Experts Agree Around The World
A strong scientific consensus is evident about Lyme disease diagnosis and testing.
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.
Beware Igm False Positives
IgM Lyme testing is notorious for producing false positive results, which is why it is only used in very limited circumstances, i.e. during the first 30 days of illness before detectable IgG antibodies would be produced in the event of a Lyme infection.
The CDC diagnosis and testing page states:
Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
The CDC Lyme FAQ addresses how to interpret long-lasting symptoms where an IgG test was negative but the IgM test was positive:
If you have been infected for longer than 4 to 6 weeks and the IgG Western Blot is still negative, it is highly likely that the IgM result is incorrect . This does not mean that you are not ill, but it does suggest that the cause of illness is something other than the Lyme disease bacterium.
Avoid Unnecessary And Unscientific Testing
As part of the admirable Choosing Wisely campaign to reduce unnecessary tests and treatments, the American College of Rheumatology warns:
Dont test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.
The CDC , French Society of Internal Medicine, and other experts around the world have expressed similar sentiments to the ACR.
As discussed in the CDC video below, determining the pretest probability of Lyme disease is very important:
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What Is The Most Accurate Test For Lyme Disease
Lyme disease is more common than many people think. Figures from the Center for Disease Control suggest that roughly 300,000 Lyme disease cases occur every year in the US.
The numbers are alarming, but it gets worse as finding accurate diagnostic tests can be challenging. Although the disease is treatable, it is nearly impossible to tackle it effectively if it is not diagnosed accurately and early enough.
Late detection can lead to severe health problems such as arthritis, heart blockage, and inability to concentrate, among other problems.
Given the prevalence and seeming elusiveness of the disease, some of the logical questions concerned persons would ask are: what is the most accurate test for Lyme disease? And when should I get checked for Lyme disease? This article will proffer answers to these and many other related questions. But first, a little background would be in order.
The Test Isnt Designed To Detect The Exact Disease
A number of Lyme disease lab tests are designed to identify only a few species of the Borrelia bacteria that can cause Lyme disease. In the United States, for example, many tests are only designed to detect Borrelia burgdorferi, leaving out many other species that are less common yet still known to cause the disease in humans, including the recently discovered B. mayonii.
In fact, a recent internal study showed exactly how easily tests could miss infections from species other than B. burgdorferi. IGeneX researchers tested 43 samples all positive on IGeneX Lyme ImmunoBlot tests using the more limited Western blots prepared from the following species of Borrelia:
- burgdorferi B31
- spielmanii
- valensiana
When only a B. burgdorferi B31 Western Blot was performed, only 14 of the 43 Lyme ImmunoBlot-positive samples were Western-Blot-positive. In other words, the B. burgdoferi Western Blot missed 29 of the 43 infections. However, when all eight Western Blots were performed, the remaining twenty-nine samples were detected.
This inability of many lab tests to cast a wide enough net of detection could result in false-negative results for patients infected with different strains of disease-causing Borrelia.
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More About Western Blot Testing In North America
The IgG Western Blot test is designed to detect antibodies specific to Borrelia burgdorferi, the bacteria that cause Lyme disease. For Lyme disease in North America, a positive IgG Western Blot test requires at least 5 of 10 measured bands to be positive .
The scored IgG bands are 18 kDa, 24 kDa , 28 kDa, 30 kDa, 39 kDa , 41 kDa flagellin , 45 kDa, 58 kDa , 66 kDa, and 93 kDa.
The Lyme IgM Western Blot test measures 3 different types of antibodies. The North American IgM Western Blot is considered positive only if 2 of 3 IgM bands are positive .
The scored IgM bands are 24 kDa , 39 kDa , and 41 kDa .
As discussed above, the IgM Western Blot should only be used in the first 30 days of illness.
According to CDC, Depending upon the assay, OspC could be indicated by a band of 21, 22, 23, 24 or 25 kDA.
What Precautions Can I Take Against Tick Bites
- Avoid wooded, brushy, and grassy areas, especially in May, June, and July.
- Wear light-colored clothing so that you can see ticks that get on you.
- Wear long pants and long-sleeved shirts, and shoes that cover the entire foot.
- Tuck pant legs into socks or shoes, and tuck shirts into pants.
- Wear a hat for extra protection.
- Spray insect repellent containing DEET on clothes and uncovered skin.
- Walk in the center of trails to avoid brush and grass.
- Remove your clothing, and wash and dry them at high temperatures after being outdoors.
- Do a careful body check for ticks after outdoor activities.
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What Is A Lyme
A LLMD is a physician whose experience with Lyme disease patients makes them familiar with the vast range of symptoms, co-infections, and complications associated with the disease at various stages. Because of this knowledge and expertise, many patients also find LLMDs more open-minded and understanding of their experiences, especially if theyre having a hard time getting an accurate diagnosis from another physician.
But how do you know if you need to see a LLMD? Below are some common reasons, any or all of which may apply to you.
When Should I Get Checked For Lyme Disease
Generally, it is best to get tested for Lyme disease if you live where ticks are common or have recently visited such areas. Most certainly, you should get tested if you suspect that a tick has bitten you. It is important to talk to your doctor if you think you have any of the following early Lyme disease symptoms:
- A rash resembling a bulls eye on the spot where youve been bitten
- Fatigue
- Headaches
- Fever
Other symptoms dont show up immediately. Sometimes, it takes up to a few weeks or months after the tick bite to notice the following:
- Swelling on the joints or severe joint pain
- Tingling in the feet and hands
- Dizziness
- Shortness of breath
While it is okay get checked early, Lyme disease test results numbers are more authentic a few weeks after youve been bitten by a carrier-tick. Your body would have developed antibodies within that period, and that can make it easier to detect the disease.
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What If Lyme Disease Goes Untreated
If Lyme disease goes untreated, it can affect other systems in the body. According to the , common symptoms of later stage Lyme disease include:
- severe headaches and neck stiffness
- additional erythema migrans rashes on other areas of the body
- facial palsy, which is a loss of muscle tone or droop on one or both sides of the face
- arthritis with severe joint pain and swelling, particularly in the knees and other large joints
- intermittent pain in tendons, muscles, joints, and bones
- heart palpitations or an irregular heartbeat
- episodes of dizziness or shortness of breath
- inflammation of the brain and spinal cord
- nerve pain
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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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Current Problems With Lyme Disease Diagnosis & Patient Care
- Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial.
- The rash is not always present or easily recognized
- Misdiagnosis and delayed diagnosis can make Lyme disease more difficult to treat and lead to prolonged and debilitating illness
- Early symptoms can be mistaken for a summer flu
- Lyme disease can involve several parts of the body, including joints, connective tissue, heart, brain, and nerves, and produce different symptoms at different times.
- Antibody testing done after early treatment may be negative and never turn positive for some cases
- Borrelia burgdorferi can evade our protective immune system and trigger immune system dysfunction.
- No reliable blood test is presently available to measure treatment success, necessitating close clinical follow up and improved physician education.
- Presently there is no vaccine to prevent Lyme disease available to humans.
What Happens After A Tick Bite
Ticks can attach and feed in any part of the human body. The bite is painless. Because they are very tiny nymph bites are often overlooked. Borrelia are transmitted from the midgut of the infected tick to the attached skin when attachment lasts for 3648 hours.
Several things can happen after being bitten by an infected tick.
- The bodys defence mechanisms can overwhelm and eliminate the infecting bacteria.
- The bacteria can remain localised at the site of the bite and cause a localised skin infection.
- The bacteria may disseminate via the blood and lymphatic system to other organs and cause a multisysteminflammatory disease.
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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.
The Role Of Lyme Disease Tests
The purpose of the most common type of Lyme disease testing is to determine whether you have developed antibodies as a result of past exposure to the Borrelia bacteria that cause Lyme disease. Antibodies are proteins created by the immune system that target specific threats like bacteria and viruses.
Blood testing alone cannot determine whether you have Lyme disease. Instead, testing can provide helpful information that your doctor can consider along with other factors, such as any symptoms youve had and whether youve been exposed to ticks that can carry Borrelia, to determine if a diagnosis of Lyme disease is appropriate.
Beyond blood testing, it is possible to analyze fluid from the central nervous system for signs of the Borrelia bacteria.
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Your Test Was Not Sensitive Enough
Many doctors and labs adhere diligently to the two-step tests for Lyme disease approved by the FDA and recommended by the CDC, which involves an initial enzyme-linked immunosorbent assay followed by a Western blot test. Both tests are designed to detect antibodies in the patients blood to the B. burgdorferi bacteria. According to the CDC, both must be positive for a patient to be diagnosed with Lyme disease.
However, recent studies have raised concerns about the Lyme disease test accuracy, particularly the ELISA, which has been found to have a poor sensitivity rate, or ability to detect antibodies in the blood. Recent studies, in fact, report that the ELISA and Western blot can miss up to 60 percent of well-defined Lyme disease cases.
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Warning To Anyone With Key Covid Symptom Over Risk Of Long
However, life debilitating complications can occur if the infection is left undetected and undiagnosed, and the virus spreads to the nervous system or heart.
Some people live with Lyme disease their whole life, suffering pain, memory loss or brain fog, headaches and disturbed sleep among a list of 70 symptoms.
Similarly, Covid can leave people unwell for months on end, even after they got over their initial illness.
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Is Lyme Disease Curable
While there is no vaccine to prevent us from getting Lyme disease, it can be treated with antibiotics, and most people recover within a few weeks. However, some people can get what is known as Post-Treatment Lyme Disease Syndrome, in which symptoms such as pain, fatigue, or difficulty thinking can last for months.
Why You Might Need To See A Llmd:
- Your Lyme disease test results were negative, but you still have symptoms of Lyme disease.
- Youve been treated for Lyme disease in the past but still have symptoms, which could indicate chronic Lyme disease.
- Youve been treated or are being treated for common misdiagnoses of Lyme disease, such as Rheumatoid Arthritis or Chronic Fatigue Syndrome, but your symptoms havent gone away.
- Your physician doesnt believe in Lyme disease, chronic Lyme disease, or Post-Treatment Lyme Disease Syndrome.
Even patients who dont fall into the above categories may simply feel safer in the hands of a LLMD who is familiar with the various ways Lyme and other tick-borne diseases present themselves.
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Access To Lyme Disease Testing Services
This guidance on the laboratory diagnosis of Lyme disease is intended for healthcare professionals in the UK. Patients concerned about possible Lyme infection should consult an appropriate healthcare professional, for example their GP, in the first instance.
Health professionals wishing to discuss a possible case or ascertain local arrangements for testing should contact a local Infection specialist .
NHS testing for Lyme disease is available through local service providers and the Rare and Imported Pathogens Laboratory at UK Health Security Agency Porton where ISO15189 accredited confirmatory testing is also provided. RIPL also provides a testing service for neurological Lyme disease.
RIPL provides medical and laboratory specialist services to the NHS and other healthcare providers, covering advice and diagnosis of a wide range of unusual bacterial and viral infections, including Lyme disease.
RIPL continuously updates its methods and will make further information on Lyme disease diagnostic testing available as it arises.
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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.
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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.
How Is Lyme Disease Diagnosed
Though several types of tests do exist for the diagnosis of Lyme disease, the best tests for a Lyme disease diagnosis are blood tests, also known as serological tests. These tests are indirect, meaning they dont detect the infecting bacteria or its antigens but rather the antibodies an infected persons body produces in response to these antigens.
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