A test may support the diagnosis of LD, but cannot be used solely to make the diagnostic decision. No
test can definitively "rule-out" Lyme disease.
Antibodies are the immune system's response to fight off infection. Tests strive to be both sensitive
(detecting any LD-antibody reaction) and specific (detecting just LD antibodies.)
Types of Tests
Titer (ELISA or IFA) tests measure the level of Bb antibodies in body fluid. Laboratories use different
detection criteria, cut-off points, types of measurements, and reagents.
Western blot produces bands indicating the immune system's reactivity to Bb. Labratories differ
in their interpretation and reporting of these bands.
Direct Detection Tests
Antigen detection tests look for a unique Bb protein in fluid (e.g. urine) of patients. This may be useful
for detecting LD in patients taking antibiotics or during a patient's symptom flare-up.
Polymerase chain reaction (PCR) tests multiplies
the number of Bb DNA to a detectable level. It is expensive and requires expertise. Culturing is difficult and can take weeks. Staining is time consuming and has a low yield.
Types of Results
False Negative tests occur due to: defects in test sensitivity; too low an antibody level to detect (e.g.
they are bound to the bacteria, with too few freefloating; the patient taking antibiotics or other drugs;
naturally low antibody production); the bacterium has changed, limiting recognition by the immune system;
the bacterium has masked itself in some way; or bacterial strain variations.
False Positive tests occur due to: test failure, crossreacting antibodies (e.g. syphilis, periodontal disease).
The following testing should also be done to rule in or out other disorders and prevent a false negative or positive result:
ESR (sed rate)
glucose urea nitrogen
babesia IGG (co infection)
babesia IGM (co infection)
bartonella HEN. IGG (co infection)
bartonella HEN. IGM (co infection)
bartonella QUIN. IGG (co infection)
bartonella QUIN. IGM (co infection)
ehrlichiosis A. Phagocyt IgG (co infection)
ehrlichiosis A. Phagocyt IgM (co infection)
ehrlichiosis E. Chaff IGG (co infection)
ehrlichiosis E. Chaff IGM (co infection)
Labs should be sent to a Lab familiar with testing for Lyme Disease. If there is any questions, contact the lab ahead and confirm that they are familiar with the tests ordered. A Lyme Literate Physician will be aware of a proper lab to send to.