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provided for patient information only. ILDA 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 ).
Types of Tests
(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 indicitive 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.
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For more general information on Lyme disease tests and diagnostics visit:
The International Lyme and Associated Diseases Society web site: ILADS
Testing laboratories:
These labs are listed for informational purposes only. ILDA 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
- Bowen Research & Training Institute, Inc. 245 North Seminole Avenue, Lake Alfred, Florida 33850 Ph.863.956.3538
Bowen Institute
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
- 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.
- 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.
- Lyme literate physicians will often consider using intravenous antibiotics when:
- oral medications fail in patients with persistent, recurrent, or refractory Lyme disease
- certain conditions, (i.e., encephalitis, meningitis, optic neuritis, joint effusions, and heart block) are present.
- needed to penetrate into the central nervous system and brain.
- 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.
- Many Lyme literate physicians will begin 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.
- The management of chronic Lyme disease must be individualized, since patients will vary according to the severity of their
symptoms, previous treatments, and overall medical history. Other risk factors include: coinfections, previous treatment
failures, frequent relapses, neurologic involvement, previous use of corticosteroids, or evidence of unusually severe Lyme
disease must be considered before deciding on appropriate duration of therapy (i.e., weeks versus months). Generally, 4-8
weeks of oral antibiotics are prescribed for early Lyme disease symptoms. 6-12 months may be needed to treat persistent or
later stages of the disease. For many chronic Lyme disease patients, antibiotics are administered daily, weekly or monthly for
the rest of their lives to inhibit bacteria growth and disease progression.
- 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.
