As a rheumatology clinic, we see quite a few patients suffering from chronic infections, including Lyme disease. Since 2009, we have diagnosed and treated thousands of patients with Lyme disease.
When it comes to diagnosing Lyme disease, we use a combination of blood work from standard lab tests as well as physician interpretation and experience. In certain circumstances we turn to specialty Lyme testing labs that perform specific testing for Lyme and other co-infections.
In this post we will discuss the specialty Lyme testing labs we choose, when we use these tests, and why we believe these tests are necessary.
Diagnosing Lyme disease: Laboratory Testing and Physician Interpretation
Because Lyme disease is a chronic infection, similar to many chronic infections, the nature of Lyme disease is characterized by periods of exacerbations and remission. As a physician, when I suspect Lyme disease as the cause of illness, there are three key questions I am looking to find answers to with blood work.
These questions are:
- Does the patient have Lyme disease?
- Is the patient dealing with acute Lyme disease or is the disease in a dormant state?
- What other co-infection(s) can be present?
The laboratory diagnosis of acute Lyme disease can occur from several days up to 3-4 weeks from the tick bite episode. It is based on detection of microorganisms, their antigens or nucleic acids in the tissues (for example, the skin) and biological fluids (blood, cerebrospinal fluid, synovial fluid, saliva, and urine), as well as detection of Borrelia-specific IgM antibodies in the blood.
An antibody, or immunoglobulin, is a protein that your immune system produces to neutralize foreign materials such as bacteria and viruses. Therefore, if high levels of antibodies are detected in your blood, it is a good indication that an infection is present. The body makes different immunoglobulins to combat different viruses. There are five subclasses of antibodies, IgA, IgG, IgM, IgE, and IgD.
In general, the presence of either IgG or IgM antibodies to the Borrelia burgdorferi (Borrelia burgdorferi is the bacteria that causes Lyme disease) protein is indicative for Lyme disease. IgM is the first immunoglobulin produced following exposure to a virus; therefore, in acute cases IgM will be present. IgG antibodies remember what viruses you have been exposed to and if they come back, they are produced again. So testing for IgG lets you know if you have been infected before. IgG is helpful in diagnosing chronic Lyme disease—meaning someone has been infected for a while.
Lyme Testing Labs: The Western Blot Test
The standard for determining the presence of Lyme disease is confirmed by the Lyme Western blot blood test. This test can detect two different classes of antibodies: IgM and IgG.
During the procedure proteins extracted from Borrelia burgdorferi microbial cells and a patient’s blood are placed onto gel strips, if a patient’s blood contains antibodies to Borrelia burgdorferi, they react with the bands in the gel forming so called “positive bands.” The Western blot test measures for levels of antibodies to the Borrelia, not the Borrelia itself.
Another approach to Western blot
If the physician suspects Lyme, but the patient has an inconclusive Lyme Western blot test result, another approach can be used. In our clinic we call it band shift. Let’s presume that a patient with a clinical picture suspicious for Lyme disease has only one or few bands in the Lyme Western blot, which is/are not the most unique or specific for Borrelia burgdorferi. In this situation, we ask the patient to take an antibiotic or antimicrobial herb for 1-2 months, and then repeat the Western blot test. If there is a change in the band profile, to the highly specific bands, then this is an indication that the disease is present.
Why does this happen? Taking an antibiotic or antimicrobial kills the Borrelia pathogen and releases toxins into your bloodstream. In response to the release of toxins, your antibodies increase, resulting in the band shift.
At IFSMED we also perform Lyme Western blot on synovial fluid (fluid aspirated from swollen joints)
Our joints and synovial spaces represent biological traps for various microbioligical antigens which stimulate a local intrasynovial immune response. Based on that principle, synovial fluid analysis should produce more positive results than the corresponding serum analysis. Based on our statistics, patients with Lyme disease have more positive bands upon analysis of synovial fluid as compared to the paired serum samples.
A positive Lyme Western blot means that the patient has acquired a Borrelia infection at some point in time. With a single serological test it is not possible to decide whether this infection is active or dormant. It is important to understand that a negative serological finding does not rule out Lyme disease.
In our clinic, we use many different factors to diagnose Lyme disease including the following laboratory markers to test for Lyme disease activity.
None of these markers are unique for Lyme disease. However, taken together with clinical symptoms and Lyme Western blot results, they can be used as surrogate markers of disease activity. Furthermore, these markers can be used to monitor the outcome of antimicrobial therapy in patients with Lyme disease.
C4a: This marker serves as a mediator of the local inflammatory process and is commonly highly elevated among people with Lyme disease. It induces the contraction of smooth muscle, increases vascular permeability and causes histamine release from mast cells and basophilic leukocytes. Patients with active Lyme disease are characterized by the increased blood levels of C4a.
CD57: is a marker present on natural killer (NK) cells. NK cells are activated as a response to an infection and work to control infections. Patients with chronic Lyme disease are characterized by a low count of CD57 + NK cells compared to those with acute Lyme disease.
Immune complexes: An immune complex, sometimes called an antigen-antibody complex, is a molecule formed from the integral binding of an antibody to a soluble antigen. An increase in the concentration of immune complexes is found in patients with various chronic infections, including Lyme disease, as well as in patients with certain autoimmune disease, for example, systemic lupus erythematosis.
IgM antibodies to phospholipids (APL antibodies): The presence of low affinity IgM APL antibodies is seen in various chronic infections, including chronic Lyme disease. Affinity is the binding strength of the antibody to an antigen. It determines the rate at which an infection is eliminated. The higher the affinity, the faster an infection will be eliminated.
Anti-histone and anti–chromatin antibodies: are autoantibodies frequently found in patients with autoimmune and chronic infectious diseases, including Lyme disease. Most likely, the level of these antibodies parallels the concentration of immune complexes.
Specialty Lyme testing labs—are they necessary?
As an alternative to standard Western blot tests, in certain instances we also use specialty Lyme testing labs where their individual focus is on developing and administering the most precise and effective diagnostic tests for Lyme disease and other tick-borne diseases.
When should someone consider using specialty Lyme testing labs as opposed to standard blood work?
Typically, we use reference labs to confirm various co-infections or to test antibodies against tick-borne microorganisms in biological fluids different from the blood (for example, synovial fluid – fluid from the swollen joints).
The following Lyme testing labs are tests we use on a regular basis. We will cover why we choose the tests we do, show you an example of each test, and when we believe additional testing is necessary.
IGeneX uses an ImmunoBlot test that detects antibodies to more Borrelia burgdorferi species than the current Western blot does. By combining the results from more significant protein bands, IGeneX testing provides higher sensitivity for detecting Lyme exposure.
In fact, the ImmunoBlot test for Lyme disease has a sensitivity greater than 93%, whereas the ELISA and Western Blot two-tier testing protocol recommended by the CDC has a sensitivity of only 57.6%.
IGeneX claims to test more relevant strains of tick-borne pathogens than any other lab, allowing for one test to show results from many different species.
The following are examples of test results from IGeneX.
This lab we use for Bartonella testing.
Their process uses PCR testing. Polymerase chain reaction, or PCR, is a method of detecting target bacterial DNA in a sample.
Research shows that the Bartonella bacteria that make people sick can cause a cyclical bacteremia. That means that sometimes the bacteria is in the blood and sometimes it isn’t. This allows the bacteria to evade the host immune response and makes it very hard to test for.
In order to overcome this challenge, Galaxy has developed a method of adding an enrichment culture to the sample allowing the bacteria to grow to detectable levels. Performing PCR on a sample after allowing bacteria to grow maximizes the chance of detecting present DNA. Using PCR after culturing reduces the chance of false negatives.
Unlike the other tests, this is a urine sample that you collect at home.
Prior to collecting, physical provocation is highly recommended.
This can include:
- 30 minutes of vigorous exercise
- 1 hour lymphatic or deep tissue massage
- 30 minutes of infrared sauna
The urinary tract is known to be a place where spirochetes collect.
Why exercise first?
Many clinicians believe that exercise, infrared sauna, and deep tissue massage are good provocators of the microorganisms into the blood and then ultimately into the urine prior to urine collection.
This is because B. burgdorferi disseminates throughout the body and can hide in different places, such as the lymph nodes and joints.
Physical movement aids in releasing the organisms and getting them moving through the system, including the urinary tract.
How do we choose which test a person needs?
It mostly depends on an individual person’s clinical presentation and their presenting symptoms, as well as our experience with each lab.
An important thing to remember: because these labs use different techniques, it is not uncommon to get different results from different labs even when targeting the same infection.
Are these specialty labs worth it?
In our opinion, they are definitely worth it because it allows us to diagnose specific tick-borne illnesses more precisely compared to conventional labs.
Even though these Lyme testing labs provide us valuable information, it is important to remember that the lab result is only an adjunct tool. An actual diagnosis is made by an experienced physician who relies not only on labs, but also clinical symptoms, analysis, and a patient’s history.