- Last Updated: February 28 2014
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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.
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.
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)
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.
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.
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
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.
- 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.
- 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.
In Better Health,
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