Lyme Disease Test
The main test for Lyme Disease is to determine the presence of antibodies to the bacteria that causes Lyme Disease, in a process known as serology.
Pathogens are micro-organisms such as viruses and bacteria that cause disease. Lyme Disease is caused by the bacteria Borrelia burgdorferi – there are many species of Borrelia bacteria worldwide, not all of which cause disease, but there are four main species that are known to cause disease that are found in the UK tick population.
Ideally, a direct confirmation of the presence of the Borrelia pathogen would be best, but this is not always possible, so instead we use indirect test procedures that measure how the body’s immune system is responding to the infection. Our immune system responds to any infection by producing pathogen-specific antibodies to destroy the bacteria.
There are two elements to the immune system that we can measure; first is the humoral immune system that produces the antibodies. Secondly, there is the cellular immune system that can provide additional information we can use in our diagnosis.
Humoral Immune System Tests; serological tests, such as ELISA, CLIA and immunoblots, measure the type of antibodies, the quantity that has been produced and how they are behaving.
Cellular Immune System Tests; we use the EliSpot test to analyse activity on a cellular level.
Problems with Lyme Disease diagnostic tests
There are some limitations to this type of indirect testing; if it is performed too early, then the antibodies may have not developed sufficiently and the test is negative. If the person is on a course of antibiotics or immunosuppressants to treat another condition then this may also affect the antibody response. Furthermore, newly discovered or undiscovered strains of the borrelia bacteria will remain undetected by current testing procedures.
On the other hand, antibodies may persist for many years in the body, producing a positive result even through the disease is inactive. Autoimmune conditions such as rheumatoid arthritis can also produce a false positive.
Another issue is a lack of standardisation in antibody testing between different laboratories, typically due to differences in the sensitivity of the testing system and also the experience of the laboratory in testing for specific diseases. This can result in different findings – either negative, borderline or positive – in the same samples. Specific antibodies might not be found if the laboratory’s testing system uses the incorrect antigens.
Unfortunately, in the absence of any of the physical evidence of Lyme Disease, these laboratory results can often form the basis of diagnosis and a false negative result could lead to the exclusion of Lyme Disease.
It is fast becoming accepted that new methods of testing and measuring for Lyme Disease need to be found. Our partners BCA Clinic remain committed to finding a new parameter to measure this disease, particularly in relation to chronic stage Lyme.
The importance of the clinical diagnosis
At our central London clinic, we put emphasis on the clinical diagnosis. This is a diagnosis based on the reported symptoms and medical indications and Dr Joshua Berkowitz, our medical director, will take a comprehensive patient history.
In certain medical conditions, for example MS, Alzheimers or Parkinson’s, no laboratory evidence is required for a diagnosis. Some Lyme practitioners, such as our partners BCA Clinic in Germany, feel that a clinical diagnosis of Lyme Disease, based on symptomatic evidence, could be sufficient.