- Introduction and treatment guidelines
- Testing for Lyme disease
- Direct detection methods
- Pathology Laboratories
- Overseas Laboratories
- Australian Laboratories
Introduction and treatment guidelines
Lyme disease is a clinical diagnosis, based on patient’s history, symptoms & current presentation. Blood tests are used to support a Lyme disease diagnosis; however blood tests are not very reliable and should not be the defining mechanism to rule a diagnosis of Lyme disease in or out. Physicians should use one of four treatment guidelines guide them in their diagnosis:
- Australian Chronic Infectious Disease Society guidelines (currently being updated, expected 3rd quarter 2016) www.acids.org.au;
- ILADS treatment guidelines;
- Burrascano Diagnostic Hints and Treatment Guidelines for Lyme and other tick borne illnesses; or
- Deutsche Borreliose-Gesellschaft e. V. Diagnosis and Treatment of Lyme borreliosis.
Testing for Lyme disease
Globally, laboratory diagnostic tests are recommended by the medical community if there are symptoms or clinical findings consistent with Lyme disease. However the type of tests used to determine whether a positive exposure to Lyme borreliosis has occurred is controversial. To determine if a causative agent is present for infection, laboratory scientists use either ‘direct detection’ where they isolate the actual organism or its DNA, or ‘serology’ – where they study antibodies contained in blood.
Direct detection methods
According to strict scientific criteria, the direct detection of an infectious organism (Borrelia) or DNA by polymerase chain reaction (PCR) or culture is the only definitive proof of a Borrelia infection. Direct detection relies on the significant expertise of the interpreting analyst.
A blood test to determine whether antibodies to Borrelia infection are present in a patient’s blood is the most common form applied in the diagnosis of Lyme disease. However there are limitations to this test process as Borrelia causes immune dis-regulation which decreases the specificity of antibodies. Often there is minimal, or no, measurable response (production of anti-bodies) by the immune system to a Borrelia infection. As such antibodies cannot be detected by ELISA tests. Therefore many patients test negative using this method and are not formally diagnosed with Lyme disease as a result.
Generally, antibody testing follows a stepwise diagnostic process whereby a patient must test positive on an Enzyme-linked immunosorbent assay (ELISA) in order to proceed to a more sensitive ‘confirmatory’ immunoblot that looks for antigens – a Western Blot.
Currently, the most reliable laboratory test for Lyme disease is a Western Blot. However, Western Blot testing is difficult to interpret. There are nine known [Lyme] Borrelia burgdorferi species specific Western Blot antibodies (bands): 18, 23, 31, 34, 37, 39, 83 and 93.
The range of specialty Lyme disease and associated co-infection testing services available from Australian Biologics are included on their website.
Patients requesting Lyme disease testing through Australian Biologics are encouraged to complete a short questionnaire about their travel history and medical symptoms to help build an evidence base of epidemiological data.
The LDAA encourages patients to contact Australian Biologics directly to discuss testing services and how to obtain a testing referral.
Overseas Pathology Laboratories
Laboratories specializing in testing for Lyme disease and associated co-infections overseas are:
IGeneX laboratory in California, USA.
For information about how to ship your blood to the USA you can download a copy of our: