Monday, July 15, 2024

Which Lyme Test Is Most Accurate

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Choosing A Lyme Disease Test

Why Lyme testing isn’t always accurate

Often the diagnosis of Lyme disease depends upon the physicians readiness to listen and ask questions and on the mutual exchange of information, beginning with the initial doctor-patient interview.

Often the diagnosis of Lyme disease depends upon the physicians readiness to listen.

Lyme disease should be diagnosed clinically, without reliance on testing. However, all too often, physicians will ignore clinical presentations if laboratory tests are negative. Yet there are numerous scientific articles documenting false negatives and low sensitivity of such tests.

There can be several reasons for the inaccurate results. The sensitivity of the tests varies greatly depending upon how long an individual has been infected and on the type of clinical manifestations. If a patient has received antibiotics in the early stage of the disease, antibody levels may be too low to be detected or nonexistent. Antibodies to Borrelia burgdorferi do not appear in the blood until several weeks after the tick bite. The Lyme bacteria are not always present in the blood. The person could have been infected with a strain of Bb that is not covered in testing.

That said, laboratory tests can be used to support the diagnosis. Because of the varied presentations and necessity of relying on a patients symptoms, several tests may be helpful.

The ELISA and Western blot are the most common tests used to diagnose Lyme disease. Both tests measure antibodies to Bb, the bacterium that causes Lyme disease.

Lyme Tests: When And What

So this is a lot of information to digest and to figure out how to use. Here is a way to proceed with testing based on the above information.

1. Never do an IFA or an ELISA.

2. The first test to do is the IGenex Immunoblot IGG and IGM test. This is the best test with sensitivity of 90.9% There are a couple of drawbacks though. One is cost. At $450 US it is expensive and at this writing, it is doubtful insurance will pay. By comparison the IGenex IGM and IGG Western blot is $250 and insurance often pays. In addition, because it is not a western blot, I am not sure if insurers will recognize it when determining to cover IV antibiotics. On the IGenex order form get tests: 325 and 335.

3. As an alternative to the IGenex Immunoblot, do the Western Blot. Be sure to have it performed by a lab that tests and reports for all of the Lyme specific bands including 18, 23-25, 31, 34, 39, and 83-93. These labs include IGenex and the Lyme Disease Laboratory at Stony Brook. Note that the western blot in Canada does not test for all of these. In addition all commercial labs like LabCorp, Quest Diagnostics, PAC LAB, and PAML here in the United States use the FDA approved kit using the CDC/IDSA criteria and do not test for all of these bands either. On the IGenex order form get tests: 188 and 189.

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Is There An Aphl Guide For Interpreting Lyme Disease Serologic Test Results

New! APHL Guidance and Interpretation of Lyme Disease Serologic Test Results This report describes the proper interpretation of serologic testing for B. burgdorferi and identifies best practices for reporting results to clinicians, public health agencies, and patients.

How long does it take to get Lyme disease test results?

The Centers for Disease Control and Prevention recommends a two-step blood test for diagnosing Lyme disease that looks for antibodies against Lyme disease. These tests require specialized laboratory equipment and can require days or weeks to return results. Faster, more sensitive Lyme test?

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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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I would be a bit hesitant and a bit skeptical about using them, Dr. Dattwyler says. Home tests may not be covered by your insurance company if you have insurance, but it is typically an accepted health care expense if you have a flexible spending account or a health savings account . These tests can run anywhere between about $90 to $120, according to various at-home test company websites. So initially, this may cost less than getting tested through a medical provider if you dont have insurance or if your insurance doesnt cover Lyme disease testing.

But its not that simple. Again: Testing for Lyme disease is far from perfect even when its done in a qualified lab and analyzed by an expert. Add on the margin for user erroryoud need to collect a perfect blood sample during the ideal post-infection window and it would need to make it to its destination intactand youve got a recipe for misleading results.

Plus, even if you do test positive for Lyme disease using an at-home kit, you still need to see a doctor. Chances are, your physician wont accept an at-home test in place of a standard laboratory test, so they would likely recommend going through the official process anyway. They will also need to do a thorough assessment of your overall health because diagnosing Lyme relies on more information than a lab test alone, Dr. Dattwyler says.

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Why Is Lab Testing For Lyme Disease Not Definitive

The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, its not used as the sole basis for diagnosis.

How accurate is Lyme antibody test?

A tricky diagnosis In the first three weeks after infection, the test only detects Lyme 29 to 40 percent of the time. .

What does a positive Lyme IgM mean?

The positive IgM or IgG Western blot indicates that your immune system is generating antibodies against some of the surface proteins that are carried by the organism that causes Lyme disease. Your immune system however may continue to generate these antibodies long after the infection has left your body.

Lyme Disease Diagnostics Research

There is a great need to develop rapid, point-of-care tests to determine whether people are infected with Borrelia burgdorferi, the bacterium that causes Lyme disease. NIAID is committed to improving Lyme disease diagnostics by supporting innovative research projects.

Priorities include finding potential targetssubstances that new diagnostic tools might measure in patient samplesand improving the sensitivity and specificity of currently available diagnostic tests, thereby leading to more accurate results.

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A False Negative Test Leads To Misdiagnosis

Because your test comes back negative, your doctor will look for other reasons why youre having all these strange symptoms.

That will lead the doctor to often misdiagnose you with either rheumatoid arthritis, fibromyalgia, depression, multiple sclerosis, an autoimmune disease, or some other neurological disease or condition.

Its scary enough to experience these weird Lyme symptoms but then to be told you have some other dreadful health condition is even worse!

Serologic Tests Are The Gold Standard

Lyme Disease Serologic Testing

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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What Is The Most Reliable Lyme Disease Test

There is no one answer when it comes to determining which Lyme disease test is the most reliable. This is because each test looks for a different thing at a different stage of the infection. When investigating a long-term infection, tests that look for the bodys response to the infection are the most reliable, whereas for an active infection, a test that identifies the bacteria itself will be the most effective. Some tests only show up on an active infection and fail to indicate chronic Lyme, so the most reliable test option depends on which stage a persons infection is currently at.

Featured image by Emin Baycan on Unsplash

Lyme Disease Test Two

Two-tiered Lyme disease testing uses two tests. The first is a screening test that should detect anyone who might have the disease. Tests that do this well have are regarded as having high sensitivity. This test is followed by a second test that is intended to make sure that only people with the disease are diagnosed. Tests that do this well have high specificity.

HIV/AIDS is diagnosed with tests that are both highly sensitive and highly specific. They are accurate more than 99% of the time. In Lyme disease, the second test is highly specific. So there are few false positives. Unfortunately, the screening test is highly insensitive and fails to accurately identify patients who have Lyme disease. The two-tiered test system misses roughly 54% of patients.

Because of this, LDo recommends the patients and physicians skip the ELISA and go straight to the Western blot.

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Central Nervous System Lyme Disease

Central nervous system Lyme disease is diagnosed by 2-tiered testing using peripheral blood samples because all patients with this infectious manifestation should have mounted an adequate IgG response in the blood.

B cells migrate to and proliferate inside the central nervous system, leading to intrathecal production of anti-Borrelia antibodies. An index of cerebrospinal fluid to serum antibody greater than 1 is thus also indicative of neuroborreliosis. Thus, performing lumbar puncture to detect intrathecal production of antibodies may support the diagnosis of central nervous system Lyme disease however, it is not necessary.

Antibodies persist in the central nervous system for many years after appropriate antimicrobial treatment.

Other Diagnostic Tests For Lyme Disease

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Some laboratories offer Lyme disease testing using urine or other body fluids. These tests are not approved by FDA because they have not been proven to be accurate. For example, one study of urine-based polymerase chain reaction assays for Lyme disease diagnosis showed that with currently available tools, urine cannot be used to accurately diagnose Lyme disease. Another study by NIAID-supported scientists showed that the Lyme Urinary Antigen Test was unreliable and resulted in excessive numbers of false positives. In the same study, researchers confirmed that an ELISA followed by a Western blot test was nearly 100 percent reliable in diagnosing Lyme disease. With the availability of so many Lyme disease tests, including non-commercial tests developed by individual facilities, it is impossible to address the accuracy of each one. The development of new, rapid, clearly validated diagnostic tests continues to be a need.

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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.

Can Lyme Disease Be Detected By A Blood Test

In a word: yes!

A blood test does not only detect Lyme disease it is the most accurate and preferred test for diagnosing the disease. If a patient with Lyme disease shows signs that the central nervous system has been affected by the disease, western blot testing on the cerebrospinal fluid can be performed. If ordering from Walk-In Lab, a doctors note is not needed. Just pick your Lyme disease test and place your order online.

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How Do They Test For Lyme Disease

Lyme disease is best tested using two different blood testing methods. These are:

  • The Enzyme-linked Immunosorbent Assay test: In a nutshell, this test will look for signs that your body is trying to fight off Lyme disease by producing antibodies. However, the ELISA test may come back negative even when a person is infected by the Borrelia burgdorferi bacteria. False-negatives can occur during the early stages of the disease, where the infected persons body has not produced enough antibodies to fight off the B. burgdorferi bacteria. For this reason, reliable diagnosis is not usually based only on the ELISA test results.
  • Western Blot test: Heres a simple way to explain the western blot test without getting into all the nitty-gritty details of what it does and how it does it. Put simply, it separates the blood proteins and detects antibodies to the bacteria causing the Lyme disease. Usually, when an ELISA test comes back positive, a western blot test is performed to confirm the diagnosis.

Ideally, the CDC recommends standard two-tier testing to confirm the veracity of the Lyme disease test accuracy. Together, the ELISA and western blot tests are 99.9% accurate.

Is Lyme Disease Completely Curable

Rapid test for Lyme disease

Yes, you can completely recover from Lyme disease. Most individuals infected by this condition eliminate the bacteria altogether after a 2-to-4-week course of antibiotic treatment.

While chronic Lyme disease can linger for months, it is rare to sustain the symptoms for years. Unless in rare cases when the condition is not diagnosed correctly.

However, if the infection escalated to multisystemic complications, the treatment could be more complex and probably take longer to complete. Likewise, it could retain permanent neurological and joint damages.

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Testing For Lyme Disease At Home

People can find many at-home Lyme disease tests online.

They typically come with instructions, and most companies require individuals to collect their samples at home and mail it to a lab for testing. The lab then issues the results, and a person can access them via email or through a companys online portal.

People may also be able to speak with a companys medical team to discuss their results and, if applicable, any next steps.

MNT chooses at-home tests that meet the following criteria where possible:

  • Laboratories: Where possible, MNT will choose companies that process test samples in

What Happens If You Go Untreated For Lyme Disease

If you happen to test positive for Lyme disease but go untreated, then your symptoms may increase significantly. You may develop early-onset arthritis, facial palsy, and inflammation of the brain stem and spine. Those symptoms can affect how your brain works and your ability to function cognitively.

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Important: Dont Misinterpret A Negative Test As Positive

Many people without Lyme disease will test positive for some bands. Therefore, 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.

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