Testing and diagnosing Lyme disease is not as straightforward as it may seem.
Like all other aspects of this illness, the topic of testing is complicated. There are basically two ways to test for Lyme disease and its co-infections.
Obviously, a positive test for the bug itself would be the best and most direct method for diagnosing Lyme disease. These tests are known as PCR (polymerase chain reaction) tests. They identify the DNA of a bug in the blood stream.
However, Borrelia doesn’t like to live in the blood stream. Relying on a blood test to find the actual bug doesn’t make much sense. Borrelia prefers to live inside cells and tissues so it’s not very common to have a PCR blood test comes back positive for Lyme. A negative PCR test does NOT means a person is negative.
There is a newer PCR test available which looks for the presence of Borrelia in the urine. To avoid the same issues of the blood tests, the bug is coaxed or “provoked” out of hiding prior to collection. This is done through a variety of different methods such as vigorous exercise, Rolfing / deep tissue massage, and more recently using ultrasound.
The most common way of testing for bugs is looking for antibodies to the infections in the blood. These are the proteins our body makes in response to invaders. Antibodies bind to infections in an effort to destroy and facilitate their elimination.
Vaccines work by stimulating the body to produce antibodies to infections before our body comes in contact with the bug. If tested, most people have antibodies to the measles virus for instance, even though they never had measles.
Testing positive for Lyme antibodies means the body has seen the bug. Conventional medicine often argues that the presence of antibodies does not mean there is a current infection.
The problem with that is Lyme disease and its co-infections are bugs that are designed to live in our bodies long-term. People rarely clear these bugs on their own.
Bartonella is a known immune suppressant, so a person is less likely to test positive for Lyme if there is a co-infection present. Since Lyme disease prefers to live inside cells and deeper tissues, antibodies drop over time.
The Lyme bug is known to shift the markers it carries on the outside of itself in an effort to avoid detection by the immune system.
These markers are the binding sites for antibodies. The immune system is making antibodies that are specific to these markers. If the markers are constantly changing, antibody levels can go up and down pretty quickly creating confusion.
These situations can create the production of antibodies that are associated with new infections. It can leave a doctor puzzled when they see new antibody production to Lyme disease but the patient has had symptoms for many years.
ELISA & Western Blot
There are several different lab procedures for testing the presence of antibodies. The Centers for Disease Control (CDC) developed a two-tiered testing process for Lyme Disease (Borrelia only) that includes the ELISA and Western Blot tests (1).
Someone must test positive for a certain number of “bands” on an ELISA test (which is accurate in 35% of cases at best) before being referred to a Western Blot test. Both are required to be positive for an official diagnosis. This was developed to track movement of the infection through the US population, not for clinical use with patients.
There are new tests being used now called T-cell activation tests. They differ from antibody testing in that they are attempting to differentiate active infections from older infections and are poised to become the preferred method of testing.
The biggest issue that encompasses all the testing methods is that they do not account for all the possible species of these infections. Lyme disease used to be thought of as an infection with the bug, Borrelia burgdorferi, but we now know there are other species of Borrelia including: Borrelia afzelii, Borrelia miyamotoi, Borrelia recurrentis, Borrelia japonica, Borrelia garinii, etc. Standard tests do not look for all of these.
It is important to find a lyme literate doctor who can test for and interpret ALL of the infections associated with Lyme disease….not just Borrelia.
Author: Dr. Shaun Riddle
August 28, 2018