Lyme Disease

WHAT IS LYME DISEASE?

Lyme disease is a world-wide infectious disease caused by microscopic bacteria carried by tiny ticks.

B. burgdorferi, a spiral bacteria (spirochete) that causes Lyme Disease, seen through a microscope.

HOW IS LYME TRANSMITTED?

There are several species of deer ticks across the US that become infected with the spiral bacterium, Borrelia burgdorferi.

Unsuspecting humans and animals walking through woodlands and brushy areas may be bitten by a tick and never know it. The tiny ticks, some the size of poppy seeds, may stay on your body for hours to days. The tick engorges itself with blood. If infected, the spirochete is transmitted to the bloodstream of the person or animal during the bite.

WHAT IF I SUSPECT EXPOSURE?

Early recognition is important. If you find a tiny tick attached to your skin, if you were in a known
tick-infested area, or if you have symptoms described herein, see your physician.

WHAT ARE THE SYMPTOMS?

A characteristic red bulls-eye rash (EM) at the site of the bite is present in less than 40% of
patients. The rash may appear within days to weeks after the bite, but could be hidden in hairline
or underarms.

EM RASH – Rashes from other bacteria in the tick may show up immediately. Typically the rash from

Lyme bacteria appears days or weeks after the bite. Some patients report flu-like symptoms, fever, aches, fatigue, neck stiffness, jaw discomfort, muscle pain and stiffness, swollen glands, and red eyes. Symptoms may appear, disappear and reappear at various times.

Nervous system abnormalities include memory loss and partial facial paralysis (Bell’s palsy).
Migratory joint pains, and pains in the tendons, muscles and bones may occur later in the disease. Arthritic symptoms, if present, usually affect the large joints like the knees.

HOW IS LYME DISEASE DIAGNOSED?

Lyme disease is a clinical diagnosis. This means that the physician makes the diagnosis using your
clinical history and symptoms. If a physician observes an EM rash, a diagnosis of Lyme disease will
be made. If a rash is not seen by a physician, laboratory tests are often needed to help with the
diagnosis.

CAN TICKS BE TESTED?

Not all ticks are infected with the spiral bacterium, B. burgdorferi. If the tick was saved, it can be
tested by our laboratory for the presence of the Lyme bacteria using a test called PCR. We also test
ticks for Babesia microti andor Babesia duncani (formerly WA-1), Ehrlichia, Bartonella henselae and
Rickettsia (Rocky Mountain Spotted Fever). These diseases are also carried by ticks.

A Nymph, which is a baby tick, can be as small as the dot at the end of this sentence.

Tick in Nymph stage is the size of a poppy seed.

ARE THERE OTHER TICK-BORNE DISEASES?

The same tick that carries the bacteria that causes Lyme Disease, can also transmit other illnesses.
The most common are Babesiosis, Ehrlichiosis, and Bartonella henselae and Rocky Mountain
Spotted fever (Rickettsia). It is estimated that up to 20% of the ticks with Lyme disease may have
one of these other diseases. Babesiosis is like malaria with the symptoms of acute disease being
fever, chills, vomiting and fatigue. It is usually self-limiting except in Lyme patients and those who
have undergone splenectomy. There are two forms of Ehrlichiosis: Anaplasma phagocytophila
(HGE) and HME (Human Monocytic Ehrlichiosis). HGE is primarily on the East coast, upper Midwest
and California. HME is primarily in the Southeast, lower Midwest and Southwest, with cases reported
in CA, NJ, NY, and WI. These acute diseases may have symptoms of fever, chills, vomiting and
fatigue and require prompt antibiotics. Subclinical forms of these diseases may be present in
patients with Lyme disease.

WHAT TESTS ARE AVAILABLE?

A variety of tests is available. Many doctors who are unfamiliar with Lyme disease just use the
Lyme test available in their local laboratory. This is usually the Lyme ELISA. This tests measure a
patient’s antibody, IgM and/or IgG, in response to exposure to the Lyme bacteria. By today’s standards, these tests are not very sensitive. IGeneX, Inc. will only perform the ELISA test in
conjuction with Western Blots.

The Lyme IFA (performed as part of a Lyme Panel) detects IgG, IgM and IgA antibodies against
B. burgdorferi. IgM-specific titers usually persist in the presence of disease. Antibody levels tend to rise above background levels about 2-3 weeks after infection and may remain elevated in case of prolonged disease.

The WESTERN BLOT tests (IgG and/or IgM) can visualize the exact antibodies you are making to
the Lyme bacteria. In some cases the laboratory may be able to say that your “picture of Lyme
antibodies” is consistent with early disease or with persistent/recurrent disease. Not all patients
have antibodies at all times when tested. Antibodies are more commonly detected within the first
year after infection, although reinfection may cause a significant rebirth of antibodies. At most, only
60% of patients have antibodies early, and the presence of antibodies alone does not make a
diagnosis of disease.

The LYME DOT BLOT ASSAY (LDA) looks for the presence of pieces of the Lyme bacteria in urine. When compared to the Western Blot, , they both had similar sensitivities; however, the immunodot assay was more specific and had greater positive predictive value than the Western blot assay. The results obtained indicate that the immunodot assay performs as well as or better than the Western blot assay for diagnosing Lyme borreliosis. Furthermore, because it uses a limited panel (n = 5) of antigens, the immunodot is easier to read and interpret than standard Western blots. cvi.asm.org/content/5/4/503.short

The PCR (Polymerase Chain Reaction) Test, a highly specific and sensitive test detects the presence of the DNA of the Lyme bacteria. The PCR test is often the only marker that is positive in all stages of Lyme disease. The test can be performed on blood, serum, urine, CSF and miscellaneous fluids/tissues. Unfortunately, Lyme bacteria like to “hide” in the body, therefore, PCR can often be negative. Studies performed on different sample types suggest that performing PCR on multiple sample types improves assay sensitivity.

WHICH TEST IS BEST?

Lyme Disease is very complicated to diagnose because:

Lyme bacteria are not always detectable in the whole blood, even in active disease. The bacteria like to hide in joints, teeth, the heart, and the brain.
Every patient responds differently to an infection.
Antibodies may only be present for a short time.
For patients with clinical symptoms of Lyme Disease who test negative by the IFA Screen or IgG or IgM Western Blot, the Whole Blood PCR or the LDA/Multiplex PCR Panel on urine may be appropriate. There are physician developed antibiotic protocols to enhance the sensitivity of the LDA. In addition, there seems to be increased sensitivity of this test during the start of menses.

Lyme Disease Tests

IgG/IgM/IgA Screen (IFA)*
IgG/IgM and IgM Antibody ELISA
C6 Peptide
IgG Western Blot and IgM Western Blot
30/31 kDA Confirmation Test*
Lyme Dot Blot Assay (LDA)*
Reverse Western Blot (Confirmation test for LDA)*
Multiplex PCR for urine, whole blood, serum, CSF
Multiplex PCR for Miscellaneous samples (ex: Skin biopsy, breast milk, semen)
In addition to Lyme Disease, a co-infection may be suspected for Babesiosis, Ehrlichiosis, Bartonella or Rickettsia. We offer tests for these other tick-borne illnesses. The tests are IFA (fluorescent antibody) or direct tests by PCR. In the case of Babesia, we offer PCR tests for both B. microti and Babesia duncani (West Coast strain). In addition, we offer a Babesia FISH (fluorescent in situ hybridization) test that detects Babesia parasites directly on air-dried blood smears. The FISH test is highly specific for Babesia, unlike the standard test, the geimsa stain smear, which is neither sensitive or specific.

Babesiosis Tests

B. microti IgG/IgM Antibody
B duncani IgG/IgM Antibody*
Babesia PCR Screen
Babesia FISH (RNA)
Ehrlichiosis Tests

Anaplasma phagocytophila (HGE) IgG/IgM Ab
Anaplasma phagocytophila (HGE) PCR
Human Monocytic Ehrlichia (HME) IgG/IgM Ab
Human Monocytic Ehrlichia (HME) PCR
Bartonella Tests

Bartonella henselae IgG/IgM Antibody
Bartonella henselae PCR for Whole Blood, Serum*, or CSF
Rickettsia Tests

Rickettsia PCR for Whole Blood, Serum or CSF
There are Testing PANELS that have been put together to provide cost savings to the patient when more than one test is ordered. Please refer to the FORMS AND CODES Section. Our Patient Test Request Form lists all of the Panels available, including Panels for certain Regions of the Country you live in.

TICK TESTING IS ALSO AVAILABLE FOR:

Lyme, Babesia microti and/or Babesia duncani (formerly WA-1), Ehrlichia,
Bartonella henselea, and Rickettsia by PCR.

Patients with neurological symptoms of Lyme disease may need to have a spinal tap in order to study “the blood of the brain,” the CSF (cerebral spinal fluid). These patients may have negative blood and urine tests and show positive results with CSF. The LDA and PCR can be performed on CSF.

WHAT IS THE TREATMENT?

It is reported that Lyme disease can be treated successfully with antibiotics if caught early in the infection. Prevention is the best cure for infection. Patients whose disease is caught late often need to be on antibiotics for longer periods of time. There is controversy between physicians as to the length of treatment. ILADS physicians’ feel treatment should continue for 2 months after patient feels better. Ehrlichiosis is often treated with many of the same antibiotics used for Lyme disease. Babesia is often treated with Metron and Zithromax. Many physicians believe that they need to treat the Babesiosis before treating Lyme disease to achieve clinical success.

HOW CAN LYME DISEASE BE PREVENTED?

Wear long sleeve shirts and long pants when going into tick country. Light colors are best – ticks can be seen easier. Tuck pants into socks and spray the clothes with a known tick repellent. After being in a tick area, check skin and all hair areas completely. Promptly remove all ticks after being in an area known to harbor Lyme ticks. Check pets carefully, they are a source of entry for ticks into the house. Deer hunters need to spend extra time checking their gear before bringing it into autos and home.

HOW DO YOU REMOVE A TICK?

1. Use tweezers or forceps.
2. Grasp the tick mouthparts close to the skin.
3. Avoid squeezing the tick which may spread infected body fluids.
4 Pull the tick straight out. Do not twist. Do not attempt to burn the tick.
5. Save the tick (you may want to have it tested for B. burgdorferi or other tick-borne diseases)
6. Wash your hands with soap and water.
7. Apply antiseptic to bite site.

*Tests not available for New York Residents