Patient First Lyme Disease Test

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.

Investigation Of Suspected Lyme Disease

Erythema migrans is a clinical diagnosis and does not require confirmation by laboratory testing. Lyme disease is not a notifiable disease so there is no statutory requirement to notify clinically suspected cases to the local Health Protection Team.

The 2018 NICE Lyme disease guideline provides detailed advice about when a diagnosis of Lyme disease should be suspected and about which tests to use and when.

The NICE Lyme disease guideline also contains a useful summary diagram of the routine serological testing recommendations for Lyme disease.

When A Lyme Diagnosis Is Tricky

There are several reasons it can be hard to diagnose Lyme disease.

• Tests are less accurate for a short period of time after you first become infected. Thats because Lyme tests look for proteins created by your immune system to help you fight off infection , rather than for the infection itself, and it can take a few weeks for your body to make enough antibodies to cause a positive test.

• The only sure sign of Lyme disease is an erythema migrans rash, which often has a bullseye shape. But up to 30% of people who get Lyme disease never get a rash. It is also possible that a person may not notice a rash before it goes away.

• Symptoms of Lyme disease like fever and body aches can also be caused by other illnesses. This may result in Lyme diagnoses being missed because symptoms are attributed to another illness.

• Using todays tests, it is difficult to distinguish between an old Lyme disease infection and a new one.

Thats why Lyme disease cases may be missed, and as many as 40% of Lyme disease cases are not diagnosed until a later stage of the disease. By that time, Lyme disease is harder to treat, and long-term complications are more likely, so an early, accurate diagnosis is very important.

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Erythema Migrans ‘bullseye Rash Of Lyme Disease

Rash – the classical symptom of Lyme disease is a typical rash called erythema migrans. However, this does not always occur. It may depend on which species of borrelia is involved. In the UK, most people with Lyme disease have or have had this rash.

The rash is usually a single circular red mark that spreads outwards slowly over several days. The circle becomes bigger and bigger with the centre of the circle being where the tick bite occurred. As it spreads outwards, a paler area of skin emerges on the inner part of the circle. Therefore, the rash is often called a ‘bullseye’ rash. Some types of the germ do not cause a rash, or the rash is different. For example, in the USA, the rash is less likely to have the ‘bullseye’ appearance.

The rash usually spreads over at least 5 cm but may be much bigger.

The rash is not usually painful or particularly itchy. You may not even notice it if it is on your back. Without treatment, erythema migrans typically fades within 3-4 weeks. However, just because the rash fades it does not necessarily mean the infection has cleared from the body.

Note: many insect bites cause a small red blotchy ‘allergic’ rash to appear soon after the skin is bitten. These soon go away. The rash of erythema migrans is different in that it usually develops several days after the bite, lasts for longer and has a typical spreading circular appearance.

What Happens During Lyme Disease Testing

Lyme disease testing is usually done on a sample of blood. In certain cases, a cerebrospinal fluid test may be done.

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.

For a CSF test:You may need a cerebrospinal fluid test if your symptoms could mean that Lyme disease is affecting your nervous system, such as a stiff neck or numb hands or feet. Providers may order a CSF test if the results of your blood test show you likely have Lyme disease or if the results are uncertain.

To get a sample of your cerebrospinal fluid, a provider will do a procedure called a lumbar puncture, also known as a spinal tap. During the procedure:

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What Can I Do To Lower My Chances Of Getting Lyme Disease Or Any Other Disease From Ticks

Prevention begins with you! Take steps to reduce your chances of being bitten by any tick. Ticks are most active during warm weather, generally late spring through fall. However, ticks can be out any time that temperatures are above freezing. Ticks cling to vegetation and are most numerous in brushy, wooded or grassy habitats. When you are outside in an area likely to have ticks , follow these simple steps to protect yourself and your loved ones:

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You Do Not Usually Need Tests To Show That You Have Lyme Disease

In most cases, theres a clear sign of Lyme diseasea painless, spreading rash that often grows to look like a bulls eye. If you have this rash, and you recently had a tick bite or were in an area known for Lyme disease, you dont need a test. Instead, your doctor can just start treating you with antibiotics, as appropriate.

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Traditional Lyme Disease Testing Misses The Mark

The most common testing used for diagnosing Lyme disease is the two-tiered CDC recommended tests. These include the ELISA and the Western Blot. Both are indirect tests in that they merely measure the immune systems response to an infectious agent instead of looking for evidence or components of the agent itself. Many physicians falsely yield to the CDC definition case of Lyme disease to make a diagnosis. However, these tests were originally designed for surveillance of one single species of Borrelia. The tests were never intended to be used in making clinical diagnosis. These standard Lyme tests can give false negatives between 50% and 80% of the time, depending on which study you are looking at. Even on the CDC website, they state, Lyme disease is diagnosed based on symptoms, physical findings and the possibility of exposure to ticks. Yet, despite this information, doctors are still relying on laboratory tests to definitively determine whether a patient has the disease or not. This current method of diagnosing has serious and sometimes deadly consequences for patients who indeed have Lyme disease and/or co-infections, but do not receive treatment due to a negative lab result.

Limitations Of Lyme Disease Testing

Unfortunately, the two-tier testing for Lyme disease recommended by the CDC misses approximately one-half of actual cases pursuant to numerous peer reviewed studies. States like Maryland and Virginia have enacted laws requiring laboratories or doctors to explicitly inform you that you may still have the infection, even if you test negative for Lyme disease.

Simply put, you cant rule out Lyme with existing laboratory tests. Based on the limits of two-tiered serological testing, a clinical diagnosis is often necessary.

If initial Lyme disease tests dont show evidence of exposure to Borrelia burgdorferi, consider the following options:

Alternative Western Blot Alternative Criteria

Western Blot test results will include both IgG and IgM assays. Carefully consider Lyme-specific bands . Many Lyme specialists believe a single Lyme-specific band, along with a patients clinical presentation, is sufficient to diagnose Lyme disease. Likewise, in China, a single positive IgG band coupled with a single IgM band is considered to be a positive Western Blot when the patient also has symptoms of Lyme.

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Serology And Dna Testing

There are two main types of Lyme testing. The first one tests the bodys reaction to the bacteria. You can do this by detecting whether antibodies are being created against that particular microbe. Secondly, you can check for the presence particles of the DNA of the bacteria.

There are other types of testing available, but the above are the two main types, namely, serology or antibody testing and, DNA or PCR testing.

Both these types of tests are designed to detect acute Lyme disease.

In the initial stages of infection, the bacteria is still in the blood, and it is relatively easy to find it. Later on however when the bacteria have moved away from the blood and invaded the tissue, then it becomes harder to detect.

This latter scenario highlights one of the problems with testing for Lyme in that many people who are initially infected with Lyme often do not have an acute reaction.

Many people begin to exhibit symptoms much later after their immune system begins to deteriorate, and by then the bacteria is deeply embedded in tissue.

So whether you are going to find the bacteria depends on firstly if the concentration of microbes in tissue is high enough to give a reaction and secondly if the immune system is reacting to it.

In acute Lyme, research shows that current testing has a pickup rate of 95%. On the flip side, in chronic Lyme, scientists do not know the pickup rate. They do not know if it a 30% pickup rate or 80%.

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Molecular Testing For Detection Of Borrelia Species Bacterial Dna

PCR is available for Borrelia species DNA detection but is of limited value in routine testing for Lyme disease because the organism is only present in blood during the early stages of the disease and is predominantly restricted to the affected tissues.

Diagnostic molecular testing for Borrelia species DNA is available on request for relevant specimen types. Please call RIPL to discuss individual cases.

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Who Should Get Testing

Testing is usually indicated if a person has symptoms of Lyme disease and a known or possible exposure to ticks that can carry the Borrelia bacteria. However, because it takes time for antibodies to develop, the timing of testing is important to consider.

Lyme disease symptoms depend on the extent of the bacterial infection. Three phases are used to describe the infection:

It is important to understand these phases because testing is not equally valuable in each stage. With early localized disease and erythema migrans, blood testing is generally not helpful because antibodies have not had enough time to develop.

Because of similar concerns about potential false positive results, random screening for Lyme disease in people without symptoms is not recommended even in areas that are known to have ticks that can carry the Borrelia bacteria.

Lyme Disease Test Two

Two-tiered Lyme disease testing uses two tests. The first is a screening test that should detect anyone who might have the disease. Tests that do this well have are regarded as having high sensitivity. This test is followed by a second test that is intended to make sure that only people with the disease are diagnosed. Tests that do this well have high specificity.

HIV/AIDS is diagnosed with tests that are both highly sensitive and highly specific. They are accurate more than 99% of the time. In Lyme disease, the second test is highly specific. So there are few false positives. Unfortunately, the screening test is highly insensitive and fails to accurately identify patients who have Lyme disease. The two-tiered test system misses roughly 54% of patients.

Because of this, LDo recommends the patients and physicians skip the ELISA and go straight to the Western blot.

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Her ordeal is a common one every year, some 300,000 people in the United States are diagnosed with Lyme disease, according to the Centers for Disease Control and Prevention, and that number is on the rise. Some people wait months or years to get a correct Lyme diagnosis. And their cases highlight a problem: Tests for Lyme in the first month of infection are frequently wrong. When diagnosed and treated early the infection is a simple one to get rid of, but left untreated it can cause a myriad of lingering symptoms, from severe arthritis to short-term memory problems.

Now, a number of research groups are working to improve Lyme tests to catch infections in the early stages. One avenue being studied by the CDC aims to create a Lyme signature of small molecules in the blood an approach that, in early testing, catches a dramatically higher share of early infections.

Is There Anything Else I Need To Know About Lyme Disease Tests

At-home test kits for Lyme disease are available. To do these tests, you usually collect a drop of blood from your finger and send it to a lab for testing. If you want to do an at-home test, it’s important to talk with your provider first. Some at-home tests may use lab methods that aren’t proven to work, so your results may not be accurate.

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What Are The Symptoms Of Lyme Disease

Early stage : The most common early symptom is a rash where the tick was attached. It often, but not always, starts as a small red area that spreads outward, clearing up in the center so it looks like a donut. Flu-like symptoms, such as fever, headache, stiff neck, sore and aching muscles and joints, fatigue and swollen glands may also occur. Even though these symptoms may go away by themselves, without medical treatment, some people will get the rash again in other places on their bodies, and many will experience more serious problems. Treatment during the early stage prevents later, more serious problems.

Later stages : If untreated, people with Lyme disease can develop late-stage symptoms even if they never had a rash. The joints, nervous system and heart are most commonly affected.

• About 60% of people with untreated Lyme disease get arthritis in their knees, elbows and/or wrists. The arthritis can move from joint to joint and become chronic.
• Many people who dont get treatment develop nervous system problems. These problems include meningitis , facial weakness or other problems with nerves of the head, and weakness or pain in the hands, arms, feet and/or legs. These symptoms can last for months, often shifting between mild and severe.
• The heart also can be affected in Lyme disease, with slowing down of the heart rate and fainting. The effect on the heart can be early or late.

Focus Group Data Collection And Analysis

The initial target study population included primary care and emergency and urgent healthcare providers practicing in a small-town community endemic to Lyme disease with emerging incidence of additional TBDs. Invitation emails for focus group participation were sent to practice managers and medical directors for medical practices employing members of the study target population. Researchers coordinated with these key contacts within the practices to schedule in-person focus groups at a date and time convenient to the participating providers. Focus groups were scheduled in late fall 2018 and early spring 2019. Participants included both prescribing and non-prescribing providers.

Academic project team members developed guided focus group questions covering current knowledge, perceived challenges, and needed resources on tick-borne illness, which were reviewed by physician and health department team members prior to finalization . Focus groups were hosted at each participating practices office location and time-appropriate meals were offered to participants. After receiving verbal informed consent from participants, a project team member trained in qualitative interviewing techniques led a group discussion based on the guided questions. All focus groups were audio-recorded and transcribed verbatim for analysis. No names or other personally identifiable information were recorded in the transcripts, including the business names of the participating clinics.

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