Written by Dr. Diane Mueller
Understanding which Lyme Disease test to use is a big and important question.
As antibody-based tests like ELISA, IFA, Western blot, and Immunoblot, though they’re the most common tests, don’t directly detect the presence of the bacteria. Instead, they identify antibodies in your blood or spinal fluid, which form in response to the bacterial infection.
Lyme disease test typically involves checking your blood for the presence of antibodies or Lyme disease bacteria DNA.
The test results can be a bit ambiguous, a negative result can mean that you don’t have Lyme disease or it could be a false-negative. A positive result could indicate an ongoing infection or a previous encounter with the disease.
Testing for Lyme disease is crucial, particularly in the later stages, due to its diverse symptoms. The test involves a simple needle prick to check for antibodies or bacterial DNA in the blood.
Several types of tests can be used to detect Lyme disease such as blood tests, Lyme Screen Immunoassay (LSA), Lyme Broad Coverage Ab Assay, and others. The right test for you will depend on your specific condition and symptoms.
Additional methods for diagnosing Lyme disease include cerebrospinal fluid tests, imaging techniques like MRI, SPECT, and PET scans, skin biopsy, EMG/nerve conduction studies, etc. These tests provide further insight into the disease’s impact on your body.
One of the biggest challenges in Lyme disease testing is the possibility of false positives or negatives. Existing tests have a sensitivity of only 70-90% in neurologic Lyme disease, leading to a high risk of misdiagnosis.
You’re most likely asked to undertake a Lyme disease test when you show symptoms common to the illness. Administering this test is vital as it provides crucial information that assists clinicians in determining if Lyme disease is the correct diagnosis. A positive test result indicates a high probability of a past or recent infection from Borrelia burgdorferi. This indication may also include instances of stiff neck or numb hands or feet, which suggest the disease is impacting your nervous system.
Remember, a negative test result isn’t definitive, especially early in the infection. It typically takes the immune response about one to three weeks to form antibodies. And this is crucial. Why? The formation of antibodies is essential for the tests to function properly, which is why Lyme Disease testing is particularly applicable in the late disseminated stage of the disease.
Postponing testing or disregarding Lyme disease can lead to problematic situations. By the time antibodies have risen sufficiently to be detected, Lyme disease may have advanced to more severe stages. In extreme instances, ten to twenty-year-old studies have shown, people can still test positive due to the long-term memory of the immune response.
From the above, it’s clear that Lyme disease testing is a process famed for its uncertainties. With studies indicating a sensitivity of only 70-90% in neurologic Lyme disease for current tests, there’s always a risk of a false positive or negative. And as the tests are somewhat subjective, especially the IFA, reliance on just test results can lead to misdiagnosis.
But, don’t let this discourage you. In the end, Lyme disease tests still provide valuable information on the possibility of infection, even if insufficient on their own. So, they remain an instrumental part of diagnosis, serving as a critical tool that aids healthcare professionals in making informed decisions about treatment protocols. Balance these facts, and you’ll appreciate that, fraught with challenges as it may be, Lyme Disease testing is a necessary step on the path to regaining your health.
Keep in mind at our medical clinic that most of the people we find positive for Lyme Disease testing do not even remember getting a tick bite.
To determine the presence or past occurrence of Lyme disease, different diagnostic tests come into play. The focus here is mainly on antibody detection. By evaluating the body’s immune response to the Borrelia bacteria which causes Lyme disease, doctors can make a more precise diagnosis.
Blood tests are the first line of defense for Lyme disease detection and are extensively used for initial screening. Blood samples collected are analyzed for specific antibodies that the immune system produces against the Borrelia bacteria.
Lyme IgG/IgM Antibody Serology, for instance, identifies both IgM and IgG antibodies. As the first antibody in the body’s immune response, IgM comes into focus at an early stage. In contrast, IgG antibodies indicate a late-stage infection or previous exposure to the bacteria.
The Lyme Screen Immunoassay (LSA) offers quicker results. It employs an antigen to detect Lyme antibodies, and this relatively new LSA seeks to speed up diagnosis and treatment.
Another blood-based test, the Lyme Broad Coverage Ab Assay, detects other antibodies against Borrelia, providing comprehensive insight into your body’s immune response.
The Lyme ImmunoBlot, Lyme Western Blot, Lyme IgM, and IgG 31kDa Epitope Test checks your body’s immune reaction and verifies the presence of Lyme disease-specific antibodies.
Tests such as the Lyme Multiplex PCR and Lyme Dot-blot Assay (LDA) identify the bacteria’s DNA or RNA, providing more direct evidence of the infection. They are helpful when antibody production has yet to be initiated.
The Lyme IgXSpot test assesses the immune response on a cellular level, detecting significant defensive cells to implicate an active infection. In contrast, the Lyme cePCR technique detects the DNA of Lyme bacteria in your blood, providing evidence of current infection.
|
Diagnostic Method |
Purpose |
Advantages |
Limitations |
|---|---|---|---|
|
ELISA |
Initial screening |
High sensitivity |
False positives possible |
|
Immunoblot |
Confirmatory testing |
High specificity identifies specific antibodies |
More labor-intensive, higher cost |
|
IFA |
Initial screening |
Useful for various diseases |
Requires technical expertise |
|
Chemiluminescent assay |
Initial screening |
High sensitivity, rapid results |
High-cost, specialized equipment |
Other diagnostic techniques can provide a more comprehensive identification and understanding of Lyme disease. These methods investigate different aspects of your body’s response to this disease and its potential co-infections.
Apart from blood testing, your health provider may turn to cerebrospinal fluid (CSF) tests. If your symptoms indicate a possible nervous system disruption—like a stiff neck or numb extremities—CSF tests may be in order.
A lumbar puncture is a procedure for performing a CSF test. A needle is inserted between two lower spine vertebrae to obtain a CSF sample, so an anesthetic is required.
Magnetic Resonance Imaging (MRI), SPECT, and PET scans are imaging tools that provide insight into potential damage to your brain and nervous system.
Electromyography (EMG) and nerve conduction studies explore your muscle and nerve functioning, indicating possible nerve damage caused by Lyme disease.
Lyme disease often manifests as a skin rash, so a skin biopsy may be required to analyze tissue from the rash area for evidence of infection.
As mentioned, Lyme can impact neurological function, so getting neuropsychological tests provides data on cognitive functions.
Due to the infection’s intricate nature, Lyme disease tests can be complicated. The disease can coexist with Bartonella, Rocky Mountain Spotted Fever, and Babesia infections.
You should consult with a Lyme Literate Doctor to ensure comprehensive evaluation and accurate interpretation of test results.
A common challenge in Lyme disease. Testing involves false negatives and positives. Usually, the first step in testing employs the Elisa test, but it’s worth noting that this method carries up to a 66% chance of a false negative. It means that the Elisa test could report a negative result when, in truth, you are positive for Lyme. Despite a significant margin of error, this is considered the gold standard in Lyme disease testing.
If, by chance, your result from the Elisa test comes back positive, you’ll then go through a confirmatory Western Blot test. But the interpretation of a Western Blot test isn’t as straightforward as it could be. It’s a complex process, and your test findings could be misread if the interpreter isn’t adequately trained. So, you might be diagnosed as normal, even though having Lyme disease.
What is the Most Accurate Lyme Disease Test?
There are options, however! First, work with a Lyme-literate doctor to ensure you are adequately evaluated for Lyme Disease.
Secondly, make sure that you are working with someone who understands that Lyme Disease (which is technically an infection from the microorganism called Borrelia) often coexists with other infections such as Bartonella, Rocky Mountain Spotted Fever, and Babesia (as well as others). You will want to be evaluated not only for Lyme but also for other infections that are transmitted through insects. (note that we say insects because some preliminary research shows mosquitoes and fleas may carry Lyme).
Thirdly, there is no good test for determining if Lyme has gone away. With most infections, the body will have elevated immune markers in acute infections (IgM) and immune markers that are signs of a remnant previous infection (IgG). With Lyme Disease, the microorganisms can go in and out of dormancy. Because of its ability to go dormant, someone may only have the IgG (remnant) markers elevated in these cases. But, Borrelia can easily come out of dormancy (which happens a lot with stress), and then the acute markers could elevate again. Therefore, treatment progress is based mainly on symptom improvement. More advancements in Lyme Testing still need to be made to better identify acute versus past infections.
Consider reading the following pieces of information to support you:
At-Home Lyme Disease Tests: Learn about options for getting tested at home
Lyme Disease Test Kit: Learn about the pros and cons of various testing companies out there
Lyme Disease Test Years Later: If you believe that you contracted Lyme a long time ago
Tests for Chronic Fatigue Syndrome: If you are feeling unusually exhausted
Fibromyalgia Symptoms in Females: Women, should you feel fatigue, pain, or a range of other issues.
What Is Chronic Fatigue Syndrome: Find out if you have CFS versus just being tired
Lyme Disease and Brain Fog: Read about how Lyme affects cognitive function
Lyme Disease Eyes: How Lyme can affect your vision
One of the most significant take-home points is the importance of being a self-advocate regarding Lyme Disease testing. Remember, most doctors are not well-versed in truly understanding Lyme Disease Testing and even fewer are versed in the number of symptoms and complications that can occur from Lyme Disease.
Often, people think that if they do not have a bullseye rash and a fever, they are fine but left untreated, Lyme Disease and other tickborne infections can cause a wide variety of neurological, cognitive, cardiac, and inflammatory processes. Many people are told that everything is normal with them when they know something is wrong because, with Lyme Disease, standard tests look normal most of the time. People are often told they are crazy and that it must be in their heads because standard tests fail to elicit the underlying actual problem.
References:
Cook MJ, Puri BK. Application of Bayesian decision-making to laboratory testing for Lyme disease and comparison with testing for HIV. Int J Gen Med. 2017 Apr 10;10:113-123. doi: 10.2147/IJGM.S131909. PMID: 28435311; PMCID: PMC5391870.
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