I've heard Lyme disease testing is unreliable. What are the available tests, and how reliable are they?
One of the most vexing issues in Lyme disease diagnosis is the debate over the role and reliability of currently available laboratory tests. Patients and their treating physicians may often turn to excessive or inappropriate testing after receiving negative results using the standard two-step testing method (ELISA and Western blot). This practice can result in conflicting evidence leading to misdiagnosis and unnecessary treatment while the real cause of illness remains obscure.WHAT TESTS ARE AVAILABLE?
A variety of tests is available. Many doctors who are unfamiliar with Lyme disease use the Lyme testing available in their local laboratory. This is usually the Lyme ELISA. This tests measure a patient’s antibodies, a total of the IgM and/or IgG, in response to exposure to the Lyme bacteria. By today’s standards, these tests are not very sensitive. IGeneX lab in Palo -Alto California and Clongen Labs in Germantown, MD run a very specific and sensitive panel for the diagnosis of Lyme disease, including an IFA and Western Blot.
The Lyme IFA (performed as part of a Lyme Panel) detects IgG, IgM and IgA antibodies against B. burgdorferi (the spirochetal bacteria that causes Lyme disease). IgA antibodies are the first to become elevated. IgM antibody levels tend to rise above background levels about 2-3 weeks after infection and may remain elevated in case of prolonged disease. IgG's are the last antibodies to form.
The WESTERN BLOT (IgG and/or IgM) can visualize the exact antibodies you are making to specific parts of the Lyme bacteria. In some cases the laboratory may be able to say that your “picture of Lyme antibodies” is consistent with early disease or with persistent/recurrent disease. Not all patients have antibodies at all times when tested. Antibodies are more commonly detected within the first year after infection, although re-infection may cause a significant rebirth of antibodies. At most, only 70% of patients have antibodies early, and the presence of antibodies alone does not make a diagnosis of disease. In many instances, a clinical diagnosis (diagnosis based on the history of the patient and their symptoms) from a Lyme Literate doctor is necessary in order to begin treatment immediately.
