Tests and Treatment | Iowa Lyme Disease Association

TESTING FOR LYME DISEASE

**Disclaimer: The information provided on this web site should not take the place of any quality medical care. It is
provided for patient information only. ILDA-ED does not engage in rendering medical services.

There is no test that can determine if a patient is infected with the Lyme disease (Ld) bacterium and then demonstrate that the patient has
become bacterium-free. Therefore, Ld is a clinical diagnosis, based on signs and symptoms, with the patients travel history to endemic areas
and test results being additional pieces of information in the complete picture. No test can "rule-out" Lyme disease.

Laboratory tests - Testing is generally done through a blood test. The tests are not accurate at present. Urine tests and tests of spinal fluid are
not reliable either. False positives and false negatives do occur. Medication taken for other ailments and pre-existing conditions can interfere with
the tests.

Indirect tests (antibody tests)
Antibodies are the immune system's response to "fight off" infection. Tests strive to be both sensitive (detecting any Ld antibodies) and specific
(detecting just Ld antibodies).

Test Interpretation: False negative tests occur due to defects in test sensitivity; too low an antibody level to detect (e.g. they are bound to the
bacteria, with too few free-floating; the patient taking antibiotics or other drugs; naturally low antibody production); the bacterium has changed,
limiting recognition by the immune system; or bacterial strain variations. False positive tests occur due to test failure or cross-reacting antibodies
(e.g. Syphilis, periodontal disease, ANA).

For more general information on Lyme disease tests and diagnostics visit:
The International Lyme and Associated Diseases Society web site: ILADS

TREATMENT OF LYME DISEASE

TESTS AND TREATMENT

Iowa Lyme Disease Association -
Education
P.O. Box 221
Brighton, IA 52540
[email protected]

This site has several treatment guidelines for Lyme
disease. Be sure to share this with your physician.
Treatment Guidelines

DISCLAIMER: The guidelines on the site linked above are the
products of the guidelines' authors who are solely responsible
for their content. The ILDA-ED is not a medical organization and
does not make any recommendations or warrantees concerning
these guidelines. When ever medical advice is needed, the
services of a qualified medical provider should be sought.

GUIDELINES

First-line drug therapies for Lyme disease may include
(in alphabetical order): oral amoxicillin, azithromycin,
cefuroxime, clarithromycin, doxycycline, and tetracycline. These
antibiotics have similar results in comparative trials of early
Lyme disease.

Common IV antibiotics are: ceftriaxone, cefotaxime, and
penicillin. Other drugs used include: Intravenous imipenem,
azithromycin, and doxycycline, especially if they are not
tolerated orally.

Intramuscular benzathine penicillin is sometimes effective
in patients who do not respond to oral and intravenous
antibiotics.

Combination therapy with two or more antibiotics is now
increasingly used for chronic Lyme disease symptoms.

Oral amoxicillin, cefuroxime, or (more recently) cefdinir
combined with a macrolide (azithromycin or clarithromycin) are
examples of combination regimens that have proven
successful in clinical practices.

When antibiotics are administered to Ld patients, they usually
experience a Herxheimer reaction which is a worsening of
symptoms. As the bacteria die they release endotoxins
causing an overload and response by the immune system.
Herx's usually begin 1-5 days after the start of an antibiotic,
and may last a few days to weeks. This condition was first
described under syphilis treatment.

Copyright © 2007 - 2023 Iowa Lyme Disease Association (ILDA).
All Rights Reserved.

One well indisputable fact about Lyme disease: The prompt
use of antibiotics during the early stage can prevent chronic
Lyme disease. Antibiotic therapy should be initiated upon
suspicion of the diagnosis, even without definitive proof.

Therapy usually starts with oral antibiotics, and some experts
recommend high dosages.

Lyme literate physicians will often consider using intravenous
antibiotics when:

oral medications fail in patients with persistent,
recurrent, or refractory Lyme disease.

certain conditions, such as: meningitis,
encephalitis, optic neuritis, joint effusions, and heart
block are present.

needed to penetrate into the central nervous
system and brain.

Many Lyme literate physicians will begin chronic Lyme patients
on intravenous therapy first (e.g., intravenous ceftriaxone),
at least until disease progression is arrested and then follow
with oral therapy for persistent and recurrent Lyme disease.

Increasingly, Lyme literate physicians recommend that certain
drugs used for Lyme disease be given at higher daily doses:
for example, 3,000�6,000 mg of amoxicillin, 300�400 mg
doxycycline, and 500�600 mg of azithromycin. Close
monitoring of complete blood counts and chemistries are also
required with this approach.

Using higher doses of antibiotics may increase adverse
events in general and gastrointestinal problems. However,
using Acidophilus has reportedly reduced the incidence of
Clostridium difficile colitis and non-C. difficile antibiotic-related
diarrhea.

ANTIBIOTICS

TREATMENT NOTES

(ELISA, EIA, IFA) - These tests measure the level of "Borrelia
burgdorferi" antibodies in fluid. Laboratories use different
detection criteria, cut-off points, types of measurements, and
reagents. According to the International Lyme and Associated
Diseases Society, "the ELISA screening test is unreliable. The
test misses 35% of culture proven Lyme disease (only 65%
sensitivity) and is unacceptable as the first step of a two-step
screening protocol. By definition, a screening test should have at
least 95% sensitivity". (See their web site below)

Western Blot - This test produces bands indicating the immune
system's reactivity to Bb. Laboratories differ in their interpretation
and reporting of these bands. A positive 31 or 34 band is highly
indicative of Borrelia burgdorferi exposure. Yet these bands are
not reported in commercial Lyme tests, due to a CDC ruling in
relation to the Ld vaccine which is no longer available. When
used as part of a patient diagnostic evaluation for Lyme disease,
the Western Blot should be performed by a laboratory that reads
and reports all of the bands related to Borrelia burgdorferi.
Generally, 41KD bands appear the earliest but can cross react
with other spirochetes. The 18KD, 23-25KD (Osp C), 31KD (Osp
A), 34KD (Osp B), 37KD, 39KD, 83KD and the 93KD bands are
the most specific but appear later or may not appear at all.
Basically, the 41KD band and one of the specific bands above
are indicative of Ld exposure.

Direct detection tests:

Antigen detection tests - They detect a unique "Bb" protein
in fluid (e.g. urine) of patients and may be useful for detecting Ld
in patients taking antibiotics or during symptom flare-up.

Polymerase chain reaction (PCR) - This test multiplies
the number of Bb DNA to a detectable measurable level.

Culturing - Growing the bacterium in culture is a difficult and
lengthy procedure.

These labs are listed for informational purposes only. ILDA-ED
does not guarantee their testing capability, or accuracy, and
they are not a substitute for professional medical care.

		IgeneX, Inc., 795 San Antonio Rd., Palo Alto, CA USA
		94303 IgeneX Laboratories Tel. 650.424.1191 / 800.832.3200 Fax. 650.424.1196

		Medical Diagnostic Laboratories, 2439 Kuser Road,
		Hamilton, NJ 08690 Phone: 877.269.0090 Medical Diagnostic Laborato ry

		Laboratory Corporation of America, Laboratory
		Corp. of America

		Specialty Laboratories, 27027 Tourney Road,
		Valencia, CA 91355 Phone: 661.799.6543, 800.421.7110 Specialty Labs

		Sunrise Medical Laboratories, Sunrise Lab

TYPES OF TESTS

TESTING LABS