Lyme disease and co-infection testing vary in terms of cost, sensitivity, and specificity. Based on available testing, it can still be difficult to determine who has the illness, the most effective course of treatment, and when treatment can be safely discontinued.
The CDC currently recommends a two-step testing process for Lyme disease that was developed for surveillance purposes, the enzyme-linked immunosorbent assay (ELISA) and the Western blot. If the ELISA test is positive or equivocal, this test is usually performed to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi. The CDC surveillance criteria requires 2 out of 3 IgM bands and/or 5 out of 10 IgG bands for a positive test result.
Unfortunately, the two-tier testing recommended by the CDC misses approximately ½ of actual cases pursuant to numerous peer-reviewed studies. States like Maryland and Virginia have enacted laws requiring laboratories or doctors to explicitly inform you that you may still have the infection, even if you test negative for Lyme disease.
It is critical to note that certain bands on the Western blot are more specific for Lyme disease than others. With a clinical presentation of Lyme and reactive bands, your doctor may diagnose Lyme disease even if you do not meet the CDC’s criteria. Your doctor may also elect to order a Western Blot without a positive ELISA to increase sensitivity. Additionally, it is important to keep in mind that some laboratories may use different methodologies or criteria which could result in a positive test for one lab and negative at another.
Simply put, you can’t rule out Lyme with existing laboratory tests. Based on the limits of two-tiered serological testing, a clinical diagnosis is often necessary.
If initial Lyme disease tests don’t show evidence of exposure to Borrelia burgdorferi, consider the following options:
- Use more sensitive interpretive criteria as detailed below
- Use more sensitive Lyme disease tests that cover divergent Borrelia strains, which may or may not be covered by insurance
- Start an antibiotic trial to gauge your response
- Consider the possibility of co-infections with many overlapping symptoms to Lyme disease
Western Blot test results will include both IgG and IgM assays. Carefully consider Lyme-specific bands (those bands represent serological evidence of exposure to Borrelia burgdorferi). Many Lyme specialists believe a single Lyme-specific band, along with a patient’s clinical presentation, is sufficient to diagnose Lyme disease. Likewise, in China, a single positive IgG band coupled with a single IgM band is considered to be a positive Western Blot when the patient also has symptoms of Lyme.
The following bands are generally considered to be significant or Lyme-specific:
18 (most sources)
22-25
28
30
31
34
35
37
39
58 (some sources)
66 (some sources)
83
93
Whatever test you use, be sure to request a copy of your test results. Oftentimes, patients are told that their Lyme test was “negative,” even when there are significant indications of infection such as reactive bands on a Western Blot. Accurate and complete records may also be important for insurance, disability, or continuing medical treatment.
We recommend more sensitive laboratories that include additional strains of Borrelia (Lyme), Babesia, and Bartonella such as IGeneX (noting IGeneX Lyme ImmunoBlot test has received FDA clearance, Vibrant Wellness, or T Lab, or Galaxy Diagnostics.
