Lyme disease remains a clinical diagnosis. However, with different tests available it is confusing for the patient to understand what may be the best testing options for them. Conventional standard critieria require often travel to an endemic location, and 2 step testing (ELISA and then western blot) to be positive.
Chronic lyme disease test and lyme symptoms
Lyme disease is caused by infection with a spirochete called Borrelia burgerfori. In Europe often lyme disease is caused by another species of Borrelia and thus medical literature on both lyme disease test and treatment may or may not apply in North America).
Lyme disease is often considered a great mimicker of other illnesses. It may go undetected while patients get treatment for another condition. Examples where this may be the case include chronic fatigue syndrome and fibromyalgia, various types of arthritis, and neuropathic pain.
Again, lyme disease mimics many other chronic conditions. The spirochete that causes lyme disease, Borrelia, is unique in that it has more lipoproteins coded for in its DNA than any other organism (as far as we know), over 100. Furthermore, very few of the genes code for proteins related to biosynthesis. This may be associated with why lyme symptoms can be so severe and chronic, with lots of pain and inflammation due to the unusually high number of lipoproteins present. Further, in chronic lyme the spirochete is adept at living “with” the host cells and multiplying slowly, since it does not have the proteins for biosynthesis it relies on the host cells of the patient to provide nutritional requirements.
The conventional medicine textbook Harrison’s Principle’s of Internal Medicine lists the following lyme symptoms:
· classic erythema migrans rash (bull’s eye rash)
· coinfection with anaplasma or babesia may indicate changes on a regular complete blood count, including low platelets (thrombocytopenia) or low white blood cells (leukopenia)
· facial palsy (similar to Bell’s palsy with facial muscle droop)
· arthritis or pain in the joints
· symptoms of chronic fatigue syndrome or fibromyalgia
Very limited group of symptoms, but relatively specific especially when combined with the lyme disease testing.
The International Lyme and Associated Disease group has the following symptoms published in their guidelines: (note ILADS is an unconventional group which has gone far to educate doctors and the public about chronic lyme treatment and lyme diagnosis)
ILADS CNS type lyme symptoms:
· memory loss
· sleep disturbance
ILADS General lyme symptoms:
• Low grade fevers, ‘hot flashes’ or chills
• Night sweats
• Sore throat
• Swollen glands
• Stiff neck
• Migrating arthralgias, stiffness and, less commonly, frank arthritis
• Myalgia (muscle aches)
• Chest pain and (heart) palpitations
• Abdominal pain, nausea
• Sleep disturbance
• Poor concentration and memory loss
• Irritability and mood swings
• Back pain
• Blurred vision and eye pain
• Jaw pain
• Testicular/pelvic pain
• Cranial nerve disturbance (facial numbness, pain, tingling, palsy or optic neuritis)
Clearly the ILADS group of symptoms is much more broad and encompassing. In my mind it becomes especially important to exclude other causes of illness, and have objective, lab based evidence of infection to support chronic lyme diagnosis as the cause of suspected lyme disease related symptoms.
Lyme disease test
The conventional standard for lyme disease diagnosis confirmation is a two-tiered test consisting of an ELISA test for lyme first, and if “equivocal” or positive, then confirmation by western blot testing. In Canada, if the ELISA is negative then the diagnosis is considered excluded by most conventional physicians.
The ILADS guidelines for a lyme disease testing involves the use of a western blot with less strict criteria for interpretation. In general, the western blot lyme disease test measures antibodies or immune system proteins against specific antigens (foreign molecules). Some of these antigens are very specific for lyme, and others are shared with other spirochete infections. Conventional positives for a western blot lyme disease test involve 2 of 3 specific IgM antibodies and 5 of 10 specific IgG antibodies.
There is no perfect lyme disease test, and diagnosis can be made based on strong clinical suspicion. The western blot is very helpful though, and for certain coinfections, it is important to test as treatment for chronic lyme disease may not cover certain infections (such as Babesia).
In my own practice, if chronic lyme is suspected, then the lyme disease test to start with is the western blot for both IgG and IgM. If there is a swollen joint that is painful, then the joint fluid may be tapped and sent for analysis to see if the Borrelia DNA is present. Occasionally, tests for the immune system and its suppression can be used (CD57 activity). I do tend to test for coinfections depending on the symptoms that present, and use tests that look for the immune system response to these infections. Elispot testing to assay for T cell activity can be very useful as well. Both the treatment of biofilm and the coinfections becomes important in my opinion, so that extended antibiotic therapy is not the only option.