Lyme Disease Association of Australia

Interpreting Blood Tests


 Interpreting Lyme disease blood tests

The US Centre for Disease Control (CDC) has stipulated that certain “bands” in the Western Blot test must be positive in order for a Lyme test to be declared positive – the problem is that these bands were chosen for statistical, rather than diagnostic criteria. For example, the more specific bands for Lyme disease (bands 31 and 34) were excluded from the CDC criteria because they were used to create the Lyme disease vaccine (which is no longer available), thus eliminating valuable testing data. If you have not received the Lyme disease vaccine and you test positive (“+”) or indeterminate (“IND”) to bands 31 and 34, you probably have Lyme disease. The CDC testing criteria actually includes a number of bands which are not specific to Lyme disease, which increases the chances of a false-negative, but only if the CDC criteria for test reporting is used.

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What is the difference between “+”, “++”, “+++” and “IND”?

These are the level to which the laboratory technician can see the immune response to the specific part of the bacteria. Both “++” and “+++” results are very rare, and show a strong immune response to the Lyme disease bacteria. If a patient’s immune response is compromised (as it is in most Lyme disease patients and particularly in patients with neurological, late stage or severe Lyme Disease), a “IND” result is a weak positive immune response to Lyme disease and should be treated as a positive result. After treatment, many patients who are retested return stronger results, as their immune system has been able to mount a more effective response against the Lyme disease bacteria.

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What is the difference between the Western Blot IgG and IgM tests?

The IgM is generally regarded as the body’s response to recent exposure to Lyme disease. IgG is generally regarded as the body’s response over time (i.e. longer term) to Lyme disease. Because the immune system is compromised in Lyme disease, often the IgG and IgM responses can become mixed up.

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How do I interpret my Lyme disease blood test results?

Currently there are 9 identified bands specific to Lyme disease – 18, 23-25, 31, 34, 37, 39, 83 and 93. A “+” or “IND” to one of these bands is considered a positive result. A “+” or “IND” to two or more of these bands is considered a strong positive result.

Other bands on the Western Blot report such as 22, 28, 30, 41, 45, 58, 66, & 73, all add significant weight to the result, but at this stage are not necessarily considered as absolute specific for Lyme bacteria.

NOTE : It must be stressed that a Lyme disease diagnosis is not based on a blood test result, but is rather based on medical history and current presenting symptoms – blood tests can assist in diagnosis, but should not be used to base a diagnosis on. Also, almost all Lyme disease patients have co-infections such as Ehrlichia, Rickettsia, Babesia, Bartonella, Mycoplasma Fermentans, Chlamydia Pneumonia, etc – these have their own testing and diagnostic problems, but should be considered in the diagnosis and treatment of a patient with Lyme disease.

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Information regarding the bands
  • 31 (also written as 31kDa) – is the outer surface protein A (ospA) – this is a classic Lyme disease band, used in the Lyme disease vaccine.
  • 34 (also written as 34kDa) – this is the outer surface protein B (ospB) – this is also a hallmark Lyme disease antibody, but is excluded from CDC criteria.
  • 23-25 (also written as 23-25 kDa) – these are the outer surface protein C.
  • Patients that have a 31 or 34, or 23-25 band have a 97% response rate to the correct antibiotic treatment in conjunction with correct treatment for co-infections.
  • For more information on interpreting Lyme disease Western Blot blood tests, please see this article on Western Blots made easy. There are 9 known [Lyme] Borrelia burgdorferi species specific Western Blot antibodies (bands): 18, 23, 31, 34, 37, 39, 83 and 93.
  • Only one of these Borrelia burgdorferi genus specific bands is needed to confirm that there is lab evidence of exposure to the Borrelia burgdorferi spirochete and can confirm a clinical diagnosis of Lyme disease.

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70 thoughts on “Interpreting Blood Tests

  1. Pingback: Interpreting Lyme Disease Blood Tests | ntxlymegroup

  2. Susan Neophytou

    Dear Sir/Madam
    Please could you be so kind as to tell me if I tested positive for ProteusOX19 would that mean I have Lyme Disease
    Kind Regards
    Susan Neophytou

    1. Sharon Whiteman

      Susan, I’ve passed your question onto our consultant. We’ll be in touch.
      Sharon

  3. Gary Knowles

    l had a tick on my body for 2/3 days on left wrist in Janurary l then devoleped a very large pusy lump on lower back had removed but since have had very bad joint pain l have had blood test for Rickettsia but have asked for a lyme disease test but they say is the same as Rickettsia .Is this true .One doctor has said Lyme Desease does not excist in Australia .l am in Perth West Australia .

    1. Sharon Whiteman

      Gary, no, it’s not true, they’ve given you inaccurate information. We’ve emailed you,
      Sharon

  4. Gabe

    I had a tick on my neck for 2 days in aug 2012. Since then I’ve had joint pain, tendonitis in arms, tingling and numbing of dif body parts. I’ve also had l4-5 disc protrusion and 2 failed knee grafts for ruptured acl. Pain specialist indicates that in spite of mechanical knee probs he thinks pain is referred from back injury. Is it possible that symptoms are more likely to reflect lymes? Not sure where to go from here so would appreciate any advice
    Regards
    Gabe

  5. Joy

    Hi – I was bitten by a horsefly in Czech in 2009 – I developed a large swollen area and was put on doxy for 3 weeks. Shortly thereafter I got a flu like illness with terrible headaches. Since then I have experienced numerous symptoms that fit the Lyme profile. I’ve tested negative twice for Lyme (Western Blot) in the last 2 years. Is it possible to develop lyme from a horsefly bite rather than a tick? I’ve found conflicting info on this online.

    1. Sharon Whiteman

      Joy, There are reports of the Lyme organism being found in fleas, mosquitos, horseflies and mosquitoes, and possible associations between fleas and Lyme cases. Further research is needed on the role of these insects as vectors for the Lyme spirochete. Any insect that bites an infected animal is a potential for transmission. Ticks are found on migrating birds, so Lyme disease can be found anywhere birds fly. It’s also possible you’re not aware of the bite that infected you. I would persist in being evaluated by a Lyme-aware practitioner. Sharon

  6. May

    I suspect i was bitten by a tick 6 months ago. My dog brought in a lot of ticks and I have been very sick since then.
    I live in Townsville Qld
    Regards
    May

  7. Craig

    Hi
    This is a great article. (The site also is very helpful)

    I am wondering whether I should do Lyme testing and if so, what tests I should do (them all?)

    I am 36/m, was bitten by a tick in 2007, then 2 more in late 2010, mid 2011.
    I didn’t develop any symptoms at the time.

    In 2012 I was very run down and had a lymph node removed that was ‘reactive’.
    I have now peripheral neuropathy in hands and feet, and at times all over. I understand one of the causes could be Lyme.

    Any advice on tests would be greatly appreciated!

    Kind regards
    Craig

  8. Theresa

    Hi,

    I have tested positive for Bartonella and have been unwell for 16 years. I have been on a trimester course of antibiotics but still don’t feel well. My doctor only diagnosed me with Bartonella. Is there any chance that I could have Lyme’s and if so is there a specialist doctor who you can refer me to in order for me to receive appropriate treatment?

  9. Hester

    This was most informative. A Micro-Biologist here in SA found Borellia in my daughter’s blood (and mine). She looks for spirochetes in capaliray blood. She did not want to stick her neck out and say that it is Borellia burgdorferi, but my child has reconized Lyme symptoms and most in the most severe degree. We had a Western Blood done – she is already Phase III and it was negative. She had Abx prior to the test, but Igenex says that Abx does not influence the test. It is contradicted by other Biologists, so I do not know what to think.
    Hester

  10. Peter

    Hello, Is the bullseye rash a indicator of Lymes disease? We have deer on our property and they graze close to the house in Brisbane at times. I recently developed a rash from a tick bite 3-4 weeks after the bite and it resembles the images online.

  11. sam

    hi i got bitten by a tick on my head aound 10years ago ever since my health has been getting worse and worse im 30 and feel like im in a 90 year old body everything from muscle weakness to heart problems and nothing ever seems to come up in blood test my eyes are now starting to get really bad ive been tested for lyme as i was convinced this is what i had but it come back negitive, please help me to get in touch with someone that could possibly get a test by a professional in this field, regards Sam

  12. Karen Parker

    My 15 year old son has been extremely sick for the past 4 months. He has symptoms of fatigue,nausea,joint pain,weight loss,asthma has returned after being asthma free for several years and throws up most days. He has been unable to attend school for the entire term. He has had numerous blood tests,gastroscopy and other tests. He recently went to a natropath as we were so frustrated with Doctors and specialists as this has been going on for so long,with no answers to his condition. The natropath hooked him up to her machine and said it was coming up with Lymes disease. I recently took him to our doctor and asked if he could be tested for Lymes ,he was also tested for Ross river. The results came back after a week,although the results were negative. My son has been badly bitten by Mosquitos months back and after reading your article I am wondering if he may still have Lymes. Is there any where in Perth WA that he can be clinically tested?

  13. Rosie

    Hi there
    I’m 99% sure bothmy two rottweiler dogs and I all have lymes. Live on a horse property, wild deer have lived nearby for decades, as well as an abundance of mosquitoes, horseflies and a recent flea outbreak. I have the bullseye rash, one of my dogs has been paralyzed in her hind legs previously and the other has lameness, a skin condition, chronic eye and ear infections and most recently fluid in her abdomen … Any help would be greatly appreciated as all vets and doctors both refuse to believe Lyme disease
    exists in SA. Thank you

  14. Lisa

    I have had Epstein Barr Virus followed by pains of the joints, headaches, Fatigue etc. I was bitten by ticks 1 x America/ Texas 22 years ago, Sweden 16 years ago and Australia Narrabeen 12 years ago. Around the time of the texan bite i developed ringworm ( can’t remember if it was before or after tick bite) but looked pretty distinctly like ringworm ( i think) with raised edges and not like lyme rings. I had contact w horses too who carry ringworm..). I have been asked to do a LYME test and was referred to Australian Biologics to do a Borrelia immunoblot, Borrelia elispot, Borrelia pcr (blood and urin), and mycoplasma pcr ( blood). I have a few questions. What are the risks associated with using an unacredited lab (ABiologics)? Do you recommend them or do you still recommend the overseas labs over AB? Are other tests required? Does my symptoms sound like It could be LYME? I have other theories too (CFS, mould etc). Thanks in advance, Lisa

  15. Lisa G

    Hi,
    I was bitten by a number of ticks in Qld approx. 6 yrs ago and one of the bites resulted in a large bullseye rash about the size of a dinner plate. Over the past couple of years I have developed an abnormal heart rythm (missing beats, palpitations…). I also suffer with anxiety and mood swings. I was recently tested for Lymes (blood serology test) which came back negative. After reading your website, my symptoms sound very much like I might have Lymes. I live in North Eastern Victoria. Could you please recommend a Lymes practitioner or any other advice would be much appreciated.
    Kind regards,
    Lisa.

  16. Eric

    I have neurological symptoms, dizziness, nausea, etc. The symptoms do not add up to a common disease and all bloods are normal. My symptoms have been present for 5 months and fit with the Lyme disease, although I never had the rash. How can I get tested? Will the sample need to go overseas? How can a normal GP organize this? Will it really cost $1,000?

    Thanks.

  17. Tenille

    Hi my name is Tenille my 8 year old son was I’ll 10 weeks ago with what we thought was the flu that night a very small tick was found in his hairline behind his ear so I took him to a after hours doctors. The doctor refused to move it and sent us to emergency where they removed it and told us he had a virus and it was unrelated. 2 days later my son Kai was so unwell he couldn’t move his neck and could barely get out of bed and his lymph nodes were huge. He was taken to the gp and put on antibiotics (not the correct ones for lymes). He recovered other than the swollen lymph nodes although 8 weeks later awoke one morning with double vision in his right eye and a head tilt so we took him to emergency where they did a ct scan and as it was clear sent us home. By the following night his vision was worsening and he was experiencing dizzy spells so I took his back up to emergency and they kept us in for 3 days we had to see an opthomoligist who diagnosed him with having inflammation of the right trochlear nerve in his eye but not knowing what’s causing it. He was put on a course of steroids and was to be seen again in 6 weeks for a follow up. I went to the gp and asked for some tests to be taken one of which was for Borrelia burgdorferi which came back yesterday as being detected. He has been put on a 2 weeks course of amoxicillin but I am worried that as he has had the inflammation in his trochlear nerve that it isnt enough. If you have any suggestions for me it would be much appreciated as I am terrified for his health.
    Kind regards Tenille

  18. Tara Halverson

    Hi
    My dad has been ill now with various symptoms that fit the Lyme disease symptoms for 3 or more years. He had a blood test recently which was sent to the Sydney lab but it came back negative. He has been bitten my many many ticks over the years some of which stayed on him for days before realising. I am convinced it is lyme but drs are telling us otherwise. Where can we take him now for more rigorous testing? Or is there any harm in starting a Lyme disease treatment plan and seeing if improvements in his condition result? Desperate for answers.
    Thanks

  19. peta

    Hi
    I was bitten by a tick in 2007approx. A couple of years later I suffered from extreme fatigue. My dr was unable to pinpoint why this occurred. It was servere for months. Until this day I still suffer from fatigue and tiredness not as servere as before. I have numerous tests. Im considering have a test for lyme disease. What exactly should I request. Im located in Sydney.
    Thank you for your time.

  20. Tony Tan

    Hi Support,
    Look like I have lyme disease. I got this red patch below my leg and a small bite in the middle a few months ago
    Even now I that slot of light pain that most often happen on the left side of the chest, pain look like its can move closed to the heart.
    At night ,sometime have this sharp pain on side of right toe.
    When I was very young I had Dengue fever bite by mosquito.
    I went for check up even my heart, everything are normal.

    Please recommend me a doctor in Sydney close to Hurstivlle.
    Thanks and appreciate your work you put in.

  21. Jannete

    Hi,
    3 months ago i was very sick of sinus infections, headache, dizziness and anxiety, i still have headache and jaw, stuffed ears and infections and also facial muscle pain for 3 months until now. 7 years ago I got bitten by a tick in my neck and stay there overnight, i didn’t have a rashes but a small lymp. i had 2 dogs and one has been bitten by a pralysis tick a year ago, just wondering if this is related to lyme? is there any GP that practice about Lyme D here in Brisbane?

    Thank you for your time.

  22. Adelia

    Hi,
    I have been so unwell the past 2 years where I seem to have a number of things that doctors just can’t seem to find out what is wrong with me! I’m a 25 yr old female. 2 years ago I had chest pains I was in and out of hospital and had all the tests you could possibly think of ct MRI X-rays all coming back negative. I went from doctor to doctor one put it down to costocondritis another fibromyalgia and still they don’t know what it is! the last 9 months have been the worst for me! I first started with a cold that seemed to never go away and I was constantly feeling unwell! The past 6 months I have had head pain / pressure like pain every single day and night and ontop of that I have now developed migraines! The pressure in my head is so bad at times that I just don’t want to get out of bed! I’ve had MRI ct scans blood tests and all have come back negative. The only thing I can think of is that I went to see a naturopath about a year ago and she put a machine on me which detected I had an insect virus/infection? I just need some guidance as where to go from here I just want my life back! Could you please tell me where I can go to get tested for lymes disease? I have majority of the symptoms listed on your website. I’m in Melbourne (northern suburbs) you help is greatly appreciated !

  23. Elissa Chighine

    Hi There
    I am also after a contact in Sydney who specialises in lyme disease. I was in the Blue Mountains last August and within days of returning, broke out in a mad rash everywhere, mostly on my upper limbs and some on my arms. I had flu like symptoms as well and my gp at the time tested for a tick infection but this came back negative (which is expected from what I have now read, given it was within 2 weeks of returning from the Blue Mountains). It was put down as some random virus. Went back to the GP a few times as everytime I would go running I would end up with a sore throat and mild swollen glands. Ended up in hospital for 10 days in late October as a result of my blood pressure going up then going down 5 minutes later….Lots of tests excluding anything to do with lyme disease and still nothing. Improved, then on the weekend the symptoms of dizziness light headed and jelly legs returned. Saw GP yesterday and I am having a 2 hr GTT with insulin test done as she thinks may be its hyperinsulinism??/ hypoglycemia, etc. All my problems started from the Blue Mountains and I’m wondering if my symptoms are the result of lyme disease. Like all the others above I just want to get some answers as I am an active person who tries to run daily and have a young family. I would greatly appreciate any information you can provide.

  24. Dei

    5 yrs ago I was travelling thru Malaysia, and I thought that I got a ringworm… It was a round pattern at the base of my skull, many months later I was still having problems with it and a chemist treated it…Now 5 yrs on, I’m still having problems with it, it stays at the base of my skull, but since then I have had joint pain in my feet & hands, numbness in my hands, nausea, confusion, difficulty reading, the list just keeps going…Last week I was tested for Neuropathy, which apparently I don’t have? Is there anyone that I can see I live in the Northern rivers NSW

  25. Nev Ryan

    Hi, I travelled to Europe in 2011 and developed a rash similar to cellulitis, since then I have had many symptoms, shortness of breath, croaky voice, heart palpatations, tingling and numbing sensations, pain in wrist, forearm, elbow, reflux, sensation of slurred speech, difficulty concentrating, brain fog, short term memory issues, anxiety. Am waiting on Neurologist to interpret MRI results. I am concerned that I may have Lyme but worried that symptoms will be explained as anxiety. Where I can I go to seek another opinion. I live in the West of Melbourne.

  26. Katherine

    I am a 52 year old female and wondering if I have Chronic Lyme symptoms and what the best test indicator would be. My GP will not base it on a clinical diagnosis, nor will my neurologist. My GP sent me for a blood test which came back Negative – Elisa.
    These are the issues that I’ve been experiencing, mainly this past year:
    - parasthesia and neuralgia (tingling and burning hands, feet, spine, hips, buttocks, thighs, sometimes tongue and scalp) x 6 months. My neurologist did a nerve conduction test with no indication of the cause. He then put me on a low dose of Lyrica, which was changed last month to a low dose of Elavil which seems somewhat more effective but still does not know the cause of the nerve issues.
    - Knee joint issues and had 2 knee surgeries this past year including an arthroscopy in my right knee in May 2013 to debride and remove cartilage, Baker’s cyst, and then a left tendon transfer and the surgeon felt the cartilage damage in that knee damaged due to Patella Alta. Either way, both knees had severe chondromalacia.
    Other issues this past year that could be indicators:
    - piriformis type syndrome at present
    - mammogram that came back showing swollen lymph node
    - gastritis (now on prescription meds for it)
    - Restless leg syndrome
    - Neck that creaks and cracks
    I have also had a frozen shoulder, tennis elbow and golfer’s elbow within the past 15 years but other than that, no previous health issues, blood work and EKG normal.
    I do not recall having the bullseye bite or a rash, or any of the first stage flu-like symptoms, however given all the outdoor time in summers spent hiking and camping, I want to rule it out and try and get to the bottom of the CNS issues. I recall when we lived in California in ’93 and ’94, picking ticks off of our retriever. I didn’t know about Lyme Disease back then. We also spent a lot of time in the outdoors there and never recall being bitten by a tick.
    I would really appreciate your help/recommendations.
    Thank you kindly!

  27. Michelle

    This is a wonderful article. Thank you. I found a tic on my ankle two years ago a couple days after I’d been hiking in California. Developed a small rash, started antibiotics, and then quit them mid-way because I thought it was overkill given that it had been on the west coast, and because the rash didn’t have the large concentric bulls eye shape. Two years later, I developed neck and shoulder stiffness and pain, pain in my finger joints, costochondritis, insomnia (frequent night urination, nightmares), and spells of my heart rate going up and feeling blurry and surreal. I also had a fever of 102 this week. I tested positive on the Elisa, and with an ANA titre of 320, and then two weeks later they did it at another lab and it came back negative with confirmation by Western Blot. They say that means I don’t have Lyme and the other one must have been a false positive. But given that I don’t seem to have markers for Lupus or RA, the two other most probable things, and given that I did prematurely quit my antibiotic treatment, should I try to pursue this more with my doctor?

  28. Anke

    Hi there,
    I was bitten by a tick in North Germany in 2005. The doctor over there was very concerned about Lymes (Borreliose) and told me to come back if a rash developed. It never did, so I figured all was good. About six months later I had a sore shoulder / arm, diagnosed as a tendon injury (without any cause as far as I could make out), followed by a swollen and sore finger which was then diagnosed as arthitis. (No test were done, just based on medical history.) Arthritis kept coming and going once or twice a year usually in fingers or toes, lasting for a couple of months at a time. I also had spells of lower back pain (who doesn’t have that at times), sore hips at night and a stiff neck but put that down to the mattress not being ideal. Went back to Germany for Christmas last year and came home with a lump on the back of my leg growing to about the size of a walnut. We put on some plantain (plantago lancelata) pulp and the lump disappeared within days, but within a week I developed pain in my hands, elbows, shoulders and subsequently my knees, feet and developed slight headaches (never had headaches before) and other issues. The doctor ran various tests, with Rickettsia coming back borderline but all others negative (Ross River, Barmah Forrest, Borrelia burg. Lyme IgG / IgM EIA). Iron was very low (history of low iron), Lymphocytes were low and it was noted there were a few pencil cells in the red blood cells. A live blood screening showed massive problems with oxidisation of RBCs and a Naturopath confirmed on her second VEGA test that both Ross River and Lymes were a problem and Staph was present.
    At this stage the doctors are saying it is not Lymes (as proven by the tests) but looking at the symptoms others describe, it certainly feels similar. Do you have any experience with natural remedies / treatment options I can try while awaiting results for further tests? Been on 3-5000mg of Vit C, 4-5000mg Vit D, Vit B complex, Cats Claw, Liver Tone, Tumeric, Parex (herbal antibiotic), CoQ10, Antiox Complete, Olive Leaf 10g, Zinc 60mg and other remedies for the last 4 weeks and while it seems to have slowed the process, it doesn’t seem to reverse things in a hurry.
    Also what is the story with testing for German species of Borreliosis – are they different to the Australian tests?
    Looking forward to your reply!

  29. Ian Koker

    Hi There,

    I suspect I’ve had Lyme Disease for quite a number of years, and I’m wondering if you still supply the testing kits for the Californian lab that tests for it? Appreciate the wealth of information!

    Best,
    Ian

  30. Karen

    I am in Rheinland-Pfalz, Germany near Kaiserslautern. I just tested positive for Lyme disease after nearly 4 weeks of feeling very fatigued and in the last 3 weeks rib cage pain and then back pain at the bottom edge of my shoulders.

    The German doctor did not acknowledge that I could have this disease despite my mentioning a tick bite in April, so I went to a private practice with American doctors who tested me and it came back positive.

    Even this doctor could not explain the test to me but only said I had “190″ on IgM and normal is 18.

    Do you have any idea what test this was??

    I cannot find any similar scoring system online and the doctor could not tell me if it was ELISA or Western blot or something else.

    I am told to rest at home for 7 days and take doxycycline for 28 days.

    I also have to get an ultrasound of my spleen and liver and chest X-ray due to pain in my rib cage. Thank you for any insights on the tests used over here. The only information I see online in English pnotes that Germany’s tests are not standardized, if I read it correctly.

    I am just trying to understand this better. I like to run and hike so I am really hoping I caught this in time to treat it.

  31. Isha

    A lyme disease doctor in edison nj ot somewhere around here. My IgM was lositive IgG negative. Pcp said there is nothing to worry about which angers me because i want help