The information outlined here on testing for Lyme disease and related co-infections is based on my own personal experience.  It may not be an all-exhaustive analysis of possible testing options and is not intended as a substitute for your own research.  Many of the comments represented are opinion as there are numerous debates in the arena of Lyme testing.

It is important to differentiate between tests that look for antibodies and tests that look for antigens, or the actual organisms (or DNA of the organisms themselves).  Antibody testing can be highly unreliable (as can antigen testing).  Lyme disease often evades the immune system and thus false-negatives are not uncommon.  It may be only after the start of treatment that one finds a Western Blot, for example, becoming positive.  This is generally due to the recovery of the immune system and the immune system's ability to now begin to mount an attack and recognize the foreign invaders.

1) ELISA (Enzyme Linked Immunoassay) -  a simple, inexpensive test for detection of antibodies created as a response to an infection with Borrelia Burgdorferi (the main causative agent in Lyme disease).  Personally, I do not believe this test is of any significant value and may represent a doctor that is not well-versed in diagnosing and treating Lyme disease.  It may be a sign to turn and run to find a new doctor if your doctor is relying on an ELISA test to determine the course of your care. In one study, the test was found to be 55% inaccurate.  Thus the odds are better with a simple coin toss.  The test is not recommended until at least four weeks after exposure.  The C6-peptide ELISA is a more accurate form of the ELISA test though still not recommended.  A positive ELISA must be followed up with a Western Blot.

2) Western Blot - This is likely the most commonly used test for Lyme disease.  It is still an antibody test and thus false negatives are not uncommon, but it is, in my opinion, an important place to start.  Western Blot test results will include both IgG and IgM assays.  In many traditional infections, IgM is an indication of recent infection whereas IgG is an indicator of late infection.  With Lyme Disease, there appears to be a cycling between IgM and IgG and thus, these are not accurate indicators of the length of time the infection has been present in most cases.   In my opinion, IGeneX is the best place to have this test performed. 

It is critically important that one not look at the NEGATIVE or POSITIVE summary result of the Western Blot test.  That criterion is based on CDC guidelines which many argue are not appropriate for Lyme disease.  Instead, it is important to look at all of the bands and map those to the known Lyme-specific bands (those bands that represent evidence of serological exposure to Borrelia Burgdorferi).  According to Dr. Charles Ray Jones, these are:  18 23 30 31 34 37 39 83 93.  Other doctors focus on 23-25, 31, 34, 39, 83-93 as the most specific bands.  Additional information on the specific bands and what they mean can be found here.

If any of these bands appear in either IgG or IgM, that is a likely indication of past or present infection with the causative agent in Lyme disease.   Thus, that is NOT a clear "negative" test result; "something" consistent with infection with Borrelia was observed.  Some labs reports only + (positive) and - (negative) and ignore equivocal or IND (indeterminate) bands.  This is, in my opinion, an error.  If anything is visible, this is not negative. Quest, for example, does not report IND bands whereas IGeneX does.  In my opinion, testing for Lyme disease via Quest, and most other major labs, is not ideal as they do not test for bands 31 and 34 which where used for Lyme vaccine development.  Something else to consider is that most labs in the US only test for Borrelia burgdorferi.  This may miss many strains of the Borrelia organisms, especially those from Europe.

IGeneX also offers a 30-31kDa Confirmation IgG and IgM test.  If results from the initial Western Blot are positive for bands 30 or 31 only, it is possible that these could be due to cross-reactivity with several different types of viruses.  In this confirmatory test, highly specific recombinant antigens are used to validate that the positive result is not due to cross-reaction with viruses. 

3) PCR (polymerase chain reaction) - a sensitive method of testing where minute amounts of DNA are looked for.  In a presentation that I attended by Dr. Aristo Vojdani PhD, it was noted that PCR tests are positive somewhere between 6% and 15% of the time.  Thus, it was stated that this is not generally a useful test for the evaluation of Lyme Disease.  For PCR to be useful, it should be expected that it may take repeated tests in order to get a positive result.

4) Lyme DOT-BLOT is an assay for the direct detection of Lyme antigen in the urine.  The Reverse Western Blot is an antigen detection test in urine where the urine is exposed to rabbit antibodies for Borrelia burgdorferi.  

5) IGeneX offers the IFA (immunofluorescence assay) for Borrelia.  It has shown many people that have had consistently equivocal or negative results that, in fact, they do have results consistent with Lyme disease.   IGeneX also offers a Babesia FISH and a Bartonella FISH (Fluorescent In Situ Hybridization).  These are antigen detection tests and not antibody tests.

6) CD57 - We have all likely heard of people with HIV/AIDS getting their T-cell counts or CD-4 cell counts checked on a regular basis.  Current information suggests that there is a similar population of NK (natural killer) cells called CD57 cells that are known only to be suppressed in the presence of Lyme disease.  Generally guidelines are that a score of < 20 indicates advanced or highly active Lyme disease.  Scores of 20-60 are indicative of active Lyme disease where scores > 60 start to suggest that the Lyme infection is less active.  A normal test result would be > 200.  It is the opinion of some doctors that treatment is necessary until the CD57 test score is 150 or above.  The lower the result, the more likely a relapse if treatment is terminated.

The test can be an indication of progression of disease or of progress in treatment.  However, it should be noted that it is not uncommon to see only small changes in the results until the end of treatment where the results often then jump quickly to higher levels.  It may be the case that this test can both be used as an indicator of Lyme disease presence and as a marker for when to consider stopping treatment.  Unfortunately, there are people that feel they are recovering and still have low CD57 scores as well as those that have high scores and are still quite ill.  The test doesn't seem to provide consistent value for every patient.  For more information on the CD57, go here.  The test is now available through both LabCorp and, as of late 2010, IGeneX.
 
In my experience, the CD57 test is a good initial screening test, but is not very useful for monitoring progress over time and may not be worth doing more than once a year or so during treatment.  There is anecdotal evidence that suggests that treating some coinfections such as Babesia with effective therapies can also lead to a reduction in CD57 and that CD57 may go down during Herxheimer reactions.  It has also been observed that CD57 may be low in other infections or conditions beyond just Borrelia.  Thus, while it is another piece of information, there is some debate around its usefulness.

7) In mid-2007, I did the "Borrelia Burgdoferi Direct Fluorescent Antibody by Flow Cytometry" from Central Florida Research.  The result was "NEGATIVE" which hopefully is a good sign after having treated for almost two years.  I'd welcome the experiences of others with this test as well to help me form a more complete opinion.  I still have not heard many doctors using this lab.  The one downside I have heard is that they may not look at any strains of Borrelia other than Borrelia burgdorferi and thus may miss infections with other strains of the disease.  

Update: In November 2008, I was contacted by a reader of my site indicating that they had done both Central Florida Research and NeuroImmunology Labs (specific panel no longer available).  The Central Florida panel reported that they were entirely "NEGATIVE' while the NeuroImmunology results showed abnormal levels for Borrelia, Ehrlichia, Babesia, Bartonella and unrelated spirochetal infections.  Another reader of my website contacted me regarding the Central Florida Research testing that had a negative result but was positive using IGeneX.  As of August 2013, this lab no longer appears to be in business.

8) Fry Clinical Laboratories offers a number of tests for Lyme and co-infections.  I think they are a good option and one of the few, if not the only one, labs that looks for Babesia and Bartonella in a blood smear.    I had them perform an ANA and antibody tests for Anaplasma, Babesia, and Bartonella.  My tests showed Ehrlichia antibodies as well as Bartonella-like antigens (the actual organism) in the blood smear.  I did not have a positive result for Babesia, however, I have seen other test results from this same lab that did show clear indication of Babesia.  To see my blood smear results, go here.  Contact by phone at 480-991-4555 to request a test kit or you can order the kit online at http://www.frylabs.com.
 
As of early 2012, the lab is offering a number of tests including BorreliaAnaplasmaBartonellaEhrlichiaCoxiella burnettiRickettsia,PlasmodiumBabesiaToxoplasma, and FL1953.  FL1953 was the original reference for a novel new organism now called Protomyxzoa rheumatica that Dr. Fry and his team have observed in patients with a wide range of chronic diseases.  Protomyxzoa rheumaticais a biofilm-forming protozoan with characteristics similar to Babesia and malaria.  A blog post on this new organism can be found here.  Additional information is available here.
 
Update: I do think that some exciting new directions for treatment may emerge from the work that this lab is doing though and that our understanding of TBIs will emerge as a result of their work.  At this time, I think that their biofilm and Protomyxzoa rheumatica testing may be of particular interest to those of us with chronic illnesses.
 

9) One of the emerging labs on the block for Tick-Borne Infections is Clongen.  I've heard the director of this lab speak at conferences and they appear to have a number of useful tests.  I did perform a couple of their tests and was surprised that they did not find anything in my samples.  That said, I had already been treated for quite some time for Lyme so I wasn't the best test subject.  

I am particularly excited to see that they offer testing for other strains of Borrelia such as Borrelia afzelii and Borrelia garinii.  A list of their tests can be found here.

Though the extensive panel for Lyme is over $2000, it is quite an impressive list of organisms that they are testing for:

  • Borrelia burgdorferi
  • Babesia microti
  • Bartonella henselae
  • Anaplasma phagocytophilum
  • Mycoplasma fermentans
  • Borrelia lonestari
  • Borrelia afzelii & garinii
  • Coxiella burnetii
  • Ehrlichia chaffeensis
  • Ehrlichia ewingii
  • Francisella tularensis
  • Rickettsia species (9 species)
Update: While I have had some feedback that the results from these tests were negative when positive results were anticipated, it is another option for those looking for Lyme-related testing.
 

10) MELISA testing was traditionally employed for testing for allergic responses to various metals.  It is also available as a potential method for diagnosing Lyme disease by looking at reactivity of blood cells to different strains of Borrelia.  Details on the LTT-MELISA test for Lyme Disease can be found here.  IGeneX now also offers the "Borrelia Elispot-LTT" which was discussed in my recent "Emerging Tests for TBIs" blog entry.

11) Bowen Q-RiBb (Quantitative Rapid Identification of Borrelia Burgdorferi) was an interesting test for Lyme Disease.  As of early 2007, the test is no longer available.  It was done by Bowen Research and Training Institute, a research facility.  I personally had the test done and found the information to be of some value.  However, the test is debated and many LLMDs would not use it.  I thought the test may have provided a data point that could have been of value to some especially at the beginning as additional confirmation of the disease.  It should be known that there were only a handful of negative results on this test in its history.  In the eyes of some, this spoke to the prevalence of the organism.  In the eyes of others, it drew questions about the reliability of the testing procedure.  The photos below are my personal results from Bowen Labs in 2005:

Q-RiBb ResultsQ-RiBb Results

12) Galaxy Diagnostics emerged in early 2010 as a lab with a focus on Bartonella.  I have not personally used the lab and would welcome and feedback from those that have.   For Bartonella testing, this may be one of the best options at present.  More information on Galaxy can be found here.  If I were exploring Bartonella as a potential factor in illness, this is the lab I would likely use at this time.
 
13) ImmunoSciences Lab has been around for years and is lead by Dr. Aristo Vojdani PhD.  They offer a Lyme disease panel that can be found here.  More information about the lab is available here.
 
14) Spiro Stat Technologies emerged in early 2010.  Dr. Lee Cowden said in a presentation in April 2010 that Spiro Stat is the only lab that he would use for Lyme disease at that time.  Their panel included a lengthy list of microorganisms.  I was impressed that they even include the common dental pathogen, Treponema denticola.  They offered a Lyme Panel, a Babesiosis Panel, and a Fungi Panel.  I talked in more detail about this option in a recent blog that can be found here.  
 
The lab reopened under a different name in late 2013.  KS3 Diagnostic Laboratories began offering panels for Lyme, Babesia, and fungal issues in November 2013.  This appears to be based on the earlier testing offered by Spiro Stat labs.  Their panels look very promising, and I am looking forward to feedback from people that have the testing done.  I had received feedback in the past from people where the Spiro Stat testing had shed much light on their situation.  I am optimistic about the KS3Labs panels.  
 
15) The newest lab to start testing for Borrelia as of late 2011 is Advanced Laboratory Services.  This is the first commercially available culture test for Borrelia.  This lab has the potential to be a game changer in the world of Lyme disease.  If the actual organism can be cultured after years of treatment, the argument over persistence of the organism may be forced to change.

Consultants to the lab include Dr. Joe Burrascano, Dr. Marcus Conant, and Dr. Eva Sapi.  I haven't had this test done personally because at this stage of my journey, I'm not sure how a positive or negative result would change my direction, but I do think it is the most exciting development in testing to emerge in a long time.  A recent blog on this option can be found here.
 
A July 2012 press release from Advanced Lab with more information about their testing is available here.
 
16) Another option for testing is Infectolab which is based in Germany and led by Dr. Armin Schwarzbach.  They offer the Borrelia-Elispot LTT, CD57, Borrelia-immunoblot, and other testing such as Chlamydia and co-infections.  To learn more, visit the Infectolab web site here.  To order these tests from within the US, contact Sue Vogan at 717-254-1953 or via email at This email address is being protected from spambots. You need JavaScript enabled to view it. for more information.
 
17) Pharmasan Labs now offers the iSpot Lyme panel.  This panel is available through NeuroSciences.  It is still a very new test, and I have not gotten enough information yet to see where this option may fit in the landscape of available tests.  
 
Update January 2014: My understanding is that the iSpot may not be as helpful for trying to identify Lyme disease in a patient with a negative or indeterminate Western Blot as the results may come back with low phytohemagglutinin which may suggest that there is a suppression of T-cells potentially as a response to Lyme but not provide any additional useful information. 
 
18) Medical Diagnostic Laboratories (MDL) is another lab that many people have found useful.  They have been around for a number of years, but were absent from my list until recently.  They do testing for a broad variety of relevant things such as Lyme, Bartonella, Babesia, Candida, Chlamydia, Mycoplasma, and more.  Based on feedback I 've gotten on this lab and my own use of it many years ago, I do think it is another useful option. 
 
Testing for Co-Infections
 

My experience has been that testing for co-infections is a critically important piece of the puzzle.  My initial Western Blot was equivocal and yet, I had evidence of Babesia, Ehrlichia and Bartonella.  This helped to round out the facts in support of my Lyme Disease diagnosis.  I have had the clearest results from the standard IgM/IgG antibody tests (outside of energetic medicine using ART or EAV which were far superior in my experience) from IGeneX and the test above from Fry Clinical Labs when it comes to co-infections.  I also firmly believe that people with Lyme generally have at least one co-infection (in fact I would go as far as to say almost always if not always).  Each co-infection may require different types of treatments and unless all of them are addressed, the chances of recovery are lessened.  Here are some additional thoughts on co-infections:

  • Co-infections are the RULE, not an exception
  • The average child with Lyme has 2-5 co-infections with an average of 3.
  • Treatment of co-infections is required and often, they must be treated BEFORE or concurrent with the Borrelia treatment itself.
  • If you don't test for and treat co-infections, you are not putting yourself in a good position for healing.
  • Almost everyone with chronic Lyme likely has 1 or more co-infections.
  • Co-infections require DIFFERENT treatments in many cases. Do not assume that you are covering them with only the Lyme treatment. Many people don't even know which ones they have.
  • Co-infection testing is often unreliable as well and you need to repeat them over time. It took 4 months for my Bartonella to appear and almost 8 for Babesia to finally appear, but they were there.
  • If you think you only have Borrelia, odds are you have not looked closely en
    ough.
For an article on co-infections in the Public Health Alert, go here.

My current preferred approach for testing for co-infections is to use IGeneX (particularly the Babesia and Bartonella FISH tests).  For Bartonella, Galaxy Diagnostics appears to be a very good option as well.

My Recommendations
 
For Lyme Disease / Borrelia Testing:
  • Complete Lyme Panel 6050 from IGeneX which includes Western Blots, the Lyme IFA, and PCR.
  • Borrelia Culture from Advanced Laboratory Services was made available in late 2011.  This is the first commercially available culture for Borrelia and does not rely on the immune system for a positive test result.
  • CD57 from either IGeneX or LabCorp as another key indicator that may help provide more information as to whether or not Lyme disease may be a factor in one's chronic illness.  A fantastic article on the test can be found here.
For Co-Infection Testing:
  • Complete Co-Infection Panel 5095 from IGeneX which includes Babesia antibody and FISH testing, Ehrlichia antibody testing, and Bartonella antibody and FISH testing.
  • Co-Infection Profiles from Fry Labs.
  • Bartonella testing from Galaxy Diagnostics.

I would also definitely do a good heavy metal urine challenge test, viral testing, and a good parasite test.  All too often, people focus too much on just the Lyme and in my opinion miss many of the other important things that are also going on.

LIA (Lyme in Autism) Foundation has created an excellent list of tests that are recommended for autism.  It is my opinion that these apply to anyone with chronic illness.  LIA Foundation recommendations can be found here.

In Better Health,

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