Lyme is one of the most widely misunderstood and misdiagnosed infectious diseases today. That being said, research around diagnosing and treating it has come a long way since it was first recognized.
Receiving a proper diagnosis is critical to moving forward and treating tick-borne diseases. For this, people depend on laboratory tests. Tick-borne disease tests are becoming more reliable, but it hasn’t always been that way. So, let’s look at the evolution of Lyme disease testing.
Early Lyme disease lab testing
The history of Lyme disease in North America dates back to at least the colonial period in the 17th and 18th centuries. However, in the 1980s, research discovered that Lyme disease was not only a bacterial infection but also caused by a tick bite.
As more cases emerged with people showing similar symptoms, it became clear that this was a growing public health concern. Then, in 1982, the discovery, by scientist William Burgdorfer, of one of the specific types of bacteria that cause Lyme, Borrelia Burgdorferi, opened the gates for further research into the treatment and diagnosis of Lyme disease.
The first Lyme disease lab tests became available in 1984 in Connecticut, the state where Lyme was first identified. These were serology tests, which are a type of blood test that checks for the presence or level of specific antibodies.
The two-tiered system
After Lyme disease testing became available, the disease began to get national attention, leading to federal funding for education and research.
Antibody-based tests became the gold standard for Lyme disease testing. In the 1990s, the CDC adopted the two-tiered strategy for testing, which involves using the ELISA or IFA, and, if positive, following it up with the Western blot.
These tests do not detect the presence of the bacteria itself, but antibodies that have formed in response to it. While it was a great start, the first forms of the ELISA and other antibody tests had many limitations.
The limitations of antibody tests
Blood tests can lack specificity, which can lead to false positives. A positive test can mean that a person has once been infected with Lyme disease, but may not currently have an active infection. False positives can also occur when the wrong antibodies are detected on a Lyme disease lab test. This can happen when other antibodies form as a response to proteins that are similar to the Lyme spirochete.
The antibody response takes time to develop, meaning negative tests in the early stages of infection are common, which is also a critical window for antibiotic treatment. Unfortunately, antibody tests also lack sensitivity in the later stages of Lyme disease, like in the case of neurologic Lyme disease.
While these antibody tests do have limitations, they play an essential role in the overall development of Lyme disease testing.
The development of Lyme diagnostic tools
In the early 2000s, improved versions of the ELISA became available, like the C6 Peptide ELISA. These tests were more sensitive than their predecessors but still had much room for improvement.
As doctors and researchers began better understanding the wide array of symptoms that Lyme can cause, they also developed new laboratory testing methods. Patients with neurologic symptoms, for example, can undergo cerebral spinal fluid testing. While these tests don’t always detect it, a positive test can make it highly likely patient has central nervous system Lyme disease.
Another advancement in testing is using brain imaging techniques to detect inflammatory abnormalities. SPECT imaging can also be used to assess blood flow in the brain, which Lyme can affect.
While these imaging techniques can be helpful in understanding how someone has been affected by Lyme disease, they are not accurate diagnostic tools.
Lyme disease testing continues to evolve
Today, testing for Lyme disease is more accurate and accessible than ever before, thanks in large part to the work of private laboratories. While CDC guidelines have not been updated since 1994, forward-thinking labs have continued to invest in R&D to bring more sensitive and specific tests to market. For instance, through research, it became obvious that Lyme is caused by multiple species of borrelia, not just B. Burgdorferi B31. Therefore, IGeneX developed Lyme ImmunoBlots that detect antibodies to multiple species. In addition, IGeneX recently introduced the Lyme Screen Assay (LSA) that replaces the C6 ELISA and IFA tests.
These developments have also opened the doors for research into other illnesses and tick-borne diseases.
At this point in Lyme disease testing, most cases require multiple tests using different methods to receive an accurate diagnosis. A combination of direct and indirect tests, such as the PCRs and ImmunoBlots, play an important role in whole-panel testing, covering the broad spectrum of Lyme disease testing. Although tests like the ELISA and Western blot have limitations, they have played an important role in the evolution of Lyme disease testing, and have paved the way for the tests we now have available.
IGeneX is continuing to advance the field of Lyme disease testing. We offer the most comprehensive and accurate Lyme disease lab tests and tick tests, including new technologies like PCR culture tests, which can also test for other tick-borne disease coinfections.
If you think you or a loved one may be infected with Lyme disease, it’s important to know what to look for in a tick-borne disease test and what different diagnostic tests are available to you.
