerase chain reaction may be useful in the first two weeks of infection.1
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What Are The Symptoms Of Lyme Disease
Lyme Disease is a bacterial infection that results from a tick bite. The symptoms vary, and you can feel sick for months because of it. Some of the most common symptoms of Lyme disease are flu-like symptoms such as fever, chills, and headache. A rash can also occur in 70 to 80 percent of infections. If left untreated, the symptoms can worsen into facial palsy, dizziness, heart palpitations, and more.
If The Lyme Disease Test Is Negative What Then
Testing Too Soon Can Lead to Negative Test Results
Borrelia burgdorferi
A Negative Lyme Test, or an Inadequate Response to Treatment, Doesnt Mean No Tick-borne Disease
Borrelia
Anaplasmosis
Anaplasma phagocytophilum
Babesiosis
Babesia microti
Ehrlichiosis
Ehrlichia
Rocky Mountain Spotted Fever
RickettsiaAnaplasmaBabesiaBorreliaEhrlichia
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Question 4 What Tests To Assist In The Diagnosis Of Lyme Disease Are Available At Quest
Serologic testing is the principal means of laboratory diagnosis of Lyme disease. Quest offers testing in accordance with the Centers for Disease Control and Prevention guidelines for early/acute Lyme testing.3 When laboratory diagnosis is indicated, current recommendations include using a 2-tier testing approach that begins with a sensitive enzyme immunoassay , followed by a confirmatory immunoassay for specimens yielding positive or equivocal results.3 In the standard 2-tier test algorithm, a Western blot or immunoblot assay is used for confirmation. However, on July 29, 2019, the US Food and Drug Administration cleared several Lyme disease serologic assays with new indications for use, which allowed an EIA to be used as the confirmatory test in a modified 2-tier testing algorithm.3 The MTTT algorithm is now considered an acceptable approach for the serologic diagnosis of Lyme disease and may be able to assist in the identification of early Lyme disease within the first 30 days of infection.3
Quest offers test options that use both the STTT and the MTTT algorithm:
- STTT: Lyme Disease Ab with Reflex to Blot
- MTTT: Lyme Disease Antibody with Reflex to Immunoassay
Click here for a complete list of additional tests for tick-borne infectious diseases available from Quest.
A Comprehensive Range Of Testing
Make more informed, confident diagnostic and treatment decisions relying on our extensive infectious disease test menu. Our quantitative and qualitative assays help physicians not only screen for and identify pathogens, but help in assessing treatment response and drug resistance, and in planning appropriate care.
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Stony Brook University Medical Center
Administered in conjunction with the Clinical Immunology Laboratory in the Department of Pathology at the Renaissance School of Medicine at Stony Brook University, the IgM and IgG Western Blot Lyme disease test is often covered by insurance. This is considered a more sensitive test if the ordering healthcare provider checks the box to include CDC non-specific bands on the Western Blot report.
There Are Many Types Of Lyme Tests
There are a variety of tests that can help diagnose Lyme disease by finding evidence of Lyme infection. These include ELISA, IFA, PCR, immunoblot done as a western blot, the new immunoblot with synthetic proteins, Elispot, and blood culture. Although these tests are helpful aids they are far from perfect. In this article I review each of these tests and give them a grade. With these grades in mind, I describe the way I use these tests to help decide if someone has Lyme disease.
At the end of the article I tell you what I think the best Lyme test is and why.
As you read about the tests, note that a test does not diagnose a disease. In my Seattle practice I, I did not treat a test I treated a person. Tests can be wrong. To make a diagnosis consider
- the risks of getting the infection like having a known tick bite, or a history of hiking where there are a lot of ticks that carry Lyme like in Minnesota, or a number of other risk factors,
- the symptoms,
- physical exam findings, and
- whether there is supportive testing.
Note that I said supportive testing. So the result of testing is only one part to consider in making a diagnosis. See How to Diagnose Chronic Lyme Disease. More Than A Test. for more information about this complex issue.
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Its Past Time To Take Ticks Seriously
Lyme disease is only one of 16 tick-borne disease found within the United States. How many other illnesses are being undiagnosed and/or underreported? Is there also a 10-fold difference in reporting of anaplasmosis, babesiosis, rickettsiosis and other tick-borne pathogens, including viruses?
The CDC recently acknowledged that 75% of all reported vector-borne illnesses come from ticks, and of those, most are cases of Lyme disease
Underreporting of Lyme and other tick-borne diseases is a huge problem. Its time to fix it.
LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. Follow her on Twitter: Email her at: lmarcum@lymedisease.org .
Reference:
Question 12 Where Can I Find Information On Additional Tests For Tick
Click here for a list of additional tests for tick-borne infectious diseases at Quest.
References
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New Quest Diagnostics Data Shows Lyme Disease Prevalence Increasing And Is Now Present In New Us States
Number of positive tests for Lyme disease increased significantly between 2016 and 2017.
Historically concentrated in Pennsylvania and New England states, Lyme disease has been detected in each of the 50 United States and the District of Columbia.
Outside of the northeastern U.S., California and Florida states not historically associated with significant rates of Lyme disease saw the largest absolute increases in positive Lyme disease test results.
Notable increases also observed in Georgia, Arizona, Ohio, Texas, Tennessee and Virginia.
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Lyme Disease Test Western Blot
Labs performing a Western blot use electricity to separate proteins called antigens into bands. The read-out from the Western blot looks like a bar code. The lab compares the pattern produced by running the test with your blood to a template pattern representing known cases of Lyme disease. If your blot has bands in the right places, and the right number of bands, it is positive.
The CDC requires 5 out of 10 bands for a positive test result. However, because some bands on the Western blot are more significant than others your doctor may decide you have Lyme disease even if your Western blot does not have the number of bands or specific bands recommended by the CDC. Different laboratories use different methods and criteria for interpreting the test, so you can have a positive test result from one lab and a negative test result from another.
For a comprehensive explanation of the western blot test, download Understanding Western Blot Lyme disease test.
The chart below will help you understand how to interpret the western blot test.
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How Can I Take Care Of Myself
To help take care of yourself, follow the full course of treatment prescribed by your health care provider. You need to take all of your antibiotic therapy. Do not stop taking antibiotics because you start to feel better or your symptoms go away. If you have side effects from the antibiotic, call your provider about possibly getting a different prescription.
New Research & Testing Lyme Book $$ For Researchers Available Awareness Activities
| May Lyme Disease Awareness Events May is Lyme Disease Awareness Month! These events, which sometimes start in March, help educate the public and raise funds for Lyme research. Click our calendar icon below to view events hosted by LDAs partners, members of LDAnet, LDAs umbrella organization. Keep checking back for new events. Click below for two conferences, each supported by an education grant from the LDA: In April, the 4th Annual Midcoast Lyme Disease Support & Education Conference at the Augusta Civic Center and in May, the Colorado Tick-Borne Disease Awareness Association Lyme & Other Tick-Borne Diseases: 3rd Rocky Mountain Forum. LDA also provided an education grant for Lyme Society, Inc.1st Annual Lyme and Tick-Borne Disease Conference in May, Staten Island, NY. |
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Lyme Sci: Lyme Has Been Found In All 50 States And Is On The Rise
Quest Diagnostics has released its findings from over six million Lyme disease lab tests taken over the last seven years.
Quests report says Lyme has been detected in all 50 states and the District of Columbiaand that the number of cases continues to rise nationwide.
This report provides the first national analysis of Lyme disease based on laboratory data.
Final Comment About Lyme Tests
I opened this article stating that Lyme is always a clinical diagnosis. Again a test does not diagnose a disease. Also be aware based on the concepts of predictive value and prevalence I present above. Based on these concepts there is a great chance of a false positive test in someone who does not have Lyme disease symptoms. For more information see How to Diagnose Chronic Lyme Disease.
Finally, I am often asked about test from a lab called DNA Connexions. This lab runs a urine pcr test for Lyme and coinfections. I do not order tests from this lab because they have not done any validation studies to prove their tests are accurate. Be aware they have done an effective job marketing to the naturopathic doctor community and some integrative medicine physicians. The reason I am very skeptical is the number of times I saw people in my Seattle practice with positive DNA Connexions testing for bartonella or babesia who simply did not have any symptoms of these coinfections. I suggest staying away from testing from this lab.
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Lyme Blood Culture: C
A United States lab called Advanced Laboratory Services had a Lyme disease blood culture that may have good predictive value in finding Lyme infection. Note: ALS no longer offers this tests. Traditionally the problem with Lyme blood culture has been finding a substance to grow the Lyme germ. ALS has perfected a method that involves three separate steps. In the first step the blood is incubated on a special modified BSK medium. Then after 2 weeks it is transfered to a medium that has a protein matrix. As a third step a PCR techinique is use to determine if the growth on the medium is really borrelia. PCR is a techinique that finds the dna of an infection, in this case borrelia.
There is one study of this technique performed by Eva Sapi PhD and her research group. Of note the research was supported by ALS and Dr. Sapi is a member of the Research Division at ALS. This means there is an inherent bias built into the results of the research to find a positive result supporting the effectiveness of the test.
The test included 72 people who were known to have Lyme based on the very strict standards of the CDC and IDSA. There were also 50 people put in a control group who did not have Lyme. The study results found 94% sensitivity and 100% specificity.
In fact in my limited use of this test I found it missed many that I diagnosed with Lyme disease based on other tests and clinical grounds.
Faster Easier Diagnoses For Tick
As ticks expand their habitat across the US and people travel to and from endemic areas, the incidence of tick-borne diseases continues to increase. Lyme disease and other tick-borne illnesses can vary in severity and symptoms among different patients and different geographic regions. Thats why, when it comes to diagnosing and managing tick-borne illness, knowing when to test and what to test for is essential.
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How Much Do At
Generally, at-home Lyme disease tests cost around $100, while others may cost closer to $500. The difference comes down to how many pathogens you are hoping to test for. On average, the test will look for two or three, but more expensive tests may screen for 10 to 15.
Depending on your insurance and which test you select, it may be covered. Another option is to pay for the Lyme disease test with your HSA/FSA, since some companies will accept that as a payment form.
Newer Immunoblot Using Synthetic Proteins From Igenex: Grade A
In an immunoblot using synthetic proteins grown in bacteria through recombinant dna, only the protein regions specific for Lyme on protein 31, 41, and 93 are grown. This decreases the chances of a false positive testing which I outlined above in the western blot section. In this method, like the western blot above, attention is still paid to certain Lyme specific proteins.
IGenex goes one step further in its new Lyme Immunoblot test and uses 8 different strains of Lyme proteins. These include: B. burgdorferi B31, B. burgdorferi 297, B. californiensis, B. mayonii, B. spielmanii, B. afzelii, B. garinii and B. valaisiana.
Using internal validation standards, an IGM Immunoblot is positive if there are antibodies attached to 2 of the following four proteins: 23, 31, 39, and 41. The IGG Immunoblot is positive if there are antibodies attached to 2 of the following 6 proteins: 23, 31, 34, 39, and 41.
Based on internal validation studies, IGenex reports the tests has a sensitivity of 90.9% and a specificity of 98%. This means this is by far the best test at finding Lyme with a very limited chance of false positives.
Grade: A-. The only reason I do not give this test an A grade is that it still misses 9% of Lyme. This can occur for a variety of reasons including immune suppression making it difficult to make antibodies or due to Lyme hiding where the immune system cannot see the germ.
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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.
Best For Dna Test: Selfdecode
Self Decode
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Tests for chronic conditions related to Lyme disease like PTLDS
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Results in 6-8 weeks
SelfDecode searches for more than Lyme disease. When you take an at-home test through this company, you’ll receive an entire mock-up of your DNA. You will know if you ever had Lyme disease in the past, as well as if you are susceptible to PTLDS, a chronic condition triggered by Lyme Disease.
The test involves taking a simple cheek swab, after which the test is mailed back to the company’s lab. After six to eight weeks, you will receive your results via email, and you will be contacted by a medical professional to see what the next steps are.
This is a subscription service that costs just under roughly $100 a year, so you will be able to check yourself for Lyme disease regularly when the test is shipped out. This service is great for those who enjoy the outdoors and are exposed to ticks a lot.
SelfDecode’s test is not covered by insurance, but most primary care physicians will accept these results.
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