Terms And Definitions For Lyme Tests
To help understand when to use a test or the meaning of a result physicians consider the test sensitivity, specificity, prevalence, and predictive value.
Sensitivity is the ability of a test to find an illness in all people with the illness.
Specificity is the ability of a test to correctly identify people without an illness from all people who do not have the illness.
Sensitivity and specificity are related. In general if a test is very sensitive and can find a very high percentage of people with an infection it is usually less specific. Sensitivity is the ability to find an infection when present while specificity indicates the accuracy of the positive test. A highly sensitive test often has many false positives and a lower specificity.
Let me use a fishing analogy. To catch 100% of salmon in a one mile square section of the ocean using a net a fishing boat will also capture many mackerel, halibut and other fish. That is to say it is very sensitive for finding all of the salmon. However fishing for all of those salmon using a net is not that specific because many other types of fish are also pulled in.
Prevalence is the amount of an illness as percentage or proportion of certain population.
Key Points To Remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
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.
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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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Question 10 What Other Infections Can A Tick Transmit To Humans Besides Lyme Disease
I scapularis ticks can also carry other human pathogens that have a high degree of symptom overlap, including Borrelia miyamotoi, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Babesia microti.2,10-12 Several studies on co-infected ticks indicate as many as 20% of Ixodid ticks can be coinfected with B burgdorferi and one or more of these other tick-borne human pathogens.10-12
Molecular tests can be useful to detect these organisms in early/acute stages of infection, when genetic material from the pathogen can be detected but antibodies remain below the limit of detection of serologic assays.2,10-12 Quest offers molecular and/or serological tests for B burgdorferi, B miyamotoi, A phagocytophilum, E chaffeensis, and B microti, individually and in 2 panels .
Read Also: When Should You Get Tested For Lyme Disease
The Most Common Lyme Disease Blood Tests
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.
Elisa And Ifa: Grade F
These are screening tests to see if a person has antibodies that attach to the covering of Lyme germs. Unfortunately not only do Lyme antibodies attach but other types of antibodies made against viral infections or other germs can also attach. Because of this these are “could” tests. When these tests are positive they indicate that a person could have antibodies against a Lyme germ.
As a screening test for Lyme the ELISA and IFA are very poor. In fact numerous studies indicate an ELISA test only has a sensitivity of 50%.
Believe it or not, even with such poor reliability, the CDC and the Infectious Disease Society of America recommend this as the first test to perform on a person suspected of having Lyme disease. They recommend a two step method that includes an ELISA or IFA as step one. If one of these are positive then the second step is to perform a western blot which I describe below.
Grade: F. These tests have such a low sensitivity that they should not be used. They are an absolute waste of money even when performed by a high quality Lyme testing lab such as IGenex.
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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.|
A Better Plan Starts With More Insight
When a patient has a complex or chronic infection, care planning often requires convenient, easy specimen collection, comprehensive testing, and extensive support. With flexible tests and screens for a wide range of diseases, Quest Diagnostics provides you the actionable insights that help you provide the best care possible.
From hepatitis and tuberculosis to human immunodeficiency virus , tick-borne disease, and other infections, our testing menu is both diverse and innovative, accounting for resistant organisms and newly emerging strains of some of the most dangerous pathogens. You can also count on our suite of integrated servicesincluding patient reminders and appointment schedulingto optimize compliance during monitoring, treatment, and follow-up.
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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.
Lyme Disease Testing & Results
To get the Lyme disease test near you, simply order online and get tested at the selected Quest Diagnostics lab location. Once the Lyme disease test results are available, they will be available for download. Many people wonder whether fasting is required and how long results take for the Lyme test. Fasting is not required when getting a Lyme disease blood test and results are typically available in 4 business days or less. As can be seen on the sample Lyme disease screening test report above, the Lyme antibody screen will report the antibody levels which can be compared against a reference range provided by the lab. If Lyme disease antibodies are detected, the Lyme western blot test will be performed and reported to provide more detail. This Lyme disease test is a component of the more comprehensive infection panel test that screens for a variety of infections.
In most cases, Lyme disease can be treated effectively with common antibiotics such as doxycycline, cefuroxime and amoxicillin. The risk of being exposed to Lyme disease in the first place can be reduced by avoiding regions with infected ticks. When in an at-risk location, it is recommended to wear a hat, long sleeve shirts and long pants and to use insect repellants like DEET. A recombinant Lyme vaccine used to exist but is no longer available.
- A doctor’s lab order*
- A PDF copy of your test results
- Responsive customer service
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Critical Thinking In Research And Clinical Practice
Above and beyond the direct impact of these research findings, Sanderson points out that doing research and using her critical thinking skills enables her to better understand what she is learning and will have a direct impact on patients lives. Taking the time to learn about the challenges that Lyme patients are faced with has taught her the importance of listening to patients not only to obtain a better understanding of their overall health but also to make sure they feel heard and cared for. Thank you Victoria for sharing your ground breaking research with us. We look forward to hearing more from you in the future!
If The Lyme Disease Test Is Negative What Then
Testing Too Soon Can Lead to Negative Test Results
A Negative Lyme Test, or an Inadequate Response to Treatment, Doesnt Mean No Tick-borne Disease
Rocky Mountain Spotted Fever
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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.
The Quest For Better Tests
New approaches to Lyme diagnostics with Victoria Sanderson.
In todays podcast, Sarah speaks with Victoria Sanderson about her exciting new research into Lyme disease testing at the University of Guelph. Sanderson is a current medical student and previously completed her Masters degree at the University of Guelph and became interested in Lyme disease after seeing how much the disease impacted her mothers life and the lives of so many others. Having an acute interest in biology, she started to study Lyme disease and quickly became fascinated with its complex microbiology and pathology. She connected with the G. Magnotta Lab at the University of Guelph where she works with a team of world class researchers. You can find out more about the G. Magnotta Lab in this episode of the Looking at Lyme podcast.
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Immunoblot Using Western Blot Method: Grade B
An immunoblot determines if antibodies from a person’s blood attach to proteins separated from dead Lyme germs. In a western blot method whole Lyme germs are killed, and then all of its proteins are separated on a test strip using an electrical current. This causes all proteins that weigh the same to distribute to the same part of the test strip. The proteins are identified based on what they weigh and are called bands. They are measured in kilodaltons which is a microscopic unit of weight. There are 6 bands with antibodies attached that can indicate a Lyme infection. These are the 18 Kda, 23-25 Kda, 31 Kda, 34 Kda, 39 Kda, and 83-93 Kda proteins. Some physicians do not consider the 18 Kda to be one of these. To increase the predictive value of the test for a person, it is best to have antibodies against at least 2 of these bands. Having 2 bands present though decreases the test sensitivity.
One problem with a western blot is that the proteins found at band 31 can include proteins that are not always specific for Lyme infection. And the band 41 and 93 proteins have regions that antibodies against other germs attach to. This can result in falsely positive tests. An immunoblot using synthetic proteins grown through recombinant DNA methods can over come this problem. Through artificial production of Lyme proteins, only the regions of the proteins that are unique to Lyme and not other infections are used in the testing method. .
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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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.
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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