What You Should Know About Lyme Disease
WHAT IS LYME DISEASE?
Lyme disease is a world-wide infectious disease caused by microscopic bacteria carried by tiny ticks.
B. burgdorferi, a spiral bacteria that causes Lyme Disease, seen through a microscope.
HOW IS LYME TRANSMITTED?
There are several species of deer ticks across the US that become infected with the spiral bacterium Borrelia burgdorferi. Unsuspecting humans and animals walking through woodlands and brushy areas may be bitten by a tick and never know it. The tiny ticks, some the size of poppy seeds, may stay on your body for hours to days. The tick engorges itself with blood. If infected, the spirochete is transmitted to the bloodstream of the person or animal during the bite.
WHAT IF I SUSPECT EXPOSURE?
Early recognition is important. If you find a tiny tick attached to your skin, if you were in a known tick-infested area, or if you have symptoms described herein, see your physician.
WHAT ARE THE SYMPTOMS?
A characteristic red bulls-eye rash (EM) at the site of the bite is present in less than 40% of patients. The rash may appear within days to weeks after the bite, but could be hidden in hairline or underarms.
EM RASH Rashes from other bacteria in the tick may show up immediately. Typically the rash from Lyme bacteria appears days or weeks after the bite.
Some patients report flu-like symptoms, fever, aches, fatigue, neck stiffness, jaw discomfort, muscle pain and stiffness, swollen glands, and red eyes. Symptoms may appear, disappear and reappear at various times.
Nervous system abnormalities include memory loss and partial facial paralysis (Bell's palsy). Migratory joint pains, and pains in the tendons, muscles and bones may occur later in the disease. Arthritic symptoms, if present, usually affect the large joints like the knees.
HOW IS LYME DISEASE DIAGN0SED?
Lyme disease is a clinical diagnosis, This means that the physician makes the diagnosis using your clinical history and symptoms. If a physician observes an EM rash, a diagnosis of Lyme disease will be made. If a rash is not seen by a physician, laboratory tests are often needed to help with the diagnosis.
CAN TICKS BE TESTED?
Not all ticks are infected with the spiral bacterium B. burgdorferi. If the tick was saved, it can be identified and tested. Our laboratory tests ticks for the presence of the Lyme bacteria using a test called PCR. We can also test ticks for Babesia microti and Babesia WA-1, Ehrlichia, and Bartonella henselae. These diseases are also carried by ticks.
From left to right: Larvae, Nymph, Female, Male Tick
Tick in Nymph stage is the size of a poppy seed.
ARE THERE OTHER TICK-BORNE DISEASES?
The same tick that carries the bacteria that causes Lyme Disease, can also transmit other illnesses. The most common are Babesiosis, Ehrlichiosis, and Bartonella henselae. It is estimated that up to 20% of the ticks with Lyme disease may have one of these other diseases. Babesiosis is like malaria, with the symptoms of acute disease being fever, chills, vomiting and fatigue. It is usually self-limiting, except in patients who have undergone splenectomy. There are two forms of Ehrlichiosis: HGE (Human Granulocytic Ehrlichiosis) and HME (Human Monocytic Ehrlichiosis). HGE is primarily on the East coast, upper Midwest and California. HME is primarily in the Southeast, lower Midwest and Southwest. These acute diseases may have symptoms of fever, chills, vomiting and fatigue and require prompt antibiotics. Subclinical forms of these diseases may be present in patients with Lyme disease.
WHAT TESTS ARE AVAILABLE?
A variety of tests is available. Many doctors who are unfamiliar with Lyme disease may just use the Lyme test available in their local laboratory. In many cases this is the Lyme ELISA or IFA, often called "Titer Test. These tests measure a patient's antibody, IgM and/or IgG, in response to exposure to the Lyme bacteria. By today's standards, these tests are not very sensitive. IGeneX, Inc. will only perform the ELISA test when Western Blots are ordered in conjunction.
The Western Blot tests (IgG and/or IgM) are much more sensitive and specific than the above ELISA tests. With the Western blot, the laboratory can visualize the exact antibodies you are making to the Lyme bacteria. In some cases the laboratory may be able to say that your picture of Lyme antibodies is consistent with early disease or with persistent/ recurrent disease. Not all patients have antibodies at all times when tested. Antibodies are more commonly detected within the first year after infection, although re-infection may cause a significant rebirth of antibodies. At most, only 70% of patients have antibodies early, and the presence of antibodies alone does not make a disease diagnosis.
The Lyme Dot Blot Assay (LDA) looks for the presence of pieces of the Lyme bacteria in urine. The LDA has been useful in some patients with clinical symptoms and clinical history consistent with Lyme disease, who consistently test negative with antibody tests for Lyme disease.
The PCR (Polymerase Chain Reaction) test detects the presence of the DNA of the Lyme bacteria. PCR tests have more sensitivity early in the disease before patients have received antibiotics. The best specimen to test has not been defined. The test is usually performed on whole blood, serum, urine, CSF, or miscellaneous fluids/tissues.
WHICH TEST IS BEST?
Lyme Disease is very complicated to diagnose because:
- Lyme bacteria are not always detectable in the whole blood, even in active disease. The bacteria like to hide.
- Every patient responds differently to an infection.
- Antibodies may only be present for a short time.
For patients with clinical symptoms of Lyme Disease who test negative by the IgG or IgM Western Blot, the Whole Blood PCR or the LDA/Multiplex PCR Panel on urine may be appropriate. There are physician-developed antibiotic protocols to enhance the sensitivity of the LDA. In addition, there seems to be increased sensitivity of this test during the start of menses.
Lyme Disease Tests
IgG/IgM and IgM Antibody Serology
IgG Western Blot and IgM Western Blot
Lyme Dot Blot Assay (LDA)
Reverse Western Blot (Confirmation test for LDA)
Multiplex PCR for urine, whole blood, serum, CSF, miscellaneous (ex: Skin biopsy, breast milk, semen)
In addition to Lyme Disease, a co-infection may be suspected for Babesiosis, Ehrlichiosis, or Bartonella. We offer tests for these other tick-borne illnesses. The tests are IFA (fluorescent antibody) or direct tests by PCR. In the case of Babesia, FISH (fluorescent in situ hybridization) is also available. The FISH test detects the ribosomal RNA of the Babesia parasites directly on air-dried blood smears. This test is highly specific for Babesia, unlike the standard test, the geimsa stain smear, which cannot differentiate between malaria parasites and Babesia.
B. Microti and/or WA-1 IgG/IgM Antibody
Babesia and/or Babesia WA-1 PCR
Babesia FISH (RNA)
Human Granulocytic Ehrlichia IgG/IgM Antibody
Human Granulocytic Ehrlichia PCR
Human Monocytic Ehrlichia IgG/IgM AntibodyHuman Monocytic Ehrlichia PCR
Bartonella henselae PCR with Whole Blood
TICK TESTING IS ALSO AVAILABLE FOR
Lyme, Babesia microti, Babesia WA-1, Ehrlichia, and Bartonella henselea by PCR.
Patients with neurological symptoms of Lyme disease may need to have a spinal tap in order to study the blood of the brain, the CSF (cerebral spinal fluid). These patients may have negative blood and urine tests and show positive results with CSF. The Western blot, LDA, and PCR can be performed on CSF.
WHAT IS THE TREATMENT?
It is reported that Lyme disease can be treated success fully with antibiotics if caught early in the infection. Prevention is the best cure for re-infection. Patients whose disease is caught later often need to be on antibiotics for longer periods of time. There is controversy between physicians as to how long and what is the best mode of treatment. Ehrlichiosis is often treated with many of the same antibiotics used for Lyme disease. The best treatment for Babesia is still being explored. Many physicians believe that they need to treat the Babesiosis before treating Lyme disease to achieve clinical success.
CAN LYME DISEASE BE PREVENTED?
Wear long sleeve shirts and long pants when going into tick country. Light colors are best ticks can be seen easier. Tuck pants into socks and spray the clothes with a known tick repellent. After being in a tick area, check skin and all hair areas completely. Promptly remove all ticks after being in an area known to harbor Lyme ticks. Check pets carefully: they are a source of entry for ticks into the house. Deer hunters need to spend extra time checking their gear before bringing it into autos and home.
HOW DO YOU REMOVE A TICK?
- Use tweezers or forceps.
- Grasp the tick mouthparts close to the skin.
- Avoid squeezing the tick which may spread infected body fluids.
- Pull the tick straight out. Do not twist. Do not attempt to burn the tick.
- Save the tick (you may want to have it tested for B. burgdorferi or other infectious agents)
- Wash your hands with soap and water.
- Apply antiseptic to bite site.
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