What is the Best Test for Lyme Disease?

When it comes to diagnosing Lyme Disease, there is no perfect test. In my blog, What Is Lyme Disease & Why is it So Hard To Catch, I discussed some of the reasons, Lyme Disease is so diffciulty to diagnosed. Still, it can be helpful to understand the strengths and weaknesses of different tests when determining which is right for you. I will discuss a few of the most common ones but this list by no means represents all Lyme tests out there. Having a conversation with a Lyme literate physician can be helpful when choosing the right test for you. Remember- no matter what test results reveal, Lyme is a clinical diagnosis so clinical history and symptoms are equally as important as test results.

For Lyme: 

Conventional ELISA & Western Blot: These tests can be helpful in suggesting Lyme Disease if interpreted by a skilled clinician who is aware of band specificity and patterns seen in chronic Lyme Disease. They are by far the most inexpensive but have a high error rate and do not screen for other types of Borrelia that can create Lyme-like illness. 

Alternative ELISA & Western Blots: There are several labs which have developed more sensitive versions of the ELISA and Western Blot tests, focused on detecting Lyme Disease. Some of the most noteworthy of these labs include Vibrant America, IgenX, Fry Labs, and Armin labs. Some of these labs also test for additional species of Borrelia that can create disease. 

PCR Testing: This is a method of testing that amplifies DNA. When it comes to detecting Lyme Disease and related infections, a positive PCR is a trustworthy result. However, because Lyme Disease often resides deep in tissues and PCR samples are taken from tissue like blood and urine, a negative PCR result is not necessarily accurate. Oftentimes, PCR testing must be run multiple times to truly rule in or out a Lyme related infection. 

Antigen Capture/Nanotrap Test: Instead of relying on the immune system to give us clues regarding whether or not Lyme Disease is present, this test looks for markers on the surface of Borrelia burgdorferi called antigens. Like PCR testing, a positive result is very trustworthy but a negative result less so. Additionally, it does not test for other strains of Borrelia that could be creating disease.

ELISPOT Test: this test evaluates whether the immune system is responding to Lyme Disease. This can be extremely helpful with determining response to treatment since Lyme Disease does not always convert to negative in the blood after treatment.

Spinal Taps: This invasive procedure involves taking a sample of cerebrospinal fluid (the fluid surrounding your brain and spinal cord) and assessing for the presence of Borrelia burgdorferi. This is usually only performed in individuals with severe neurological symptoms, in whom Lyme Disease is suspected. This test detects Lyme Disease in only a small percent of patients, as Lyme Disease in the nervous system is often in the hard-to-detect cyst form. 

My Favorite Test: The test I use in my clinical practice is Vibrant America Tickborne 2.0. It tests for many species of Borrelia that can create Lyme-like illness, as well as major bacterial and viral co-infections occurring with Lyme. For each infection it evaluates, it runs both an ImmunoWestern Blot (similar to a Western Blot but more advanced) and PCR tests. Its Borrelia burgdorferi Western Blot includes the traditional bands as well as additional bands that recent research has identified as the most accurate. The total cost is less than what most accurate labs charge for Borrelia burgdorferi evaluations alone. Its cost and high accuracy testing make it like no other test. You can purchase it here. 

GENIE Nanostring Test: This is another one of a kind test. This test is aimed at assessing causes of chronic fatigue, instead of merely assessing for Lyme Disease. It uses genetic markers known to create metabolic findings associated with chronic disease and informs the cause, whether that be Lyme Disease, mold toxicity, or post Lyme Syndrome. You can purchase it here.

Supportive or Suggestive Markers 

In addition to directly testing for Lyme Disease, some doctors look for markers of Lyme activity. These can include: 

• Complement Markers C3a and C4a: Complement is a function of your immune system that helps you respond to infections. Changes can occur in chronic infections. C4a can increase with Lyme Disease or mold toxicity. C3a can be normal or elevated in Lyme Disease, depending on the stage of infection but tends to decrease with mold toxicity. 

• CD57: This is a marker for a type of immune cells called Natural Killer cells. Lyme Disease inhibits these cells so some doctors use it as a marker of Lyme Disease activity. The goal for this marker is to be above 200. This test can be useful for determining activity of Lyme Disease or response to treatment but is not diagnostic. Additionally, this marker can be decreased by deficiencies in Vitamins A & D. 

• TGF-Beta: TGF beta is a chemical messenger in the immune system that has beneficial activity when it is in range. Elevations often reflect infections such as Epstein Barr, mycoplasma or chlamydia pneumoniae, and mold toxicity. In Lyme Disease, TGF beta can decrease. 

• Spirotest: measures inflammatory markers observed in early and late Lyme Disease and can be helpful for distinguishing between early and late stage infection.

Diagnostic Criteria That is Actually Helpful

 While diagnostic testing is helpful in identifying Lyme Disease in a clinical diagnosis, this means diagnosis is based on symptoms and lab testing is not required, regardless of your overall health picture. But, don’t make the mistake of thinking you have Lyme Disease just because you have all the symptoms of Lyme Disease. 

Lyme Disease is sometimes called the great mimicker, meaning the symptoms created by Lyme Disease can be created by many other disease states. When diagnosing Lyme Disease, it is important to work with a doctor who can rule out other conditions that may be creating symptoms similar to those seen in Lyme Disease. 

Some doctors may ask you if you remember being bit by a tick or having a bullseye rash. These questions are mostly irrelevant to diagnosis. Tick bites are painless and often occur in areas of the body where you would not notice them, such as on the scalp. Thus, it is easy to be bitten by a tick without knowing it. Additionally, the bullseye rash occurs in less than 10% of patients. While it is highly specific for Lyme Disease if it does develop, it does not rule out lyme Disease. If you do opt for Lyme Disease testing, most Lyme Literate practitioners use the ILAD criteria, a more informed diagnostic criteria that is more accurate than CDC criteria.

If you suspect you might have Lyme Disease, I suggest completing the Lyme Horowitz Questionnaire. This can help you distinguish between Lyme Disease and other chronic illnesses and the score is statistically correlated to likeliness of Lyme Disease. You can find the quiz here.