Lyme disease laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
[[Laboratory]] [[blood tests]] are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of [[Lyme disease]]. [[Centers for Disease Control]] recommends a two-tier testing protocol for [[Lyme disease]]. [[Polymerase chain reaction]] (PCR) tests for [[Lyme disease]] have also been developed to detect the [[genetic material]] ([[DNA]]) of the [[Lyme disease]] [[Spirochaete|spirochete]]. Currently, [[PCR]] is the only means to detect the presence of [[organism]]. Identification and testing of individual [[tick]] after removal is generally not useful. | [[Laboratory]] [[blood tests]] are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of [[Lyme disease]]. The [[Centers for Disease Control]] recommends a two-tier testing protocol for [[Lyme disease]]. [[Polymerase chain reaction]] (PCR) tests for [[Lyme disease]] have also been developed to detect the [[genetic material]] ([[DNA]]) of the [[Lyme disease]] [[Spirochaete|spirochete]]. Currently, [[PCR]] is the only means to detect the presence of [[organism]]. Identification and testing of the individual [[tick]] after removal is generally not useful. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
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==== Two-step Laboratory Testing Process<ref name="urlTwo-step Laboratory Testing Process| Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html |title=Two-step Laboratory Testing Process| Lyme Disease | CDC |format= |work= |accessdate=}}</ref> ==== | ==== Two-step Laboratory Testing Process<ref name="urlTwo-step Laboratory Testing Process| Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html |title=Two-step Laboratory Testing Process| Lyme Disease | CDC |format= |work= |accessdate=}}</ref> ==== | ||
*The [[serology|serological]] laboratory tests most widely available and employed are the [[Western blot]] and [[ELISA test|ELISA]]. | *The [[serology|serological]] laboratory tests most widely available and employed are the [[Western blot]] and [[ELISA test|ELISA]]. | ||
*A two-tiered protocol is recommended by the [[Centers for Disease Control|Centers for Disease Control]]: the more sensitive [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] is performed first, if it is positive or equivocal, the more [[Specificity (tests)|specific]] [[Western blot]] is run. The reliability of testing in diagnosis remains controversial, however studies show the [[Western blot]] [[IgM]] has a specificity of 94–96% for patients with clinical symptoms of early [[Lyme disease]].<ref name="Engstrom">{{cite journal | author=Engstrom SM, Shoop E, Johnson RC | title=Immunoblot interpretation criteria for serodiagnosis of early Lyme disease | journal=J Clin Microbiol | year=1995 | pages=419-27 | volume=33 | issue=2 | pmid = 7714202 | url=http://jcm.asm.org/cgi/reprint/33/2/419.pdf | format=PDF}}</ref><ref name="Sivak">{{cite journal | author=Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP | title=Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease | journal=Arch Intern Med | year=1996 | pages=2105-9 | volume=156 | issue=18 | pmid = 8862103}}</ref> | *A two-tiered protocol is recommended by the [[Centers for Disease Control|Centers for Disease Control]]: the more sensitive [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] is performed first, and if it is positive or equivocal, the more [[Specificity (tests)|specific]] [[Western blot]] is run. The reliability of testing in diagnosis remains controversial, however studies show the [[Western blot]] [[IgM]] has a specificity of 94–96% for patients with clinical symptoms of early [[Lyme disease]].<ref name="Engstrom">{{cite journal | author=Engstrom SM, Shoop E, Johnson RC | title=Immunoblot interpretation criteria for serodiagnosis of early Lyme disease | journal=J Clin Microbiol | year=1995 | pages=419-27 | volume=33 | issue=2 | pmid = 7714202 | url=http://jcm.asm.org/cgi/reprint/33/2/419.pdf | format=PDF}}</ref><ref name="Sivak">{{cite journal | author=Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP | title=Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease | journal=Arch Intern Med | year=1996 | pages=2105-9 | volume=156 | issue=18 | pmid = 8862103}}</ref> | ||
*The two steps of [[Lyme disease]] testing are designed to be done together. [[Centers for Disease Control and Prevention|CDC]] does not recommend skipping the first test and just doing the [[Western blot]]. Doing so will increase the frequency of [[false positive]] results and may lead to misdiagnosis and improper treatment. | *The two steps of [[Lyme disease]] testing are designed to be done together. The [[Centers for Disease Control and Prevention|CDC]] does not recommend skipping the first test and just doing the [[Western blot]]. Doing so will increase the frequency of [[false positive]] results and may lead to misdiagnosis and improper treatment. | ||
* Erroneous test results have been widely reported in both early and late stages of the disease. These errors can be caused by several factors, including [[antibody]] cross-reactions from other [[Infection|infections]] including: | * Erroneous test results have been widely reported in both early and late stages of the disease. These errors can be caused by several factors, including [[antibody]] cross-reactions from other [[Infection|infections]] including: | ||
*[[Epstein-Barr virus]]<ref name="Gossens">{{cite journal | author=Goossens HA, Nohlmans MK, van den Bogaard AE | title=Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis | journal=Infection | year=1999 | pages=231 | volume=27 | issue=3 | pmid= 10378140}}</ref><ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | **[[Epstein-Barr virus]]<ref name="Gossens">{{cite journal | author=Goossens HA, Nohlmans MK, van den Bogaard AE | title=Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis | journal=Infection | year=1999 | pages=231 | volume=27 | issue=3 | pmid= 10378140}}</ref><ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | ||
*[[Cytomegalovirus]]<ref name="Gossens">{{cite journal | author=Goossens HA, Nohlmans MK, van den Bogaard AE | title=Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis | journal=Infection | year=1999 | pages=231 | volume=27 | issue=3 | pmid= 10378140}}</ref> | **[[Cytomegalovirus]]<ref name="Gossens">{{cite journal | author=Goossens HA, Nohlmans MK, van den Bogaard AE | title=Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis | journal=Infection | year=1999 | pages=231 | volume=27 | issue=3 | pmid= 10378140}}</ref> | ||
*[[Varicella zoster virus]]<ref name="pmid1961232">{{cite journal| author=Feder HM, Gerber MA, Luger SW, Ryan RW| title=False positive serologic tests for Lyme disease after varicella infection. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 26 | pages= 1886-7 | pmid=1961232 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1961232 }} </ref><ref name="pmid9835449">{{cite journal| author=Woelfle J, Wilske B, Haverkamp F, Bialek R| title=False-positive serological tests for Lyme disease in facial palsy and varicella zoster meningo-encephalitis. | journal=Eur J Pediatr | year= 1998 | volume= 157 | issue= 11 | pages= 953-4 | pmid=9835449 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9835449 }} </ref> | **[[Varicella zoster virus]]<ref name="pmid1961232">{{cite journal| author=Feder HM, Gerber MA, Luger SW, Ryan RW| title=False positive serologic tests for Lyme disease after varicella infection. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 26 | pages= 1886-7 | pmid=1961232 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1961232 }} </ref><ref name="pmid9835449">{{cite journal| author=Woelfle J, Wilske B, Haverkamp F, Bialek R| title=False-positive serological tests for Lyme disease in facial palsy and varicella zoster meningo-encephalitis. | journal=Eur J Pediatr | year= 1998 | volume= 157 | issue= 11 | pages= 953-4 | pmid=9835449 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9835449 }} </ref> | ||
*[[Herpes simplex virus]] type 2<ref name="Strasfeld">{{cite journal | author=Strasfeld L, Romanzi L, Seder RH, Berardi VP | title=False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection | journal=Clin Infect Dis | year=2005 | pages=1826-7 | volume=41 | issue=12 | pmid= 16288417}}</ref> | **[[Herpes simplex virus]] type 2<ref name="Strasfeld">{{cite journal | author=Strasfeld L, Romanzi L, Seder RH, Berardi VP | title=False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection | journal=Clin Infect Dis | year=2005 | pages=1826-7 | volume=41 | issue=12 | pmid= 16288417}}</ref> | ||
*[[Rickettsial infections]]<ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | **[[Rickettsial infections]]<ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | ||
*[[Syphilis]]<ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | **[[Syphilis]]<ref name="pmid3049839">{{cite journal| author=Berardi VP, Weeks KE, Steere AC| title=Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 4 | pages= 754-60 | pmid=3049839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3049839 }} </ref> | ||
[[image:Two tiered testing for lyme disease 600px.jpg|center|600px|thumb| | [[image:Two tiered testing for lyme disease 600px.jpg|center|600px|thumb|The Two-tier Testing Decision Tree describes the steps required to properly test for Lyme disease. The first required test is the Enzyme Immunoassay (EIA) or Immunofluorescence Assay (IFA). If this test yields negative results, the provider should consider an alternative diagnosis. Or in cases where the patient has had symptoms for less than or equal to 30 days, the provider may treat the patient and follow up with a convalescent serum. If the first test yields positive or equivocal results, two options are available: 1) if the patient has had symptoms for less than or equal to 30 days, an IgM Western Blot is performed; 2) if the patient has had symptoms for more than 30 days, the IgG Western Blot is performed. The IgM should not be used if the patient has been ill for more than 30 days. - [https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html Source: CDC.gov]]] | ||
====Polymerase chain reaction==== | ====Polymerase chain reaction==== | ||
* [[Polymerase chain reaction]] (PCR) tests for [[Lyme disease]] have also been developed to detect the [[genetic material]] ([[DNA]]) of the [[Lyme disease]] [[Spirochaete|spirochete]]. [[Polymerase chain reaction|PCR]] tests are rarely susceptible to [[Type I and type II errors|false-positive]] results but can often show [[Type I and type II errors|false-negative]] results, and the overall reliability of [[Polymerase chain reaction|PCR]] in this role remains unclear. | * [[Polymerase chain reaction]] (PCR) tests for [[Lyme disease]] have also been developed to detect the [[genetic material]] ([[DNA]]) of the [[Lyme disease]] [[Spirochaete|spirochete]]. [[Polymerase chain reaction|PCR]] tests are rarely susceptible to [[Type I and type II errors|false-positive]] results but can often show [[Type I and type II errors|false-negative]] results, and the overall reliability of [[Polymerase chain reaction|PCR]] in this role remains unclear. | ||
* With the exception of [[Polymerase chain reaction|PCR]], there | * With the exception of [[Polymerase chain reaction|PCR]], there are not currently any practical means for the detection of the presence of the organism, as serologic studies only test for [[antibodies]] of ''[[Borrelia burgdorferi]]''. | ||
* [[Immunoglobulin G]] ([[IgG]]) or [[immunoglobulin M]] ([[Immunoglobulin M|IgM]]) [[antibodies]] to ''[[Borrelia]]'' [[Antigen|antigens]] high | * [[Immunoglobulin G]] ([[IgG]]) or [[immunoglobulin M]] ([[Immunoglobulin M|IgM]]) [[antibodies]] to ''[[Borrelia]]'' [[Antigen|antigens]]: high [[titer|titers]] of either antibody indicates disease, but lower [[titer|titers]] can be misleading. | ||
* The [[IgM]] [[antibodies]] may be present after the initial [[infection]] for a limited period but [[IgG]] [[antibodies]] may remain for years after the [[infection]].<ref>{{cite journal |author=Burdash N, Fernandes J |title=Lyme borreliosis: detecting the great imitator |journal=The Journal of the American Osteopathic Association |volume=91 |issue=6 |pages=573-4, 577-8 |year=1991 |pmid=1874654 |url=http://www.jaoa.org/cgi/content/abstract/91/6/573}}</ref> | * The [[IgM]] [[antibodies]] may be present after the initial [[infection]] for a limited period but [[IgG]] [[antibodies]] may remain for years after the [[infection]].<ref>{{cite journal |author=Burdash N, Fernandes J |title=Lyme borreliosis: detecting the great imitator |journal=The Journal of the American Osteopathic Association |volume=91 |issue=6 |pages=573-4, 577-8 |year=1991 |pmid=1874654 |url=http://www.jaoa.org/cgi/content/abstract/91/6/573}}</ref> | ||
* [[Western blot]], [[ELISA]] and [[Polymerase chain reaction|PCR]] can be performed by either [[blood test]] via [[venipuncture]] or [[cerebral spinal fluid]] (CSF) via [[lumbar puncture]]. | * [[Western blot]], [[ELISA]], and [[Polymerase chain reaction|PCR]] can be performed by either [[blood test]]s via [[venipuncture]] or [[cerebral spinal fluid]] (CSF) via [[lumbar puncture]]. | ||
* Though [[lumbar puncture]] is more definitive of diagnosis, [[antigen]] capture in the [[CSF]] is much more elusive, | * Though [[lumbar puncture]] is more definitive of diagnosis, [[antigen]] capture in the [[CSF]] is much more elusive. Reportedly, [[CSF]] yields positive results in only 10-30% of patients cultured. | ||
* The diagnosis of [[neurologic]] [[infection]] by [[Borrelia burgdorferi|''Borrelia'' ''burgdorferi'']] should not be excluded solely on the basis of normal routine [[CSF]] or negative [[CSF]] [[antibody]] analyses.<ref>{{cite journal |author=Coyle PK, Schutzer SE, Deng Z, ''et al'' |title=Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease |journal=Neurology |volume=45 |issue=11 |pages=2010-5 |year=1995 |pmid=7501150 }}</ref> | * The diagnosis of [[neurologic]] [[infection]] by [[Borrelia burgdorferi|''Borrelia'' ''burgdorferi'']] should not be excluded solely on the basis of normal routine [[CSF]] or negative [[CSF]] [[antibody]] analyses.<ref>{{cite journal |author=Coyle PK, Schutzer SE, Deng Z, ''et al'' |title=Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease |journal=Neurology |volume=45 |issue=11 |pages=2010-5 |year=1995 |pmid=7501150 }}</ref> | ||
* New techniques for clinical evaluation | * New techniques for clinical evaluation of ''[[Borrelia burgdorferi]]'' infection are under investigation, and includes: | ||
**[[Lymphocyte]] transformation tests <ref>{{cite journal |author=Valentine-Thon E, Ilsemann K, Sandkamp M |title=A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=1 |pages=27-34 |year=2007 |pmid=16876371 |doi=10.1016/j.diagmicrobio.2006.06.008}}</ref> | **[[Lymphocyte]] transformation tests <ref>{{cite journal |author=Valentine-Thon E, Ilsemann K, Sandkamp M |title=A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=1 |pages=27-34 |year=2007 |pmid=16876371 |doi=10.1016/j.diagmicrobio.2006.06.008}}</ref> | ||
**Focus floating microscopy<ref>{{cite journal |author=Eisendle K, Grabner T, Zelger B |title=Focus floating microscopy: "gold standard" for cutaneous borreliosis? |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=213-22 |year=2007 |pmid=17210530 |doi=10.1309/3369XXFPEQUNEP5C}}</ref> | **Focus floating microscopy<ref>{{cite journal |author=Eisendle K, Grabner T, Zelger B |title=Focus floating microscopy: "gold standard" for cutaneous borreliosis? |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=213-22 |year=2007 |pmid=17210530 |doi=10.1309/3369XXFPEQUNEP5C}}</ref> | ||
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* Some laboratories offer [[Lyme disease]] testing using assays whose accuracy and clinical usefulness have not been adequately established. These tests include:<ref name="urlLaboratory tests that are not recommended| Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/diagnosistesting/labtest/otherlab/index.html |title=Laboratory tests that are not recommended| Lyme Disease | CDC |format= |work= |accessdate=}}</ref> | * Some laboratories offer [[Lyme disease]] testing using assays whose accuracy and clinical usefulness have not been adequately established. These tests include:<ref name="urlLaboratory tests that are not recommended| Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/diagnosistesting/labtest/otherlab/index.html |title=Laboratory tests that are not recommended| Lyme Disease | CDC |format= |work= |accessdate=}}</ref> | ||
**Capture [[Assay|assays]] for [[Antigen|antigens]] in [[urine]] | **Capture [[Assay|assays]] for [[Antigen|antigens]] in [[urine]] | ||
**Culture, [[immunofluorescence]] staining, or cell sorting of cell wall-deficient or cystic forms of [[B. burgdorferi]] | **Culture, [[immunofluorescence]] staining, or cell sorting of cell wall-deficient or cystic forms of ''[[B. burgdorferi]]'' | ||
**[[Lymphocyte]] transformation tests | **[[Lymphocyte]] transformation tests | ||
**Quantitative [[CD57]] [[lymphocyte]] [[Assay|assays]] | **Quantitative [[CD57]] [[lymphocyte]] [[Assay|assays]] | ||
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**Measurements of [[antibodies]] in [[joint]] [[fluid]] ([[synovial fluid]]) | **Measurements of [[antibodies]] in [[joint]] [[fluid]] ([[synovial fluid]]) | ||
**[[Immunoglobulin M|IgM]] or [[IgG]] tests without a previous [[Enzyme linked immunosorbent assay (ELISA)|ELISA]]/EIA/IFA | **[[Immunoglobulin M|IgM]] or [[IgG]] tests without a previous [[Enzyme linked immunosorbent assay (ELISA)|ELISA]]/EIA/IFA | ||
*In general, [[Centers for Disease Control and Prevention|CDC]] does not recommend these tests. | *In general, the [[Centers for Disease Control and Prevention|CDC]] does not recommend these tests. | ||
*Patients are encouraged to ask their [[Physician|physicians]] whether their testing for [[Lyme disease]] was performed using validated methods and whether results were interpreted using appropriate guidelines. | *Patients are encouraged to ask their [[Physician|physicians]] whether their testing for [[Lyme disease]] was performed using validated methods and whether results were interpreted using appropriate guidelines. | ||
===Testing Ticks=== | ===Testing Ticks=== | ||
* Patients who have removed a [[tick]] often wonder if they should have it tested. | * Patients who have removed a [[tick]] often wonder if they should have it tested. | ||
* In general, the identification and testing of individual [[Tick|ticks]] is not useful | * In general, the identification and testing of individual [[Tick|ticks]] is not useful in deciding if a person should get [[Antibiotic|antibiotics]] following a [[tick]] bite because:<ref name="urlTick removal and testing | Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/removal/index.html |title=Tick removal and testing | Lyme Disease | CDC |format= |work= |accessdate=}}</ref> | ||
**If the test shows that the [[tick]] contained disease-causing organisms, that does not necessarily mean that the patient | **If the test shows that the [[tick]] contained disease-causing organisms, that does not necessarily mean that the patient was [[Infection (disambiguation)|infected]]. | ||
**If the patient | **If the patient has been [[Infection (disambiguation)|infected]], symptoms will probably develop before results of the [[tick]] test are available, so appropriate treatment should not be withheld for availability of [[tick]] testing results. | ||
**Negative results can lead to false assurance. For example, the patient may have been unknowingly bitten by a different tick that was [[Infection (disambiguation)|infected]]. | **Negative results can lead to false assurance. For example, the patient may have been unknowingly bitten by a different tick that was [[Infection (disambiguation)|infected]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Needs overview]] | [[Category:Needs overview]] | ||
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[[Category:Spirochaetes]] | [[Category:Spirochaetes]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
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Latest revision as of 22:35, 29 July 2020
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Lyme disease Microchapters |
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Lyme disease laboratory findings On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2],Ilan Dock, B.S.
Overview
Laboratory blood tests are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease. The Centers for Disease Control recommends a two-tier testing protocol for Lyme disease. Polymerase chain reaction (PCR) tests for Lyme disease have also been developed to detect the genetic material (DNA) of the Lyme disease spirochete. Currently, PCR is the only means to detect the presence of organism. Identification and testing of the individual tick after removal is generally not useful.
Laboratory Findings
- Lyme disease is diagnosed based on:
- Signs and symptoms
- A history of possible exposure to infected blacklegged ticks
- Laboratory blood tests are helpful if used correctly and performed with validated methods.
- Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease.
- Just as it is important to correctly diagnose Lyme disease when a patient has it, it is important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else.
Serology
Two-step Laboratory Testing Process[1]
- The serological laboratory tests most widely available and employed are the Western blot and ELISA.
- A two-tiered protocol is recommended by the Centers for Disease Control: the more sensitive ELISA is performed first, and if it is positive or equivocal, the more specific Western blot is run. The reliability of testing in diagnosis remains controversial, however studies show the Western blot IgM has a specificity of 94–96% for patients with clinical symptoms of early Lyme disease.[2][3]
- The two steps of Lyme disease testing are designed to be done together. The CDC does not recommend skipping the first test and just doing the Western blot. Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment.
- Erroneous test results have been widely reported in both early and late stages of the disease. These errors can be caused by several factors, including antibody cross-reactions from other infections including:
Polymerase chain reaction
- Polymerase chain reaction (PCR) tests for Lyme disease have also been developed to detect the genetic material (DNA) of the Lyme disease spirochete. PCR tests are rarely susceptible to false-positive results but can often show false-negative results, and the overall reliability of PCR in this role remains unclear.
- With the exception of PCR, there are not currently any practical means for the detection of the presence of the organism, as serologic studies only test for antibodies of Borrelia burgdorferi.
- Immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to Borrelia antigens: high titers of either antibody indicates disease, but lower titers can be misleading.
- The IgM antibodies may be present after the initial infection for a limited period but IgG antibodies may remain for years after the infection.[9]
- Western blot, ELISA, and PCR can be performed by either blood tests via venipuncture or cerebral spinal fluid (CSF) via lumbar puncture.
- Though lumbar puncture is more definitive of diagnosis, antigen capture in the CSF is much more elusive. Reportedly, CSF yields positive results in only 10-30% of patients cultured.
- The diagnosis of neurologic infection by Borrelia burgdorferi should not be excluded solely on the basis of normal routine CSF or negative CSF antibody analyses.[10]
- New techniques for clinical evaluation of Borrelia burgdorferi infection are under investigation, and includes:
- Lymphocyte transformation tests [11]
- Focus floating microscopy[12]
- New research indicates chemokine CXCL13 may also be a possible marker for neuroborreliosis.[13]
Other Types of Laboratory Testing
- Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established. These tests include:[14]
- Capture assays for antigens in urine
- Culture, immunofluorescence staining, or cell sorting of cell wall-deficient or cystic forms of B. burgdorferi
- Lymphocyte transformation tests
- Quantitative CD57 lymphocyte assays
- Reverse Western blots
- In-house criteria for interpretation of immunoblots
- Measurements of antibodies in joint fluid (synovial fluid)
- IgM or IgG tests without a previous ELISA/EIA/IFA
- In general, the CDC does not recommend these tests.
- Patients are encouraged to ask their physicians whether their testing for Lyme disease was performed using validated methods and whether results were interpreted using appropriate guidelines.
Testing Ticks
- Patients who have removed a tick often wonder if they should have it tested.
- In general, the identification and testing of individual ticks is not useful in deciding if a person should get antibiotics following a tick bite because:[15]
- If the test shows that the tick contained disease-causing organisms, that does not necessarily mean that the patient was infected.
- If the patient has been infected, symptoms will probably develop before results of the tick test are available, so appropriate treatment should not be withheld for availability of tick testing results.
- Negative results can lead to false assurance. For example, the patient may have been unknowingly bitten by a different tick that was infected.
References
- ↑ "Two-step Laboratory Testing Process| Lyme Disease | CDC".
- ↑ Engstrom SM, Shoop E, Johnson RC (1995). "Immunoblot interpretation criteria for serodiagnosis of early Lyme disease" (PDF). J Clin Microbiol. 33 (2): 419–27. PMID 7714202.
- ↑ Sivak SL, Aguero-Rosenfeld ME, Nowakowski J, Nadelman RB, Wormser GP (1996). "Accuracy of IgM immunoblotting to confirm the clinical diagnosis of early Lyme disease". Arch Intern Med. 156 (18): 2105–9. PMID 8862103.
- ↑ 4.0 4.1 Goossens HA, Nohlmans MK, van den Bogaard AE (1999). "Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis". Infection. 27 (3): 231. PMID 10378140.
- ↑ 5.0 5.1 5.2 Berardi VP, Weeks KE, Steere AC (1988). "Serodiagnosis of early Lyme disease: analysis of IgM and IgG antibody responses by using an antibody-capture enzyme immunoassay". J Infect Dis. 158 (4): 754–60. PMID 3049839.
- ↑ Feder HM, Gerber MA, Luger SW, Ryan RW (1991). "False positive serologic tests for Lyme disease after varicella infection". N Engl J Med. 325 (26): 1886–7. PMID 1961232.
- ↑ Woelfle J, Wilske B, Haverkamp F, Bialek R (1998). "False-positive serological tests for Lyme disease in facial palsy and varicella zoster meningo-encephalitis". Eur J Pediatr. 157 (11): 953–4. PMID 9835449.
- ↑ Strasfeld L, Romanzi L, Seder RH, Berardi VP (2005). "False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection". Clin Infect Dis. 41 (12): 1826–7. PMID 16288417.
- ↑ Burdash N, Fernandes J (1991). "Lyme borreliosis: detecting the great imitator". The Journal of the American Osteopathic Association. 91 (6): 573–4, 577–8. PMID 1874654.
- ↑ Coyle PK, Schutzer SE, Deng Z; et al. (1995). "Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease". Neurology. 45 (11): 2010–5. PMID 7501150.
- ↑ Valentine-Thon E, Ilsemann K, Sandkamp M (2007). "A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis". Diagn. Microbiol. Infect. Dis. 57 (1): 27–34. doi:10.1016/j.diagmicrobio.2006.06.008. PMID 16876371.
- ↑ Eisendle K, Grabner T, Zelger B (2007). "Focus floating microscopy: "gold standard" for cutaneous borreliosis?". Am. J. Clin. Pathol. 127 (2): 213–22. doi:10.1309/3369XXFPEQUNEP5C. PMID 17210530.
- ↑ Cadavid D (2006). "The mammalian host response to borrelia infection". Wien. Klin. Wochenschr. 118 (21–22): 653–8. doi:10.1007/s00508-006-0692-0. PMID 17160603.
- ↑ "Laboratory tests that are not recommended| Lyme Disease | CDC".
- ↑ "Tick removal and testing | Lyme Disease | CDC".