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Do I Need A Lyme Disease Test

Update on the Laboratory Diagnosis of Lyme and Other Tick borne Diseases TBDs

Your doctor will consider whether your symptoms and risk factors suggest Lyme disease when deciding whether you need a Lyme test. Laboratory tests can support a clinical diagnosis, but should not be used on their own to confirm or rule out a current Lyme disease diagnosis.

Your doctor may also do tests to see if other conditions with similar or overlapping symptoms for example, thyroid disease, autoimmune disease, or other tick-borne diseases could be causing your symptoms. If you have been traveling, your doctor might test you for species of Borrelia that cause Lyme disease in other parts of the world.

If you think you may have Lyme disease, but your doctor hasnt considered it or has ruled it out before testing you for it, heres how you can start a conversation: Give your doctor a list of Lyme disease symptoms and risk factors , and ask them if, given your own symptoms and risk factors, Lyme disease could be a possible cause and whether you should be tested.

In some cases, a Lyme test may not be helpful. Using todays tests it is difficult to distinguish between current and previous infections, so if you were previously diagnosed with Lyme disease and may have been re-infected, your doctor should make the diagnosis based on your symptoms and risk factors.

Tick Testing

What Is A Lyme Disease Blood Test

A Lyme disease blood test is used to determine if you have contracted Borrelia burgdorferi , the bacterium that causes Lyme disease. Lyme disease tests are conducted with a routine blood draw.

While there are other species of Borrelia that cause Lyme disease, B. burgdorferi is the most common cause in the United States. Most antibody tests in the United States only test for B. burgdorferi, but other species-specific tests are available depending on a persons travel history.

Lyme disease is transmitted to humans through ticks that are infected with Borrelia.

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Lyme disease can be difficult to diagnose. Ticks are very small, and the bites are not always noticeable. Symptoms of the disease can vary from person to person. Not everyone experiences the classic bulls-eye rash pattern around a tick bite.

It should be noted that testing is not always required to make a diagnosis. For people with a classic bulls-eye rash living in a high risk area, testing is not recommended for diagnosis.

Your doctor will use the results of a Lyme disease antibody test, along with the report of your symptoms, to confirm a diagnosis.

Antibodies are proteins your body makes in response to foreign or harmful substances called antigens. Common antigens include:

Your body produces antibodies if you have contracted B. burgdorferi. These Lyme disease-specific antibodies will be present in your blood, and your test will be positive if you have the bacterial infection.

Which B Burgdorferi Antigens Are Used And How Is The Test Interpreted

The Equine Lyme Multiplex assay is based on three antigens, called outer surface proteins , of B. burgdorferi. Various research studies have shown that Osp antigen expression changes on the bacterial surface in response to tick feeding and again after infection of a warm-blooded host, such as dogs, horses, or humans . In response to infection, horses develop antibodies to these Osp proteins and testing for antibodies to specific Osp antigens can assist in the diagnosis of infection and Lyme disease.

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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 .

What Is An At

Lyme Disease Tests

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.

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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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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.

Types Of Lyme Disease Tests

Antibody titer tests for Lyme disease measure antibodies that are specific to the bacteria that can trigger the condition. Antibodies are part of the bodys immune response. Tests look for two types of antibodies, known as immunoglobulin M and immunoglobulin G .

IgM antibodies usually peak within a few weeks after an infection with Borrelia bacteria and start to collapse 4-6 months after infection. IgG antibodies are slower to develop, beginning to show 4-6 weeks after exposure and may peak 4-6 months after exposure. While IgM tends to be associated with an active infection, both IgM and IgG can persist in the blood for many years.

The Centers for Disease Control and Prevention recommends a two-stage or two-tiered test for these antibodies. If the initial blood test is positive for IgM or IgG antibodies associated with the Borrelia bacteria, a second test is done, often using different laboratory methods.

Testing for IgM and IgG can support the finding that you have been exposed to Borrelia, but this on its own does not prove whether or not you have Lyme disease.

Follow-up testing may be necessary if testing is inconclusive. This could involve repeat blood tests or the use of different types of medical tests to rule out other health conditions. In people suspected of bacterial reinfection, imaging tests may be used to detect joint inflammation.

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If The C6 Test Is Positive What Is The Next Step

A positive C6 test means antibodies to C6 were found. The next step is to do a QC6 test, which determines if the levels of antibody are high enough to justify treatment. If the value of the QC6 is higher than 30 IU/mL and signs of illness are present, then antibiotic treatment should be considered. If the QC6 is less than 30 IU/mL and there are no signs of illness, then treatment may not be necessary.

In addition to doing the QC6 test, your veterinarian may want to take samples of blood and urine to assess kidney function and to look for protein in the urine. A positive test for protein in the urine could signal serious underlying kidney disease.

How Do You Diagnose The Later Stages Of Lyme Disease

Modified two-tiered testing for Lyme disease

Disseminated Lyme disease, due to unsuccessful or delayed treatment, can become disabling. The bacteria can leave the skin where it was initially inoculated by the tick and travel through the bloodstream to numerous systems of the body, primarily joints, heart, brain, muscles and the nervous system.

Late disseminated Lyme disease has a wide range of presentations including joint pain, extreme fatigue, neuromuscular pain, cardiac problems, headaches, and other central nervous system dysfunction. There are some distinguishable signs of later stage Lyme disease including facial palsy in the second stage, and swollen knees in the third stage that are somewhat specific for Lyme disease, but not absolutely, because there are other causes of Bells Palsy and swollen knees.

Diagnosis can be confirmed by serology blood tests which measure the antibodies that are formed by the immune system in response to the Lyme disease bacterial infection. Collection of cerebrospinal fluid by lumbar puncture may be indicated in neurologic cases that may involve the central nervous system.

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What Is The Most Accurate Test For Lyme Disease

Lyme disease is more common than many people think. Figures from the Center for Disease Control suggest that roughly 300,000 Lyme disease cases occur every year in the US.

The numbers are alarming, but it gets worse as finding accurate diagnostic tests can be challenging. Although the disease is treatable, it is nearly impossible to tackle it effectively if it is not diagnosed accurately and early enough.

Late detection can lead to severe health problems such as arthritis, heart blockage, and inability to concentrate, among other problems.

Given the prevalence and seeming elusiveness of the disease, some of the logical questions concerned persons would ask are: what is the most accurate test for Lyme disease? And when should I get checked for Lyme disease? This article will proffer answers to these and many other related questions. But first, a little background would be in order.

So When Do You Need Blood Tests For Lyme Disease

In some cases, you can have Lyme disease without the rash. Or you may not see the rash before it goes away on its own.

In these cases, your doctor should ask you about your medical history and do a thorough physical exam. Your doctor should look for these signs that you might have Lyme disease:

  • You were in an area with ticks and Lyme disease.
  • You also have fever or redness, warmth, and swelling in one or a few joints at a time usually the knees, shoulders, or wrists.

Other symptoms can occur later on. Talk to your doctor about testing and treatment choices.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2013

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Is This Test Right For Me

This test may be right for you if:

  • You spent time in an area where Lyme disease is prevalent
  • You have been in outdoor areas where ticks live
  • You are experiencing symptoms such as rash, fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes

If you are experiencing heart or neurologic symptoms, please seek immediate medical attention.

This test may not be right for you if:

  • The tick bite occurred within the past 2 to 3 weeks
  • You are not experiencing symptoms

Where Is Lyme Disease Found

Choosing A Lyme Disease Test

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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How To Test For Lyme Disease

Wondering how to get tested for Lyme disease? The Centers for Disease Control and Prevention suggests a two-step testing process to check for a Lyme disease infection, both of which involve antibody testing , typically done on the same blood sample.

If the first step in the process returns a negative test result, then the second step is not necessary. However, if the first step yields a positive result, the second test is recommended as confirmation of a Lyme disease diagnosis. The Everlywell Lyme Disease Test follows this recommended protocol from the CDC, so it includes the two-step testing process.

Prevention Of Lyme Disease

Reducing the risk of tick bites is one obvious strategy to prevent Lyme disease. In endemic areas, clearing brush and trees, removing leaf litter and woodpiles, and keeping grass mowed may reduce exposure to ticks. Application of pesticides to residential properties is effective in suppressing populations of ticks but may be harmful to other wildlife and people.

Tick and insect repellents that contain N,N-diethyl-meta-toluamide applied to the skin provide additional protection but require frequent reapplication. Serious neurologic complications in children from frequent or excessive application of DEET-containing repellents have been reported, but they are rare and the risk is low when these products are used according to instructions on the labels. Use of products with concentrations of DEET greater than 30% is not necessary and increases the risk of adverse effects. DEET should be applied sparingly only to exposed skin but not to the face, hands, or skin that is irritated or abraded. After one returns indoors, skin that was treated should be washed with soap and water. Permethrin is available in a spray for application to clothing only and is particularly effective because it kills ticks on contact.

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Limitations Of Serologic Tests For Lyme Disease

Currently available serologic tests have inherent limitations:

  • Antibodies against B burgdorferi take at least 1 week to develop

  • The background rate of seropositivity in endemic areas can be up to 4%, affecting the utility of a positive test result

  • Serologic tests cannot be used as tests of cure because antibodies can persist for months to years even after appropriate antimicrobial therapy and cure of disease thus, a positive serologic result could represent active infection or remote exposure

  • Antibodies can cross-react with related bacteria, including other borrelial or treponemal spirochetes

  • False-positive serologic test results can also occur in association with other medical conditions such as polyclonal gammopathies and systemic lupus erythematosus.

What Is The Difference Between This Indirect Blood Diagnostic Test And A Direct Test

What is Lyme Disease? | Lyme Disease Causes, Symptoms & Treatment

Direct diagnostic tests measure the presence of the bacteria directly and are much more reliable than tests looking for indirect measurement of antibodies that measure a persons immune response to an infection. Lyme disease diagnoses and disease management would benefit from validated diagnostic tests that directly measure the infection such as a culture, PCR test, or antigen detection tests. Direct tests are vital to the management of other infectious diseases such as HIV, hepatitis C, strep, and COVID-19, but have not yet become widely available for Lyme disease.

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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.

What Do The Results Mean

Lyme disease is difficult to diagnose. The symptoms are common to many conditions, and test results alone can’t diagnose the disease. To make a diagnosis, your provider will consider your test results along with your medical history, exposure, and symptoms. You may also need other tests.

A negative blood test result means that antibodies to fight the Lyme disease bacteria were not found in your blood. If you had symptoms for longer than 30 days before your test, you probably don’t have Lyme disease.

But if you had symptoms for less than 30 days before you gave your blood sample, you may need to have another Lyme disease test. That’s because it may take a few weeks for your body to make enough antibodies to show up on a test. If your test was done too soon, you could be infected even though your test was negative. This is called a “false negative.”

A positive blood test result means that antibodies to fight the Lyme disease bacteria were found in your blood. In this case, the Centers for Disease Control and Prevention recommends a second blood test on the same blood sample. If the second test is positive and you have symptoms of infection, you probably have Lyme disease.

But positive test results don’t always mean that Lyme disease is causing your symptoms. You could have antibodies from a past case of Lyme disease that your body successfully fought off months or even years ago.

Learn more about laboratory tests, reference ranges, and understanding results.

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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.

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