TESTING FOR LYME DISEASE
**Disclaimer: The information provided on this web site should not take the place of any quality medical care. It is
provided for patient information only. ILDA-ED does not engage in rendering medical services.

    There is no test that can determine if a patient is infected with the Lyme disease (Ld) bacterium and then demonstrate that the patient has
    become bacterium-free.  Therefore, Ld is a clinical diagnosis, based on signs and symptoms, with the patients travel history to endemic areas
    and test results being additional pieces of information in the complete picture.  No test can "rule-out" Lyme disease.

    Laboratory tests - Testing is generally done through a blood test. The tests are not accurate at present. Urine tests and tests of spinal fluid are
    not reliable either. False positives and false negatives do occur. Medication taken for other ailments and pre-existing conditions can interfere with
    the tests.

    Indirect tests (antibody tests)
    Antibodies are the immune system's response to "fight off" infection.  Tests strive to be both sensitive (detecting any Ld antibodies) and specific
    (detecting just Ld antibodies).

    Test Interpretation: False negative tests occur due to defects in test sensitivity; too low an antibody level to detect (e.g. they are bound to the
    bacteria, with too few free-floating; the patient taking antibiotics or other drugs; naturally low antibody production); the bacterium has changed,
    limiting recognition by the immune system; or bacterial strain variations. False positive tests occur due to test failure or cross-reacting antibodies
    (e.g. Syphilis, periodontal disease, ANA ).


                  For more general information on Lyme disease tests and diagnostics visit:
                         The International Lyme and Associated Diseases Society web site:   
ILADS   

TREATMENT OF LYME DISEASE
TESTS  AND  TREATMENT
Iowa Lyme Disease Association -
Education
P.O. Box 221
Brighton, IA  52540
iowalymedisease@yahoo.com

    This site has several treatment guidelines for Lyme
    disease. Be sure to share this with your physician.
    Treatment Guidelines

    DISCLAIMER: The guidelines on the site linked above are the
    products of the guidelines' authors who are solely responsible
    for their content.  The ILDA-ED is not a medical organization and
    does not make any recommendations or warrantees concerning
    these guidelines.  When ever medical advice is needed, the
    services of a qualified medical provider should be sought.
GUIDELINES

  • First-line drug therapies for Lyme disease may include
    (in alphabetical order): oral amoxicillin, azithromycin,
    cefuroxime, clarithromycin, doxycycline, and tetracycline. These
    antibiotics have similar results in comparative trials of early
    Lyme disease.

  • Common IV antibiotics are: ceftriaxone, cefotaxime, and
    penicillin.  Other drugs used  include: Intravenous imipenem,
    azithromycin, and doxycycline, especially if they are not
    tolerated orally.

  • Intramuscular benzathine penicillin is sometimes effective
    in patients who do not respond to oral and intravenous
    antibiotics.

  • Combination therapy with two or more antibiotics is now
    increasingly used for chronic Lyme disease symptoms.
    Oral amoxicillin, cefuroxime, or (more recently) cefdinir
    combined with a macrolide (azithromycin or clarithromycin) are
    examples of combination regimens that have proven
    successful in clinical practices.

  • When antibiotics are administered to Ld patients, they usually
    experience a "Herxheimer" reaction which is a worsening of
    symptoms. As the bacteria die they release endotoxins
    causing an overload and response by the immune system.
    Herx's usually begin 1-5 days after the start of an antibiotic,
    and may last a few days to weeks.  This condition was first
    described under syphilis treatment.

  • One well indisputable fact about Lyme disease: The prompt
    use of antibiotics during the early stage can prevent chronic
    Lyme disease. Antibiotic therapy should be initiated upon
    suspicion of the diagnosis, even without definitive proof.

  • Therapy usually starts with oral antibiotics, and some experts
    recommend high dosages.

  • Lyme literate physicians will often consider using intravenous
    antibiotics when:
    >     oral medications fail in patients with persistent,
    recurrent, or refractory Lyme disease.
    >    certain conditions, such as: meningitis,
    encephalitis,  optic neuritis, joint  effusions, and heart
    block are present.
    >    needed to penetrate into the central nervous
    system and brain.

  • Many Lyme literate physicians will b
  • egin chronic Lyme patients on intravenous therapy first (e.g.,
    intravenous ceftriaxone), at least until disease progression is
    arrested and then follow with oral therapy for persistent and
    recurrent Lyme disease.

  • Increasingly, Lyme literate physicians recommend that certain
    drugs used for Lyme disease be given at higher daily doses:
    for example, 3,000–6,000 mg of amoxicillin, 300–400 mg
    doxycycline, and 500–600 mg of azithromycin. Close
    monitoring of complete blood counts and chemistries are also
    required with this approach.

  • Using higher doses of antibiotics may increase adverse
    events in general and gastrointestinal problems. However,
    using Acidophilus has reportedly reduced the incidence of
    Clostridium difficile colitis and non-C. difficile antibiotic-related
    diarrhea.                                                                          
ANTIBIOTICS
TREATMENT  NOTES

    (ELISA, EIA, IFA) - These tests measure the level of “Borrelia
    burgdorferi” antibodies in fluid.  Laboratories use different
    detection criteria, cut-off points, types of measurements, and
    reagents. According to the International Lyme and Associated
    Diseases Society, "the ELISA screening test is unreliable. The
    test misses 35% of culture proven Lyme disease (only 65%
    sensitivity) and is unacceptable as the first step of a two-step
    screening protocol. By definition, a screening test should have at
    least 95% sensitivity". (See their web site below)

    Western Blot - This test produces bands indicating the immune
    system's reactivity to Bb.  Laboratories differ in their interpretation
    and reporting of these bands. A positive 31 or 34 band is highly
    indicative of Borrelia burgdorferi exposure. Yet these bands are
    not reported in commercial Lyme tests, due to a CDC ruling in
    relation to the Ld vaccine which is no longer available. When
    used as part of a patient diagnostic evaluation for Lyme disease,
    the Western Blot should be performed by a laboratory that reads
    and reports all of the bands related to Borrelia burgdorferi.
    Generally, 41KD bands appear the earliest but can cross react
    with other spirochetes. The 18KD, 23-25KD (Osp C), 31KD (Osp
    A), 34KD (Osp B), 37KD, 39KD, 83KD and the 93KD bands are
    the most specific but appear later or may not appear at all.
    Basically, the 41KD band and one of the specific bands above
    are indicative of Ld exposure.

    Direct detection tests:

    Antigen detection tests - They detect a unique “Bb” protein
    in fluid (e.g. urine) of patients and  may be useful for detecting Ld
    in patients taking antibiotics or during symptom flare-up.

    Polymerase chain reaction (PCR) - This test multiplies
    the number of Bb DNA to a detectable measurable level.

    Culturing - Growing the bacterium in culture is a difficult and
    lengthy procedure.

    These labs are listed for informational purposes only. ILDA-ED
    does not guarantee their testing capability, or accuracy, and
    they are not a substitute for professional medical care.

       IgeneX, Inc., 795 San Antonio Rd., Palo Alto, CA USA
94303       IgeneX Laboratories      Tel. 650.424.1191 /
800.832.3200 Fax. 650.424.1196  
                        
       Medical Diagnostic Laboratories, 2439 Kuser Road,
Hamilton, NJ 08690    Phone: 877.269.0090          Medical
Diagnostic Laboratory

        Laboratory Corporation of America,  Laboratory
Corp. of America  
        
         Specialty Laboratories, 27027 Tourney Road,
Valencia, CA 91355   Phone: 661.799.6543,
800.421.7110                Specialty Labs
 
       Sunrise Medical Laboratories,     Sunrise Lab
TYPES  OF  TESTS
TESTING LABS