Diagnosis Testing And Treatment
You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon how long youve been infected. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.
Several weeks after infection, FDA cleared tests have very good sensitivity.
It is possible for someone who was infected with Lyme disease to test negative because:
If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately.
* Silver HM. Lyme disease during pregnancy. Infect Dis Clin North Am. 1997 Mar 11:93-7.
The most common co-infections that occur with Lyme disease are anaplasmosis and babesiosis. In general:
Negative Elisa On Serum
Early clinical Lyme disease in the form of erythema migrans with an associated history of a tick bite should be treated empirically. There is no need for testing unless there are further symptoms.
A negative ELISA result in the early stages of Lyme disease does not exclude infection. If acute Lyme disease is suspected but serology results are negative, we recommend that the test is repeated in 4 to 6 weeks with a fresh sample to look for seroconversion.
In patients with long term symptoms a negative ELISA test usually excludes Lyme disease as a cause of these symptoms. Information on differential diagnosis for patients with persistent symptoms and negative Lyme disease serology results is available.
Do I Need A Lyme Disease Test
Your doctor will consider whether your symptoms and risk factors suggest Lyme disease when deciding whether you need a Lyme test. Laboratory tests can support a clinical diagnosis, but should not be used on their own to confirm or rule out a current Lyme disease diagnosis.
Your doctor may also do tests to see if other conditions with similar or overlapping symptoms for example, thyroid disease, autoimmune disease, or other tick-borne diseases could be causing your symptoms. If you have been traveling, your doctor might test you for species of Borrelia that cause Lyme disease in other parts of the world.
If you think you may have Lyme disease, but your doctor hasnt considered it or has ruled it out before testing you for it, heres how you can start a conversation: Give your doctor a list of Lyme disease symptoms and risk factors , and ask them if, given your own symptoms and risk factors, Lyme disease could be a possible cause and whether you should be tested.
In some cases, a Lyme test may not be helpful. Using todays tests it is difficult to distinguish between current and previous infections, so if you were previously diagnosed with Lyme disease and may have been re-infected, your doctor should make the diagnosis based on your symptoms and risk factors.
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Later Symptoms Of Lyme Disease
More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include:
- pain and swelling in the joints
- nerve problems such as numbness or pain in your limbs
- memory problems
- difficulty concentrating
Some of these problems will get better slowly with treatment. But they can persist if treatment is started late.
A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome. This is known as post-infectious Lyme disease. It’s not clear exactly why this happens. It’s likely to be related to overactivity of your immune system rather than continued infection.
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 onset 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:
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Other Lyme Disease Tests
Three other tests that may be used to diagnose Lyme disease are polymerase chain reaction , antigen detection and culture testing. They are called direct tests because they detect the bacteria, not just your immune response to it.
PCR multiplies a key portion of DNA from the Lyme bacteria so that it can be detected. While PCR is highly accurate when the Lyme DNA is detected, it produces many false negatives. This is because the Lyme bacteria are sparse and may not be in the sample tested.
Antigen detection tests look for a unique Lyme protein in fluid . Sometimes people whose indirect tests are negative are positive on this test.
Culture is the gold standard test for identifying bacteria. The lab takes a sample of blood or other fluid from the patient and attempts to grow Lyme spirochetes in a special medium.
Although culture tests are generally accepted as proof of infection, the CDC has advised caution on the only commercially available culture test developed by Advanced Laboratory Services. LDo recognizes that the test is new and requires further validation in other studies. However, we believe that informed patients should be able to choose the test if they prefer. Choice is particularly important given the low quality of Lyme disease tests generally.
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Where Are Ticks Found
Ticks are found throughout the UK and in other parts of Europe and North America. There are a high number of ticks in the Scottish Highlands.
They can be found in any areas with deep or overgrown plants where they have access to animals to feed on.
They’re common in woodland and moorland areas, but can also be found in gardens or parks.
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Sample Types For Lyme Disease Testing
For routine Lyme disease serological testing, you must send a serum sample .
For testing for neurological Lyme disease, you must send paired CSF and serum samples taken on the same day. If possible, please provide CSF cell count and total albumin, IgG and IgM values. If albumin, IgG and IgM measurements are not available, RIPL will make arrangements for these measurements at additional cost.
PCR testing is available. We recommend that specialists call RIPL to discuss appropriate sample types for PCR. These may include joint fluid, biopsy tissue, CSF and EDTA plasma. Please submit biopsies as fresh tissue in a sterile container, ideally with a drop of sterile saline to prevent the tissue drying out.
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.
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Treatment For Lyme Disease
Lyme disease is commonly treated with antibiotics, the most common being doxycycline. However, the specific antibiotic depends on many factors such as known allergies and interactions with other medications. All medications taken for any illness should be prescribed by a healthcare professional. While antibiotics like doxycycline may be easy to obtain online, exact dosages depend on the individual. Improper dosage of antibiotics can cause resistance, ineffectiveness, illness, or even death in some cases.
How Do I Check For Lyme Disease
Lyme disease is most common in Northern America or Northern Europe. People who spend time in wooded or grassy areas and have exposed skin are most at risk of tick bites. If you are bitten and successfully remove the tick within two days, your risk of contracting Lyme disease is low. Still, its always important to err on the side of caution and take a Lyme disease test if you have been exposed to Lyme disease-carrying ticks.
A blood test is used to identify the antibodies of the bacteria in your blood . As it can take your body some time to develop antibodies, these tests are the most reliable a few weeks after initial exposure.
If you would like to test from home, LetsGetCheckeds at-home Lyme Disease Test works by identifying Borrelia antibodies in the blood which can indicate exposure to Lyme disease. It involves a simple finger prick sample and online results will be available within 2-5 days.
The test will arrive in discreet packaging with a return envelope and clear instructions inside. Should you have any questions, our dedicated medical team is available throughout the process to offer a helping hand. If you need further information about the collection process, you can find out more here.
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Can Infection Be Spread Directly From One Dog To Another Dog Or From My Dog To My Family
Direct spread of Lyme disease from one dog to another dog has not been reported, even when infected and uninfected dogs have lived together for long periods.
Spread of Lyme disease from dogs to people has not been reported either, but people are equally at risk for Lyme disease if they are bitten by an infected tick.
How Do I Know If I Have Lyme Disease
In order to tell if you have Lyme disease, you may need to get a Lyme disease blood test. However, many cases are diagnosed through a combination of your personal history, exposure to tick bites, physical examination, and symptoms.
According to MedlinePlus, Lyme diagnostic tests identify the presence of antibodies that your body produces in response to the disease. However, it can take a few weeks for these antibodies to show up in your blood. If you get tested before this happens, a test for Lyme disease can come back negative even if you do have the condition.
However, testing can be very useful if the clinical diagnosis for your condition is unclear. According to the Mayo Clinic, there are different types of tests used to diagnose Lyme disease, including:
- Enzyme-linked immunosorbent assay test
- Western blot test
According to the CDC, its currently recommended to get both of these Borrelia burgdorferi tests done to confirm a Lyme diagnosis. The ELISA test should be done first if the result is positive, a Western blot test is done to confirm the diagnosis. If the ELISA result is negative, no further testing is needed.
Its also recommended that all children aged 3 months to 18 years are screened for Lyme disease if they live in or have traveled to an area with a high risk for Lyme disease transmission.
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Lyme disease is a serious problem here in the United States and we really need to find solutions to some of the limitations that we have, particularly in diagnosing this infection, said Claudia Molins, a microbiologist at the CDC. We want a test that can be used within the first two weeks of infection and that does not rely on antibody production.
So Molins and her colleagues are focusing on metabolomics an approach that, rather than testing directly for the immune response to the infection, instead looks for a wide spectrum of collateral damage.
Specifically theyre looking for so-called metabolite biosignatures: the litany of sugars, peptides, lipids, amino acids, fatty acids, and nucleotides normally present in the blood.
Infections like Lyme, the thinking goes, change the levels of these things and they do so in a predictable, measurable way.
Molins and her team tested that hypothesis by tapping a unique CDC resource freezers filled with well-characterized blood serum samples. They used serum from 89 early Lyme patients, within the first month of infection, and 50 healthy controls to develop an algorithm to detect Lyme blood signatures.
The researchers then tested that algorithm on a larger sample of serums and found that they could diagnose 88 percent of early Lyme cases, and could differentiate Lyme from other diseases 93 percent of the time. The results were published in a 2015 study in Clinical Infectious Diseases.
How Can I Tell If Treatment Is Working
If joint lameness is the presenting sign, improvement may be noted after 3-5 days starting antibiotics. A dogs response to therapy can be assessed by repeating the QC6 test six months after treatment is complete. Dogs that start with a moderate to high QC6 value typically show a 50% reduction or more in the QC6 at six months, indicating that treatment has been successful. Dogs that have a lower initial QC6 value may not show such dramatic reductions in the QC6 at six months, although the value should still be lower than the starting point if treatment has been successful.
A persistently high QC6 suggests treatment may not have been complete or that the dog became reinfected after treatment was stopped.
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Why Do I Need A Lyme Disease Test
You may need a test if you have symptoms of infection and were exposed or possibly exposed to ticks that carry the bacteria that causes Lyme disease. The first symptoms of Lyme disease usually show up between 3 and 30 days after the tick bite.
Early signs and symptoms may include:
- A reddish round skin rash that slowly gets bigger over several days. It usually doesn’t itch or hurt, but it may be warm. As it gets better, it may look like a bull’s-eye , but not always.
- Muscle and joint aches
- Swollen lymph nodes
Later signs and symptoms of Lyme disease usually affect your joints and nervous system. They include:
- Severe headaches and neck stiffness
- Rashes on other parts of your body
- Arthritis with severe joint pain and swelling, especially in the knees
- Pain that comes and goes in your muscles, joints, bones, and tendons
- Shooting pains, numbness, or tingling in your hands or feet
You Should Take The Test If:
- You are presenting with symptoms of Lyme disease
- You live in a place that is rich in vegetation or a woodland area
- You live in Northern America or Northern Europe
- You go camping or hiking on a regular basis, particularly during the Summer or Autumn
- You come into contact with larger woodland animals on a regular basis
The sample must be collected before 10am on a Monday, Tuesday, Wednesday or Thursday and returned on the same day.
Fasting means that you take the test in the morning before you have breakfast. You can still drink water when fasting. Always follow the advice of your physician with regards to fasting, particularly if you have any medical conditions.
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Should You Get A Test For Lyme Disease
If Lyme disease is treated soon after a tick bite, the outlook is great. Most cases of Lyme disease respond to a 2- to 4-week round of antibiotics.
If Lyme disease goes untreated, it can be more difficult to eliminate. For some, it can lead to inflammation of the joints, heart, and nervous system. Progression of the disease, and its severity, can vary from person to person.
Lyme disease is staged in categories: acute, early disseminated, and late disseminated. Later stages of Lyme disease may involve multiple systems in the body.
The most common sign of Lyme disease is an erythema migrans, or bulls-eye rash. The rash often appears after a delay of 3 to 30 days after the tick bite, according to the
Research from 2014 suggests that the bulls-eye rash may last for 3 to 4 weeks. About 80 percent of people with Lyme disease have a single erythema migrans rash. But the bacteria can spread and lead to multiple rashes, indicating disseminated Lyme disease.
While a rash is the most common symptom of Lyme disease, it isnt the only one.
With disseminated Lyme disease, symptoms can also include neurologic conditions, such as cranial nerve palsy and meningitis that mimics aseptic meningitis. Heart inflammation can also be a sign of Lyme disease.
If youre experiencing any of these signs or symptoms, an at-home test may help you identify Lyme disease. With the click of a button, a test can be shipped to your front door.
To select the best tests, we look at studies and user reviews.