Serological Testing Of Csf For The Diagnosis Of Neurological Lyme Disease
Serological testing for neurological Lyme disease is based on demonstrating intrathecal synthesis of Borrelia-specific antibodies in CSF. For laboratory testing for neurological Lyme disease, separate IgG and IgM ViraChip® serology assays are performed on CSF and paired serum and the results compared.
CSF samples must be tested in parallel with a contemporaneous serum sample and protein and immunoglobulin levels compared between the two sample types to produce a meaningful result.
For necessary sample types and volumes see Sample types for Lyme disease testing
What Is The Two Step Test For Lyme Disease
Two-tiered Testing Decision Tree If the first test yields positive or equivocal results, two options are available: 1) If the patient has had symptoms for less than or equal to 30 days, an IgM Western Blot is performed 2) if the patient has had symptoms for more than 30 days, the IgG Western Blot is performed.
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.
- Alzheimerâs disease
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What Is The Ispot Lyme Test
According to the iSpot Website
iSpot Lyme is a new testing methodology that complements the Western Blot, as it measures something completely different: T cell response to four specific Lyme antigens. Unlike antibody production, T cell response kicks in just 46 days after infection. As a result, iSpot Lyme allows for earlier detection than the Western Blot. iSpot Lyme can also identify how active the disease isand therefore how well your treatment is working. Use both, and you can finally get a much clearer picture.
Watch this video to understand how sensitive this test is.
Physicians: Let us know if you are using this test.
Lyme Patients: Let us know if your doctor used this and how your results turned out.
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.
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How Will Pregnancy Affect Treatment For Lyme Disease
Early treatment of Lyme disease during pregnancy is important. Thats because if Lyme disease is left untreated, it can affect the placenta. According to the CDC , transmission of Lyme disease from mother to fetus is possible, though rare.
For pregnant people, treatment includes a round of antibiotics. Certain treatments for Lyme disease may not be used, as they can affect the fetus. If you suspect that you have Lyme disease, talk with a healthcare professional immediately.
Best For Additional Genetic Information
- Collection method: cheek swab
- Results: within 6 weeks
This test checks for a gene that predisposes you to an increased risk of post-treatment Lyme disease.
SelfDecode is similar to the 23andMe health test. Youll find out a lot of additional genetic information.
To be specific, this test looks for P-glycoprotein, which can lead to drug resistance. If you have completed a course of antibiotics for Lyme disease but are still experiencing symptoms, this may be a good test for you. Test results may indicate post-treatment Lyme disease.
SelfDecode will give you recommendations based on your genetic results.
Its important to note that a positive result doesnt mean you have a diagnosis of Lyme disease. The tests will show that antibodies are present in your blood, but a physician will need to order another type of test before you get an official diagnosis.
If someone gets a positive at-home test, definitely see your doctor, says Dr. Puja Uppal, a board certified family medicine physician and the chief medical officer at Think Healthy.
A physician will likely order both an enzyme-linked immunosorbent assay and a Western blot test, which check for antibodies specific to Borrelia burgdorferi. They will consider the results of both these tests, along with your symptoms, to make an accurate diagnosis.
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Canadian Public Health Laboratory Network Recommendations
The appearance of a typical EM rash occurring in season and with a history of exposure to ticks should be considered an indication for antibiotic treatment, irrespective of the results of serological testing.
An EM-like rash occurring out of season and/or after exposition in a Lyme nonendemic area where ticks are not known to be established should be investigated with antibody testing.
Initial negative serological tests in patients with skin lesions suggestive of EM should have testing repeated after four weeks.
Patients with symptoms and signs suggestive of early disseminated or late Lyme disease should be tested for antibodies to B burgdorferi.
Initial testing should include an EIA commercially available and approved for use in Canada.
Sera that are positive or indeterminate by an EIA should be subjected to Western blot confirmatory testing.
Sera that are screened negative for antibodies using an EIA should not be subjected to Western blot testing.
Western blot tests should be interpreted using criteria set forth by the CDC Working Group.
Western blot tests that fail to meet all of the criteria set out by the CDC Working Group should be reported as negative testing may be repeated when it is appropriate to do so.
The specific banding patterns seen on Western blots should not be reported.
Culturing for B burgdorferi is a low-yield procedure and is not encouraged if performed, it should be done only on biopsies from EM lesions and synovial or spinal fluid.
Where Lyme Disease Occurs
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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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.
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.
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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 .
Lyme Testing: Accurate When Used Appropriately
A 2016 systematic review that included 8 studies of CDC-recommended two tier test performance in Late Lyme showed Lyme antibody testing to be 99.4% sensitive and 99.3% specific** in North America.
In other words, out of 100 people with Late Lyme disease, 99-100 of them will test positive. Out of 100 people who may believe they have Late Lyme disease but do not, 99-100 of them will test negative.
Misinformation can convince patients to ignore or misinterpret negative tests to justify a false Chronic Lyme diagnosis.
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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%.
Serological Testing Of Serum For The Diagnosis Of Lyme Disease
The most commonly used tests look for antibodies to the Borrelia species that cause Lyme disease in the UK and Europe, but they also detect infections from strains of Borrelia from the US.
The antibody response takes several weeks to reach a detectable level, so antibody tests in the first few weeks of infection may be negative. If the first sample was taken within 4 weeks from the start of symptoms and is negative and there is a clinical suspicion of Lyme disease, then retesting in 4 to 6 weeks may be useful.
It is very rare for patients to have negative antibody tests in longstanding infections. Borrelia antibodies persist indefinitely in some patients and this does not indicate continuing disease or a need for re-treatment.
Serological testing for Lyme disease in the UK and much of the world follows a two-step approach using commonly available antibody screening tests as a first stage, followed by immuno-blotting of samples that give positive or indeterminate results in the screening tests.
Sensitive screening tests are used at the first stage of testing but have the disadvantage of occasionally detecting other diseases and producing false positive results. RIPL uses the C6 Lyme ELISA for screening
Samples giving positive or indeterminate preliminary screening test results are then tested in a more specific system to confirm the presence of Borrelia-specific antibodies. RIPL uses the Borrelia ViraChip® IgG, IgM test for this purpose
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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.
How Do You Test For Lyme Disease With An At
Hereâs how to check for Lyme disease with the Everlywell test.
To take our at-home Lyme Disease Test, collect a small sample of blood with a simple finger prick. Youâll then send the sample to a lab for analysis , and youâll be able to view your results on our secure, online platform.
Consider taking this Lyme test if:
- You have traveled to areas infested with ticks that can transmit Lyme bacteria , found ticks on your body, and are now experiencing symptoms of Lyme disease.
- If you believe you have been exposed to a tick and are experiencing symptoms , taking this antibody test can help assess for Lyme disease. If you have been tested previously, but are now having new symptoms, this Lyme disease test kit can also help.
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What You Should Know About Lyme Disease
If the symptoms of Lyme disease persist and there is no known cause for them, then consulting with a Lyme literate doctor may provide treatment progress. Many health insurance plans will not cover these consultations or tests, however, so proceed with caution.
For those who are treated with antibiotics, a condition called PTLD occurs that mimics the symptoms of the disease for up to 6 months.
In regions where Lyme disease is not prevalent, it is usually up to the patient to insist on receiving the Lyme disease blood test. Use this guide to speak with your doctor about your concerns and discuss what the results may mean for your health.
Is Treatment 100% Effective
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.
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Most Accurate: Dna Connexions
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Test looks for Borrelia burgdorferi, in addition to 10 other common vector-borne pathogens
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Urine Sample
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Does not accept insurance
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No assistance after testing results are received
DNA ConneXions is a company known in the scientific community for its detailed analysis of lab results. This at-home Lyme disease test, for example, is superior to the others because it tests for all 10 vector-borne pathogens, while others only test the most common two or three.
DNA ConneXions earned our most accurate distinction because of its detailed Lyme disease test, as well as its impressive laboratory with a biosafety level 2 lab with a CLIA license. This means the company knows its stuff and is able to help people with accurate testing.
After DNA ConneXions receives your urine sample, it will review your sample, and email you your results within two to three weeks. It is unclear how much support the company offers after you receive your results, so it would be wise to schedule an appointment with your primary care doctor. This is to ensure that your body heals entirely if your Lyme disease test is positive.
This is the most expensive kit on this list, costing about $650 for the full Lyme panel. As of now, it will not work with insurance companies or accept HSA. The DNA ConneXions lab, however, is one of the most trusted laboratories worldwide.
