How Do You Test For It?
It can be difficult to determine who has a tick-borne illness. Laboratories have varying levels of sensitivity, specificity, and cost. We have compiled a variety of testing options so you can pick what is best for you.
Overview of Testing
Based on available testing for Lyme disease, it can still be difficult to determine who has the illness, the most effective course of treatment, and when treatment can be discontinued. Typical testing for Lyme disease measures IgM and IgG antibodies. The body produces IgM antibodies in response to a recent or active infection. After you’ve had an infection for a period of time, IgG antibodies may be generated and could indicate the presence of a later stage or persistent infection. As detailed more fully below, the CDC criteria is deeply flawed. However, if a patient tests positive using the CDC’s standards, this may help patients receive appropriate treatment and insurance coverage.
The CDC currently recommends a two-step testing process for Lyme disease that was developed for surveillance purposes, the enzyme-linked immunosorbent assay (ELISA) and the Western blot. The CDC recommends that doctors first order an ELISA to screen for Lyme disease and then confirm Lyme disease with a Western blot.
- Enzyme-linked immunosorbent assay (ELISA) test detects antibodies to B. burgdorferi. Studies show that the ELISA test generates false negative results approximately half of the time. Unfortunately, with a negative ELISA, most patients are definitively told they do not have Lyme without any further inquiry.
- Western blot test. If the ELISA test is positive or equivocal, this test is usually performed to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi. The CDC surveillance criteria requires 2 out of 3 IgM bands and/or 5 out of 10 IgG bands for a positive test result.
It is critical to note that certain bands on the Western blot are more specific for Lyme disease than others. With a clinical presentation of Lyme and reactive bands, your doctor may diagnose Lyme disease even if you do not meet the CDC’s criteria. Your doctor may also elect to order a Western Blot without a positive ELISA. Additionally, it is important to keep in mind that some laboratories may use different methodologies or criteria which could result in a positive test for one lab and negative at another.
Where Should You Test?
We recommend using Clinical Laboratory Improvement Amendments (CLIA) certified laboratories:
IGenex’s newer ImmunoBlot or traditional IgM/IgG Western Blots are regarded as more sensitive Lyme disease tests because they test for more strains and report additional bands than a standard Western blot. Insurance or Medicare may provide reimbursement. The Lyme Test Access Program (Lyme-TAP) may also provide financial assistance to patients who demonstrate a financial need.
Stony Brook University Medical Center
Administered in conjunction with the Clinical Immunology Laboratory in the Department of Pathology at the Renaissance School of Medicine at Stony Brook University, the IgM and IgG Western Blot Lyme disease test is often covered by insurance. This is considered a more sensitive test if the ordering healthcare provider checks the box to include CDC non-specific bands on the Western Blot report.
Medical Diagnostics Laboratory (MDL)
MDL is often covered by insurance. In addition to Borrelia burgdorferi, the lab offers testing for multiple, divergent Borrelia strains, including European strains Borrelia afzelli and Borrelia garinii and Southern U.S. strain Borrelia lonestari.
Labcorp and Quest
Both Labcorp and Quest Diagnostics provide IgM and IgG Western Blot testing for Lyme disease. The tests are usually covered by insurance, but testing doesn’t take into account divergent Borrelia strains. Both laboratories report a limited number of Western Blot bands, which may lead to decreased sensitivity and more false-negative results.
This laboratory is continuing to grow in its use by Lyme specialists. While tests from Vibrant America are only available with a doctor’s order, they offer extensive and potentially more accurate reporting.
Coinfections such as Bartonella,Babesia, Ehrlichia, Anaplasma, or divergent Borrelia strainscan have many overlapping symptoms with Lyme disease. For Bartonella testing, we recommend Galaxy Diagnostics. For Babesia, we recommend using IGeneX. Additionally, divergent Borrelia strains such as Borrelia miyamotoi, Borrelia mayonii, Borrelia garinii, Borrelia afzelii aponica, Borrelia andersonii, Borrelia lonestari, Borrelia lusitaniae, Borrelia bissettii, Borrelia spielmanii, Borrelia californiensis can cause Lyme-like symptoms.
Limitations of Lyme Disease Testing
Unfortunately, the two-tier testing for Lyme disease recommended by the CDC misses approximately one-half of actual cases pursuant to numerous peer reviewed studies. States like Maryland and Virginia have enacted laws requiring laboratories or doctors to explicitly inform you that you may still have the infection, even if you test negative for Lyme disease.
Simply put, you can’t rule out Lyme with existing laboratory tests. Based on the limits of two-tiered serological testing, a clinical diagnosis is often necessary.
If initial Lyme disease tests don’t show evidence of exposure to Borrelia burgdorferi, consider the following options:
- Use more sensitive interpretive criteria as detailed below
- Use more sensitive Lyme disease tests that cover divergent Borrelia strains, which may or may not be covered by insurance
- Start an antibiotic trial to gauge your response
- Consider the possibility of coinfections with many overlapping symptoms to Lyme disease.
Alternative Western Blot Alternative Criteria
Western Blot test results will include both IgG and IgM assays. Carefully consider Lyme-specific bands (those bands represent serological evidence of exposure to Borrelia burgdorferi). Many Lyme specialists believe a single Lyme-specific band, along with a patient’s clinical presentation, is sufficient to diagnose Lyme disease. Likewise, in China, a single positive IgG band coupled with a single IgM band is considered to be a positive Western Blot when the patient also has symptoms of Lyme.
The following bands are generally considered to be significant or Lyme-specific:
- 18 (most sources)
- 58 (some sources)
- 66 (some sources)
Whatever test you use, be sure to request a copy of your test results. Oftentimes, patients are told that their Lyme test was negative, even when there are significant indications of infection such as reactive bands on a Western Blot. Accurate and complete records may also be important for insurance, disability, or continuing medical treatment.