Testing for Lyme

Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi and is most frequently passed to humans through tick bites. However there is also evidence that other bloodsucking insects such as flies, fleas and mosquitoes are carriers as well. Lyme has also been proven to be passed in utero (from mother to unborn child) and there is growing evidence of the possibility of sexual transmission as well.

Lyme disease is found all over the globe and pretty much anywhere there are ticks there is a strain of the disease present. The only area of the world where you are guaranteed to not get infected is Antarctica.

Ticks frequently carry more than one disease as well, complicating diagnosing a tick-borne infection even further, as you cannot just test for one and not the others if you want to be sure that you are free and clear.

One of the most controversial issues surrounding the already heated debate around Lyme disease is the accuracy of the currently available testing options.

The most widely used tests, the ELISA and Western Blot, are by today's standards considered largely inaccurate, with around a 50% accuracy rate- literally the flip of a coin. The United States also only tests for one strain of Lyme disease when there are in fact many strains of the disease, leaving the possibility for misdiagnosis quite high.

Testing for co-infections is even more difficult as many of these diseases are newly emerging and/or not widely researched. Co-infection tests tend to be unreliable and the presence of a co-infection can skew the accuracy of testing for other infections as well.

Aside from accuracy issues with the ELISA and Western blot tests, in their current form they are not supposed to be used as diagnostic tools for physicians. Their intended, use as dictated by the Centers for Disease Control (CDC), is for surveillance purposes only. The CDC meant the tests main purpose to be to allow them to monitor how much Lyme was occurring where, not as a catch-all for every case or to be used to diagnose an actual patient. Despite this most physicians defer to the given results and trust the tests to be accurate.

In general you are likely to be tested with the ELISA test first and if positive, then tested with the Western Blot. Although some physicians will run both tests at once. It is based on their discretion.

The ELISA is run to measure your antibody response to the Lyme bacteria and a positive is based off of how many antibody bands make themselves evident, through IgM (new infection) and IgG (older infection). How many bands you need tends to range from doctor to doctor.

A Lyme-literate doctor may be willing to make a diagnosis with one positive Lyme-specific band whereas a general practitioner might require three to five bands to deem your test a positive. It's a very inconsistent system.

Very rarely does someone test CDC positive (your test aligns perfectly with CDC diagnostic standards). Many patients results tend to be more muddled and are often taken as a false positive or a negative result.

The timing of your test also matters. It is a common practice to be test directly following a tick bite and this is absolutely not want you want to do. The tick itself can be tested (if able) but in many patients it can take up to 4-6 weeks for antibodies to even appear. This leads to many false negative tests.

The Western Blot purpose is to visualize the exact antibodies you are making. This is used to determine whether an infection is older/recurrent or a new infection. Not every patient is going to test for antibodies every time. Some patients also suffer from seronegative Lyme disease where they don't ever test positive regardless of how many times they are tested or how active there infection is.

Both the ELISA and Western Blot are reliant on your body producing antibodies, so in the case of seronegative Lyme or in someone with a compromised immune this even further halters their already unsteady reliability. Both tests also rely on the Lyme bacteria staying in your bloodstream. Not long after infection the bacteria, by nature given their corkscrew shape, tend to burrow out of the bloodstream and into the organs, tissues and joints, putting them out of range of the tests. Through various chemical processes the bacteria are also able to suppress and evade the immune system as well.

The testing for Lyme is a two tier testing method. First your doctor will order an ELISA, and if that comes back positive, then your doctor will order a Western Blot. Unfortunately Lyme Tests have been found to be very inaccurate. I am going to write about what I have learned in the last six years studying Lyme Disease and why we should not rely on these tests. Even the CDC admits that Lyme diagnosis should be a clinical one, and that the tests are not to be relied upon.

The CDC related tests also have had some of their bands removed, due to vaccine trials in the past, so two possibilities for diagnosis are already taken away before you've even been tested. These are bands 31 and 34. One company in particular, IGeneX Labs out of Palo Alto, California has reintroduced these bands back into their tests. They are also one of the only labs that will report bands as indeterminate.

Some bands are of more interest on the tests than others. Bands 23-25, 31, 34, 39 and 93 (same as 83) are considered highly specific. Bands 18 and 41 are open to more debate.

Below is a listing of each band and a brief explanation of what it is.

18: An outer surface protein.

22: Possibly a variant of outer surface protein C.

23-25: Outer surface protein C (Osp C).

28: An outer surface protein.

30: Possibly a variant of outer surface protein A.

31: Outer surface protein A (Osp A).

34: Outer surface protein B (Osp B).

37: Unknown, but is considered a Borrelia-associated 
antibody. Some labs find it significant.

39: Unknown what this antigen is, but based on research other Borrelia do not even have the genetics to code for the 39 antigen. It is the most specific antibody for Borrelia.

41: Flagella or tail. This is how Borrelia burgdorferi moves, by utilizing the flagella. This band is considered to be cross-reactive and not entirely accurate on its own. It is the most common Borrelia antibody.

45: Heat shock protein. This helps the bacteria survive high temperatures. The only bacterium in the world that does not have heat shock proteins is Treponema pallidum, the cause of syphilis.

58: Heat shock protein.

66: Heat shock protein. This is the second 
most common Borrelia antibody.

73: Heat shock protein.

83/93: This is the DNA of Borrelia burgdorferi. It is the same as the 93. Varied significance is given between 83 vs. 93. They are however reported separately on tests.

Currently there is much research going on into new and better tests. As time goes on and information becomes more available we will add those to this site. There are also a number of new tests currently available and we will detail those, including those available for co-infections, at a later time. If you would like to know more you can contact directly at berkshirelyme@yahoo.com.