The Limitations of Lyme Disease Testing: Old Problems and New Solutions

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Have you ever been bitten by a tick? It may be more problematic than you think.

Ticks are an annoying pest that invade our personal space by biting exposed skin. They carry many different diseases. Those diseases can cause painful, exhausting, and life-changing symptoms.

One disease that ticks can pass to you is Lyme disease.

Lyme disease is the most common tick-borne illness in the United States. A 2021 study estimated that nearly 500,000 people in the United States get Lyme disease every year. According to the John Hopkins Lyme Disease Research Center, people get Lyme disease mostly in June and July.

With Lyme disease, you might experience fatigue, fevers, and rashes. These symptoms could progress into life-changing conditions if Lyme disease is not treated.

A 2021 review reports that Lyme disease testing has severe limits.

The initial stages of Lyme disease are hard to diagnose. The current testing methods require a deep understanding of the disease. Not all medical professionals are trained well enough to identify Lyme disease.

In this blog, we explore how medical professionals test for Lyme disease, the limitations of these tests, and new research about Lyme disease tests and vaccines.

Lyme Disease Diagnosis

Accurately diagnosing Lyme disease is not as easy as it seems.

The symptoms of early-stage Lyme disease could be identical to symptoms of other illnesses. These include:
· Fever
· Headaches
· Chronic fatigue
· Joint and muscle aches
People believe that you will only get Lyme disease if you have a “bull’s-eye” like rash, called erythema migrans. Yet, according to one study that assessed over 275,000 cases, the rash was present in ~75% of all cases. This means that people without the rash might think they have a common cold and may not seek medical attention.

It is also possible that physicians mistake the rash for a different condition, especially if the patient did not know a tick bit them. Not all erythema migrans rashes present with the “bull’s-eye” like rash. So, physicians might misdiagnose, and Lyme disease could be untreated.

The Mayo Clinic recommends that diagnoses be based on more than the presence of the rash. They recommend that physicians:
· Review all signs and symptoms
· Discuss history of known or possible exposure to ticks
· Perform blood tests

Blood tests should work well to diagnose Lyme disease, right?

Unfortunately, it is not as easy as it sounds.

There are blood tests available to diagnose Lyme disease. Yet, the current testing methods have limitations.

Limitations of Lyme Disease Testing

With most blood testing for diseases, there are two types of testing:
1) Direct blood tests
2) Indirect blood tests

“Direct” tests are the best blood tests because they look directly for the bacteria or virus that is causing the disease.

COVID-19, strep, and HIV tests are direct tests. Direct tests provide excellent results and are less likely to have false negatives. This means the tests typically will detect the disease when it is present.

“Indirect” tests look for a secondary measure, like antibodies, to diagnose a disease.

Both tests detect the diseases well, but indirect blood tests have limitations because they require the secondary measure, usually antibodies, to be present. Sometimes the immune system can take days to weeks to develop antibodies.

There are no “direct” blood tests used by clinics to detect the bacteria that causes Lyme disease. The only blood tests available to detect Lyme disease are “indirect” blood tests.

Developing direct blood tests for Lyme disease has been challenging. One research article discusses that the issues include:
· Takes up to 12 weeks for results to be seen after a test
· Large variability in Lyme disease bacteria proteins used to detect the disease
· Low abundance of the bacteria in blood

What does this mean?

As mentioned earlier, these are the only blood tests available for Lyme disease. Because these tests look for antibodies, the chance of having a false negative is higher, or not diagnosing the disease when it is present.

So, why are false negatives more possible with Lyme disease testing?

One study found that some individuals with Lyme disease can develop antibodies within weeks. Yet, others might not develop antibodies for 4-8 weeks.

This means that there is a window where Lyme disease may not be detected by the indirect test, which could lead to misdiagnosis and a lack of treatment.

If Lyme disease in untreated, severe symptoms could occur including:
· Arthritis
· Chronic Fatigue
· Accelerated Aging
· Heart Disease
· Neurological Disease

It is important to get appropriate treatment for Lyme disease. Knowing what to do if you have been exposed to Lyme disease is important for you to have the best health outcome possible.

The Next Steps in Lyme Disease Research

Researchers have been working to develop direct tests for Lyme disease, and they have also been working on a Lyme vaccine.

One article identifies that new testing methods could include:
· Broad Lyme bacteria protein detection
· Lyme bacteria DNA tests

The development of these have been challenging, but a 2022 article by the University of Central Florida reports that two researchers, Dr. Mollie Jewett and Dr. Brian Kim, have partnered to attempt to develop a new Lyme disease test. The hope is that they can develop a test that can detect early-stage Lyme disease within an hour.

What about prevention of Lyme disease?

Currently, there is no widely-available Lyme disease vaccine. However, the CDC reports that Pfizer and Valneva are currently testing a Lyme vaccine in humans.

Further, the University of Massachusetts Medical School is trying to develop a different prevention vaccine. Human trials are yet to begin for this method.

In our previous blog, we reviewed the problems with Lyme disease. That knowledge in combination with what you learned about Lyme disease testing, current issues with testing, and the next steps in Lyme disease treatment will leave you equipped with the essential knowledge of Lyme disease.

Daniel Chantigian, MS, is exploring Lyme Disease. This blog is the second part of a three-part series.

Discover 40+ Proven Protocols To Overcome Lyme Disease and Other Tick-Borne Infections at The Healing From Lyme Disease Summit

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Daniel Chantigian
Daniel Chantigian, MS
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When it comes to complex scientific or medical topics, Daniel can successfully communicate with any audience via writing, social media, lecturing, and one-on-one discussions. Over the past decade, he developed these skills as a researcher at the University of Minnesota and the Mayo Clinic, as a lecturer at the University...

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