Thursday, June 16, 2022

Should I Be Tested For Lyme Disease

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Is Treatment 100% Effective

Lyme Disease Serologic Testing

Scientists are divided on this topic. Some studies suggest that that even long-term antibiotics may not completely clear infection dogs may get sick again at some point after antibiotic treatment is stopped. Other studies suggest that complete clearance of infection is possible with antibiotic treatment. Further research is required to answer this question.

Contributors: Ryan Llera, BSc, DVM Kristiina Ruotsalo, DVM, DVSc, Dip ACVP Margo S. Tant, BSc, DVM, DVSc

Management Response And Action Plan

Management response and action plan

Recommendation 1

Focus on implementing the action items that are still in the early stages of implementation, or for which more needs to be done to achieve full implementation.

Management response

  • International Treatment Guidelines shared on Canada.ca/Lymedisease.
  • Laboratory diagnostic guidelines from the Canadian Public Health Laboratory Network
  • Laboratory diagnostic reference services from PHAC labs including the National Microbiology Laboratory
  • Treatment Guidelines for localized Lyme disease shared on Canada.ca/Lymedisease

Is There A Blood Test For Lyme Disease

If your doctor suspects that you have Lyme disease, they may order two blood tests. These will look for signs that your body is trying to fight it off. The results are most precise a few weeks after youâve been infected.

These tests are:

ELISA test. This test canât check for the bacteria that causes Lyme disease. It can only look for your immune systemâs response to it.

Once Borrelia burgdorferi gets into your blood, your body begins to make special proteins called antibodies to fight it off. The ELISA test checks for those antibodies.

Although itâs the most common way to check for Lyme disease, the ELISA test isnât perfect. It can sometimes give false âpositiveâ results. On the other hand, if you have it done too soon after youâve been infected, your body may not have developed enough antibodies for the test to detect them. This will give you a ânegativeâ result even though you do have Lyme disease.

Western blot test. Whether your ELISA test comes back positive or negative, your doctor will need to do this blood test, too.

A Western blot uses electricity to split certain proteins in your blood into patterns. This is then compared to the pattern of people known to have Lyme disease.

At least five band matches means that you have Lyme disease. Still, not all labs have the same standards. Thereâs a chance that you could get a âpositiveâ result from one and a ânegativeâ result from another.

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Symptoms Of Lyme Disease

A circular or oval shape rash around a tick bite can be an early symptom of Lyme disease in some people.

The rash can appear up to 3 months after being bitten by an infected tick, but usually appears within 1 to 4 weeks. It can last for several weeks.

The rash can have a darker or lighter area in the centre and might gradually spread. It’s not usually hot or itchy.

The rash may be flat, or slightly raised, and look pink, red, or purple when it appears on white skin. It can be harder to see the rash on brown and black skin and it may look like a bruise.

Some people also get flu-like symptoms a few days or weeks after they were bitten by an infected tick, such as:

  • a high temperature, or feeling hot and shivery
  • headache
  • tiredness and loss of energy

Some people with Lyme disease develop more severe symptoms months or years later.

This is more likely if treatment is delayed.

These more severe symptoms may include:

  • pain and swelling in joints
  • nerve problems such as pain or numbness
  • heart problems
  • trouble with memory or concentration

How Do Patients Test Negative For Lyme Disease In Ireland But Test Positive For Lyme Disease In Another Country

(PDF) What Should Be Done in Case of Persistent Symptoms after Adequate ...

Laboratories in Ireland generally follow the laboratory testing recommendations of the US Centres for Disease Control and Prevention , the Infectious Disease Society of America , the European Federation of Neurological Societies and the British Infection Association .

The antibody tests used in Ireland are made by commercial companies and meet strict quality criteria. Irish laboratories have their own quality assurance methods to make sure the tests are working correctly as well as being accredited by the Irish National Accreditation Body to perform the test correctly.

Testing which is performed abroad may be performed in laboratories which have not met National or International Accreditation . In some cases they may use tests which are made in the laboratory rather than purchased from commercial companies. These tests may not have the same or consistent levels of quality as commercial tests which must meet specific European criteria called CE marking. These tests may be more likely to give a false positive result for those reasons.

Some laboratories abroad do not use antibody tests like the EIA and western blot and instead will use other types of tests. For example, testing for levels of a specific white blood cell or lymphocyte transformation tests . These types of tests are not currently recommended by international groups such as the CDC, IDSA or BIA for a number of reasons:

  • There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease.
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    Questions To Ask Your Veterinarian

    If your dog has a positive Lyme test but no symptoms of the disease or protein in the urine, ask your veterinarian why he or she is recommending treatment. Experts currently recommend against antibiotic therapy under these circumstances because the dogs immune system is holding the bacteria in check and antibiotics are unable to eliminate the infection.

    Dogs who have contracted Lyme disease do not develop prolonged, protective immunity and can be reinfected at a later date. Talk to your veterinarian about how best to prevent future infections. Options include measures to prevent the ticks that carry Lyme disease from biting your dog and Lyme vaccination.

    Where Is Lyme Disease Found

    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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    Can You Use A Serology Test To Diagnose The First Stage Of Lyme Disease

    Serology antibody tests are generally more helpful for second and third stages of Lyme disease than first stage Lyme disease. Antibodies take weeks to develop, and if the initial presentation of Lyme disease is in the early stage those antibody tests may be falsely negative because the immune system has not yet had enough time to produce antibodies. If a physician is suspicious of Lyme disease but cannot make a diagnosis by the rash, then the antibody test in that first stage should be repeated 3 to 4 weeks later since a Lyme disease diagnosis can be missed with a false negative test in the first few weeks.

    The Centers for Disease Control and Prevention recommends using a two-step testing process. If an ELISA test is positive, it is then followed by a Western blot test. However, this antibody-based testing system can produce some false positive results and high numbers of false negative results, particularly in early infection.

    In addition, the immune response to borrelia is heterogeneous, and not all cases are captured by current antibody-based diagnostics. Antibody testing can also be a problem in patients with early disease who are treated with antibiotics. In these cases, a follow up antibody test done after treatment may be negative and never turn positive.

    A negative antibody test does not necessarily rule out Lyme disease and should always be considered in the context of a full health history and clinical assessment.

    Lyme Disease Signs And Symptoms

    Do you know the signs of Lyme disease?

    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
    • 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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    Management Of Individuals Without Symptoms Following A Tick Bite

    Diagnostic testing is not recommended for individuals who do not develop any symptoms suggestive of Lyme disease after a tick bite.

    Some commercial companies offer services to test removed ticks for the presence of the bacteria that cause Lyme disease. PHE does not provide such tick-testing services. The results of such tests should not be used to inform diagnosis or treatment. A positive result does not mean that the infected tick will have passed on the bacteria there are many factors that determine whether Lyme disease results from the bite of an infected tick. A negative result may not be technically valid and could give false assurance, as it does not exclude the possibility that another tick elsewhere on the body has been missed by the patient.

    PHE runs a tick surveillance scheme and is happy to receive ticks for species identification and to monitor tick distribution.

    Borrelia Species Pcr Results

    Borrelia species DNA may occasionally be detected in the blood by PCR, but a negative PCR test is of no value in excluding localised Lyme disease.

    The overall sensitivity of PCR on a skin biopsy of an EM or ACA rash is around 50% and is limited by the chance of a single biopsy hitting a site with a significant number of organisms.

    In neurological Lyme disease involving the CNS, up to 10% of cases may be PCR positive on a CSF sample a negative PCR result does not exclude the diagnosis.

    Synovial fluid may be positive by PCR in up to 50% of cases. A negative result does not exclude the diagnosis.

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    What To Expect At Home

    Home care for dogs with Lyme disease is relatively straightforward. Doxycycline is usually given by mouth twice daily for at least 30 days. Improvement in the dogs symptoms should be noted within 24-48 hours. If the dogs condition fails to improve in 72 hours or worsens at any time, call your veterinarian.

    If My Dog Tests Positive Does He Need To Be Treated

    Lyme Disease In Toddlers

    The decision to treat Lyme disease is somewhat controversial since many infected dogs show no signs of illness. Factors that would support treatment include:

    a moderate to high value of QC6 signs of illness compatible with Lyme disease at the time of testing a history of illness compatible with Lyme disease within the past year the presence of abnormal levels of protein in the urine.

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    Persistent Symptoms Following Treatment

    In most cases, timely treatment according to the appropriate regimen described in the chart above is effective. However, some Lyme disease patients have persistent symptoms following treatment. Research continues into the causes and methods of treatment.

    There is no definitive evidence that persistent symptoms represent ongoing infection. Post-infectious inflammation due to damage from the infectious process may respond to anti-inflammatory drugs.

    What To Do If Your Dog Tests Positive For Lyme Disease

    , , Diagnosis, Dogs, Infectious Diseases, Parasites

    If your dog likes running free through the lovely Virginia wilderness, chances are it is going to pick up a tick sooner or later. And because many ticks in this region also carry Lyme disease, your pets playtime could put it at risk of picking up a severe illness.

    Lyme disease begins as a bacteria in the ticks saliva. When the tick attaches to your dog, in addition to sucking blood, it swaps spit with the victim. In goes the Lyme bacteria. When this happens, your dogs immune system might react by releasing antibodies. These antibodies are what veterinarians look for when testing for Lyme disease, by administering a screening test for C-6 antigen response.

    If your dog tests positive in the screening, we will typically order a second test that will measure your pets immune response. This is called the Quantitative C-6 antibody test, and it gives us whats known as an antibody titer. This number directly relates to how vigorously your dogs immune system is defending against the infection. We administer this test when your dog begins antibiotic treatment, and then again later in the therapy. By comparing the two results, we can tell whether the antibiotics are working. Hopefully, the second test will show a lower number of C-6 antibodies than the second. This indicates the infection is no longer active.

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    Lyme Disease In Europe And Asia

    Lyme disease can also occur in Europe and Asia, where Borrelia garinii and Borrelia afzelii are most commonly found.

    Ticks infected with a Lyme disease bacterium can be found in woodlands across the European continent from northern Turkey to northern Sweden. However, Lyme disease is considered endemic in central Europe, where the following countries have the highest tick infection rates: Austria, Czech Republic, southern Germany,Switzerland, Slovakia, and Slovenia. In Europe, Lyme disease is primarily transmitted by the castor bean tick.

    Lyme disease has been reported throughout Asia, as well, such as in Russia, Mongolia, northern China, Japan, and Koreaâ âthough infection from a Lyme disease bacterium appears to be relatively uncommon in these areas. In Asia, Lyme disease is transmitted by the taiga tick .

    Where Lyme Disease Occurs

    Testing for Lyme DiseaseâWhat You Need to Know

    In the United States, Lyme disease typically occurs in the Northeast, Mid-Atlantic, and North Central states. It has also been reported to occur in Northern California. The most prevalent strain causing Lyme Disease in the United States is Borrelia burgdorferi.

    If you live or have traveled to a state where Lyme disease is endemic, this increases your risk. Lyme disease is endemic in the following states: California, Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, Washington DC, West Virginia, and Wisconsin. For regulatory reasons, Everlywell is not able to offer testing in New Jersey, New York, or Rhode Island.

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    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.

    Consult the national case definition for additional information.

    Ongoing Symptoms Of Lyme Disease

    A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years.

    These symptoms are often compared to fibromyalgia and chronic fatigue syndrome.

    It’s not clear why this happens to some people and not others. This means there’s also no agreed treatment.

    Speak to a doctor if your symptoms come back, or do not improve, after treatment with antibiotics.

    The doctor may be able to offer you further support if needed, such as:

    • referral for a care needs assessment
    • telling your employer, school or higher education institution that you require a gradual return to activities
    • communicating with children and families’ social care

    Page last reviewed: 05 July 2021 Next review due: 05 July 2024

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    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.

    How Do You Diagnose The Later Stages Of Lyme Disease

    My 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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