Most LLMD’s consider a bull’s-eye rash evidence of lyme infection and will treat on that basis alone. Testing may be done after treatment has started to monitor antibodies in the blood and test for co-infections. Others who haven’t seen the rash or who suspect they have lyme disease require laboratory confirmation before treatment.
A culture test, which is used to identify many infections is not used for lyme disease. The reason for that is that the lyme bacteria (spirochetes) grow too slowly. There are no commercially available culture tests for Lyme.
The most common tests measure the patient’s antibody response to infection. When your body is invaded by the Lyme spirochetes, your immune system makes antibodies to fight the infection. Tests that measure antibody levels are indirect tests because they measure the body’s response to infection rather than the presence of the bacteria themselves.
During the first 4-6 weeks after exposure, most people have not developed the antibody response that the test measures. Treatment should not be delayed pending a positive test result if the suspicion of Lyme disease is high (exposure, tick bite, possible rash).
Two primary antibody tests are used to diagnose Lyme disease, the ELISA and the Western Blot. Doctors commonly order an ELISA first to screen for the disease and then confirm the disease with a western blot. However, current ELISA tests are not sensitive enough for screening and may miss over half of the true cases. Because of this, the best antibody test to use for diagnosis is the Western Blot.
There are two types of western blot test that are used, an IgM western blot and an IgG western blot. These are separate tests that look for two different antibodies. Most of the time, the IgG western blot must be positive in order to indicate a potential infection with Lyme disease.
The IgM antibodies are the first antibodies to be produced in the body in response to an infection. IgM antibodies are larger than IgG antibodies and when present in high numbers, may indicate a recent or new active infection. In short, a positive IgM may be a sign of a current, or very recent, infection.
The read-out from the Western Blot looks like a bar code. The pattern produced by running the test with your blood is compared to a template pattern that represents known cases of Lyme disease. If your blot has bands in the right places, and the right number of bands, it is positive. Some of the bands are more significant than others and your doctor may decide you have Lyme disease even if your western blot does not have enough bands or the right bands to be reported to the Centers for Disease Control and Prevention (CDC) for surveillance purposes.
Different laboratories use different methods and criteria, so you can have a positive test result from one lab and a negative test result from another. Lyme disease is known to inhibit the immune system and twenty to thirty percent of patients have falsely negative antibody tests. View interpretation of the western blot test.
To view Seronegativity Fast Facts
Two other tests that may be used to diagnose Lyme disease are PCR and antigen detection tests. Polymerase chain reaction (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 Lyme bacteria are sparse and may not be in the sample tested. Antigen detection tests look for a unique Lyme protein in fluid (e.g. blood, urine, joint fluid). Sometimes people whose indirect tests are negative are positive on this test.
CALDA recommends that you use a CLIA Labortory, which is a Medicare approved lab that specializes in testing for tick borne diseases and reports all bands on the Western Blot. The healthcare professional ordering the test must ask the lab to report all bands except in the case of IGeneX, which automatically reports all bands. Blots may still vary in sensitivity.
Not all Labs are the same. Some labs are better at detecting lyme disease where others are better at detecting co-infections. Personally, I believe Igenex Labs is the best lab that tests for both lyme and co-infections.
LabCorp (800) 845-6167
Advanced Laboratories Services (855) 238-4949
Stony Brook University (631) 444-2600
Fry Labs (480) 292-8560
Spiro Stat Technologies (877) 767-7476
www.mdlab.com (877) 269-0090
Lab Test Online, uses the Western Blot testing. Haven’t heard any feedback from the lyme community on their testing or anyone that has used it. I do find it interesting that they use the western blot and that it’s online testing.
The diagnosis of Lyme disease is primary based upon clinical evidence. There is currently no laboratory test that is definitive for Lyme disease. Many tests give false negative results. Physicians not familiar with the complex clinical presentation of Lyme disease frequently misdiagnose it as other disorders such as: Fibromyalgia or Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), Multiple Sclerosis, Lupus, Parkinson’s, Alzheimer’s, Rheumatoid Arthritis, Motor Neuron Disease (ALS, Amyotrophic Lateral Sclerosis -Lou Gherig’s disease), Multiple Chemical Sensitivity Syndrome (MCS) and numerous other psychiatric disorders such as depression and anxiety.
Dr. Martz Story-
TOUCHED BY LYME: Dr. Dave Martz overcame his own ALS death sentence with Lyme treatment
As Dave Martz lay dying, an idea serpentined around his mind and would not loosen its grip: Despite the absolute diagnosis and the insistence of the doctors, including a world expert, that he was dying of ALS, despite his own vow to face things head-on and reject the lure of denial, Martz couldn’t shake the notion that possibly, just maybe, he actually had Lyme disease. (from “Cure Unknown: Inside the Lyme Epidemic,” by Pamela Weintraub.)
Dr. David Martz is kind of a rock star in the Lyme world. You may have read about him in Pam Weintraub’s Cure Unknown, and seen footage of him in the documentary Under Our Skin.
His story is riveting. After a lifetime of good health and a successful career as a physician practicing internal medicine-hematology-oncology for 30 years, in 2003, Martz suddenly started experiencing strange symptoms. First deep fatigue, then profound muscle aches and body-wide pain. Soon he was too weak to get out of bed. As his condition rapidly deteriorated, his physicians gave him a devastating diagnosis: ALS (aka Lou Gehrig’s Disease). They said nothing could stem his physical decline and he would likely be dead within two years.
But events went in a different direction. As his health spiraled downward, Martz connected with a Lyme specialist who prescribed hard-hitting, long-term antibiotics. The gamble paid off. By the end of 2004, Martz was a new man. In fact, the doctor who had diagnosed him so definitively with ALS, now pronounced that condition completely gone.
Martz devoted the next two and a half years to a project that gave extended antibiotics to about 90 ALS patients, and demonstrated objective improvements in 15% of them. He has also treated more than 800 chronic Lyme patients, with good response and minimal side effects. That work is currently being written up for publication.
Martz is moving into a new phase of life now, having recently been named president-elect of the International Lyme and Associated Diseases Society. His term will start in 2011.
An LLMD is needed to make the most accurate diagnosis of Lyme Disease.