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Western Blot Test For Lyme Disease

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How Much Does A Lyme Disease Test Cost

Lyme Disease: POSITIVE IGM Western Blot Test (2013)

The cost of a Lyme disease test depends on what type of test is performed an ELISA test or a combination of ELISA and western blot tests.

Averagely, the cost for an ELISA test for Lyme disease is in the vicinity of $120 or more. If you include a confirmation western blot test, it can attract an additional $130 or more. More details on pricing can be referenced on our website.

Although an ELISA test might come back negative, it is best to combine it with a western blot test because not everyone shows the rash or bulls eye symptoms of Lyme disease.

After a successful diagnosis and treatment, it is equally important to do a follow-up test for Lyme disease years later to be sure that any similar flu-like symptoms are something else and not the same disease reoccurring.

Important: Dont Misinterpret A Negative Test As Positive

Many people without Lyme disease will test positive for some bands. Therefore, the CDC cautions:

It is not correct to interpret a test result that has only some bands that are positive as being mildly or somewhat positive for Lyme disease.

For example, in one study, 43% of healthy people and 75% of syphilis patients tested positive for IgG band 41. In a study of US veterans in New York, 76% of those without Lyme disease tested positive for IgG band 41. In a 1996 study, in healthy people, 55% and 21% tested positive for IgG band 41 and IgM band 41, respectively.

Even without a Borrelia burgdorferi infection, many of us produce antibodies that will react on a Lyme test. Notably, harmless bacteria found naturally in our mouths can cause us to test positive for band 41.

A positive Lyme antibody test requires both tiers to be positive, as many without Lyme infections can test positive on single tests. For example, one study found up to 40% of patients with Lupus and other rheumatic diseases test positive on the first tier ELISA test. The second tier test is necessary to stop a false positive diagnosis.

The American Society for Microbiology recommends against ordering the Western blot without a positive ELISA screening:

The Lyme immunoblot test is designed only as a confirmatory test, so it is important not to test screen-negative samples.

LymeScience recommends against:

Table excerpted and reformatted*** from the longer 2013 paper :

First Comes Igm Then Igg

The pathogenesis and the different stages of infection should inform laboratory testing in Lyme disease.

It is estimated that only 5% of infected ticks that bite people actually transmit their spirochetes to the human host. However, once infected, the patients innate immune system mounts a response that results in the classic erythema migrans rash at the bite site. A rash develops in only about 85% of patients who are infected and can appear at any time between 3 and 30 days, but most commonly after 7 days. Hence, a rash occurring within the first few hours of tick contact is not erythema migrans and does not indicate infection, but rather an early reaction to tick salivary antigens.

Antibody levels remain below the detection limits of currently available serologic tests in the first 7 days after exposure. Immunoglobulin M antibody titers peak between 8 and 14 days after tick contact, but IgM antibodies may never develop if the patient is started on early appropriate antimicrobial therapy.

If the infection is not treated, the spirochete may disseminate through the blood from the bite site to different tissues. Both cell-mediated and antibody-mediated immunity swing into action to kill the spirochetes at this stage. The IgM antibody response occurs in 1 to 2 weeks, followed by a robust IgG response in 2 to 4 weeks.

Because IgM can also cross-react with antigens other than those associated with B burgdorferi, the IgM test is less specific than the IgG test for Lyme disease.

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Getting Tested For Lyme Disease

Lyme disease testing is usually ordered by a doctor and is used when there are signs or symptoms consistent with Lyme disease.

A blood sample can be drawn in a doctors office or other medical setting. If a test of cerebrospinal fluid is needed, an outpatient procedure called a lumbar puncture can be done in a hospital. Samples are then analyzed in a credentialed laboratory.

High Endemicity Constitutional Symptoms No Erythema Migrans Rash

Lyme diagnosis and lab results  Lyme Tribune

A patient from an area of high endemicity of Lyme disease presents with fever, headache, and arthralgias that had lasted several weeks, but no erythema migrans rash. After a thorough clinical evaluation, the cause of the symptoms remains unresolved.

The physician should consider serologic testing with the complete two-step approach. For this patient, the pretest probability is moderately low, taking into account the endemicity of the disease and the presence of prolonged , unexplained nonspecific symptoms. In this scenario, if the two-step approach is positive, the probability of Lyme disease is about 90 percent. Although testing probably is beneficial in this type of patient, this has not been proven. There is no clear evidence that treatment is beneficial in patients with Lyme disease who exhibit only nonspecific symptoms.

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Lyme Disease Testing: How It Works

Two common lab tests for Lyme disease are the enzyme immunoassay test and the Western blot test. These tests measure the antibodies that form when someone is infected with Borrelia burgdorferi .

Enzyme immunoassay test

The EIA test is whatâs typically used to screen for Lyme disease by detecting antibodies for B. burgdorferi.

According to the Centers for Disease Control and Prevention, if the EIA test shows negative for the antibodies, no further testing is needed. However, if this screening test comes back with results that are positive or unclear, a second round of testingâusing the Western blot methodâis recommended. This second test is referred to as a confirmatory test.

Western blot test

When the EIA test is positive, the Western blot test is usually done next. This two-step approach to Lyme disease testing helps reduce the number of false positives. The Western blot test detects antibodies for several proteins belonging to Lyme bacteria.

How Is It Diagnosed

If youâve been outside in an area where ticks are known to live, you should tell your doctor. Theyâll also want to know about the symptoms youâre having. These details are crucial to making a diagnosis of Lyme disease.

Early symptoms that usually occur within the first month after a tick bite can include:

  • Rash at the site of the tick bite that may look like a âbullâs-eyeâ
  • Racing heart
  • Problems with your short-term memory

Symptoms that come and go are common with Lyme disease. They will also depend on the stage of the disease.

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Severity Of Lyme Disease

Misconception: B. burgdorferi infection is potentially lethal.

Science: Although Lyme disease can cause heart or brain abnormalities, there have been remarkably fewif anydeaths attributable to this infection.

LymeScience note: After this paper was published, the CDC three case studies of deaths associated with Lyme carditis, though two patients had preexisting heart conditions. While its not entirely clear if the infection caused the deaths, the CDC still reiterates, Prompt recognition and early, appropriate therapy for Lyme disease is essential.

British Columbia Specific Information

The Western Blot Test And Lyme

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 .

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What Is The Western Blot Test Used For

The Western blot test is used to confirm or contest a diagnosis of HIV or Lyme disease after an ELISA antibody test comes back positive or negative. Since the ELISA test sometimes produces false positives, a second test is needed to further the diagnosis.

If you have Lyme disease, the Western blot test may detect antibodies to B. burgdorferi, the bacteria that causes this condition.

If you have HIV, the Western blot test may detect proteins from the envelope or core of the virus and enzymes generated by HIV infection.

The Western blot test is a simple blood test. It doesnt require fasting, or preparation in any way.

Like all blood tests, you may need to fill out a consent form first.

You may have blood drawn at your doctors office thats sent to a lab, or you may go directly to the lab for testing once the test has been ordered. Based upon your doctors protocols and the lab used, you should have your test results in 4 or 5 business days.

Just like all blood tests, there are no serious side effects to expect. You may have a slight amount of bruising at the blood draw site. If you get nervous or are uncomfortable doing blood draws, it may help to bring someone with you.

It can also be stressful or worrisome to wait for test results. Keep in mind that testing is a tool that helps your medical team care for you and provide treatments that can manage your condition.

Elisa And Western Blot

The first part of the ELISA test acts as a preliminary investigation to see if further testing is needed. A negative result typically warrants no further testing, but a positive one does. The first test is highly sensitive and the second highly specific. This makes sure that only people with Lyme disease are diagnosed and treated.

The Western blot test is a type of blood test that aims to single out certain proteins known as antigens. It is used to identify an active infection of Lyme disease. Although sometimes accurate, however, this test is inherently flawed because methods and criteria for interpreting results can change from lab to lab.

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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.

Serologic Tests Are The Gold Standard

When Life Gives You Lyme: ELISA &  Western Blot Tests for Dummies

Prompt diagnosis is important, as early Lyme disease is easily treatable without any future sequelae.

Tests for Lyme disease can be divided into direct methods, which detect the spirochete itself by culture or by polymerase chain reaction , and indirect methods, which detect antibodies . Direct tests lack sensitivity for Lyme disease hence, serologic tests remain the gold standard. Currently recommended is a standard 2-tier testing strategy using an enzyme-linked immunosorbent assay followed by Western blot for confirmation.

Diagnostic testing methods in Lyme disease

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The Clinical Diagnosis Of Lyme Disease

Misconception: Lyme disease is a clinical diagnosis that should be made based on a list of symptoms.

Science: No clinical features, except erythema migrans or possibly bilateral facial nerve palsyin the appropriate contextprovide sufficient specificity or positive predictive value. Laboratory confirmation is essential except with erythema migrans.

What The Experts Say

According to the CDC:

  • Patients who have had Lyme disease for longer than 4-6 weeks, especially those with later stages of illness involving the brain or the joints, will almost always test positive.
  • A patient who has been ill for months or years and has a negative test almost certainly does not have Lyme disease as the cause of their symptoms.
  • Serologic testing is generally not useful or recommended for patients with single EM rashes. For this manifestation, a clinical diagnosis is recommended.

Experts around the world agree with the CDC. A 2018 French review of 16 Lyme diagnostic guidelines from 7 countries revealed a global consensus regarding diagnosis at each stage of the infection. The only outlier was the pseudoscience group German Borreliosis Society , a German counterpart to the pseudoscience group ILADS.

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Testing For Lyme Disease Years Later

When a person doesnt know that theyve had Lyme for years and begins presenting with symptoms of a chronic Lyme disease infection, they will likely be tested to look for antibodies. This is because antibodies continue to build up within the system while the infection runs rampant.

Image by on How accurate are the results when testing for Lyme disease years later?

How Reliable Is A Lyme Disease Blood Test

Lyme Disease = The Great Imitator & Western Blot Test Info

Although the tests used to diagnose Lyme disease can be highly accurate, the timing with which they are conducted matters a great deal. When a person becomes infected with Lyme, it takes up to six weeks for their body to respond and create the appropriate antibodies to fight it off. In the two-step testing process that looks for these antibodies, detecting Lyme disease before the antibodies have had the chance to develop can be difficult, if not impossible. According to research, over 50% of cases are missed using this two-step process.

The PCR test used to detect Lyme disease bacteria itself is typically highly accurate however, it can also lead to false negatives in people who do have Lyme disease if its distribution is sparse within the body.

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Lyme Disease Western Blot Test

The Lyme Disease Western Blot test is typically used as a confirmatory test for people who have had positive results from previous Lyme Disease testing. The immunoblot test is also known as a Lyme Disease Line Blot test. This test looks for the presence of both IgG and IgM antigen bands to confirm both recent and previous exposure. The detection of multiple bands is required for a positive result. The CDC does not recommend the Western Blot test as a front-line screening as some conditions other than Lyme Disease may cause a false positive.

Lyme Disease is caused by infection with the bacteria Borrelia burgdorferi. It is most commonly spread by the Deer Tick or Black Legged Tick and is the most common tick-borne illness in the United States and Europe. Lyme disease can be difficult to diagnose because the symptoms are often similar to other afflictions. While some people will display a distinctive “bulls-eye” rash around the site of the bite, others may experience common flu-like symptoms such as fever, chills, fatigue, and headache. The ticks which spread the disease are typically very small and many people do not even realize they have been bitten. If left untreated, Lyme Disease can cause joint pain, numbness in the arms and legs, facial paralysis, Meningitis, heart problems, or memory problems.

Turnaround time for the Lyme Disease Western Blot test is typically 2-5 business days.

Detection Period:

Test Code:


Western Blot As A Confirmatory Test For Lyme Disease

Lyme disease is a multisystem disorder which may involve dermatological, musculoskeletal, nervous system or cardiac manifestations . The causative agent is a spirochete called Borrelia burgdorferi. Recent studies have shown that there is sufficient genomic and phenotypic heterogeneity among the strains commonly known as B burgdorferi to warrant their division into three genospecies: B burgdorferi, B garinii and a third, presently unnamed, genospecies .

Lyme disease has been reported from North America, Europe, Asia and Australia. Over 30,000 cases have been described from 46 American states, although most cases have been reported from only eight states . B burgdorferi has not been demonstrated in many states that have reported Lyme disease.

Lyme disease is less common in Canada. Only 140 cases were reported between 1984 and 1990 and, in fact, many of the reported cases would likely not meet the current Canadian surveillance case definition for Lyme disease . Field studies have shown the endemic presence of B burgdorferi at Long Point in southern Ontario and B burgdorferi has been isolated from an Ixodes dammini tick collected in Prince Edward Island in 1991 . A closely related spirochete, B hermsii, the etiological agent of tick-borne relapsing fever, has been found in the blood of patients in British Columbia . More recently, another spirochete has been observed in British Columbia ticks .

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What Abnormal Results Mean

A positive ELISA result is abnormal. This means antibodies were seen in your blood sample. But, this does not confirm a diagnosis of Lyme disease. A positive ELISA result must be followed up with a Western blot test. Only a positive Western blot test can confirm the diagnosis of Lyme disease.

For many people, the ELISA test remains positive, even after they have been treated for Lyme disease and no longer have symptoms.

A positive ELISA test may also occur with certain diseases not related to Lyme disease, such as rheumatoid arthritis.

What Is The Western Blot Test

LYME SCI: Paving the way for better Lyme diagnostic tests

The Western blot test is also known as a protein immunoblot test or immunoblotting. It was invented in 1979 to identify ribosomal RNA binding proteins.

If you get a positive result for Lyme disease or HIV after taking an enzyme-linked immunosorbent assay test, your doctor may recommend a Western blot test to you.

The Western blot test looks for the antibodies against an infection, not the infection itself. If you develop a viral, fungal, or bacterial infection, your body will produce proteins called antigens in response. Antigens stimulate your immune system to push out antibodies in an effort to fight the disease.

The Western blot uses a procedure called gel electrophoresis to identify and separate proteins by molecular weight and length. The proteins are placed onto blotting paper thats made from a material such as nitrocellulose.

An enzyme is added to the paper. If it causes a change in color, antibodies to a specific infection have been detected.

Since it can take several weeks or months before antibodies are found in blood, the Western blot test may not always be reliable.

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