From the Guidelines
For patients suspected of having Lyme disease, laboratory testing is necessary to confirm the diagnosis, and the recommended laboratory test in the United States is a 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting 1. When interpreting test results, it's essential to consider the patient's symptoms and the timing of the illness. The sensitivity of 2-tiered testing is low (30%–40%) during early infection, but specificity is high (>95%) during all stages of disease 1. For patients with a lesion consistent with erythema migrans and a history of exposure to Lyme-endemic areas, a diagnosis can be made without laboratory testing 1. However, for all other patients, laboratory testing is necessary to confirm the diagnosis, and the recommended approach is a 2-tiered serologic test comprised of an enzyme-linked immunoassay (EIA or ELISA) or immunofluorescence assay (IFA), followed by a reflex Western immunoblot 1. Some key points to consider when ordering tests for Lyme disease include:
- The use of other diagnostic tests for Lyme disease is limited 1
- Patients with neurologic manifestations of Lyme disease, such as meningitis or cranial neuropathies, should be tested for Lyme disease if they have epidemiologically plausible exposure to ticks infected with B. burgdorferi 1
- Patients with typical amyotrophic lateral sclerosis, relapsing-remitting multiple sclerosis, Parkinson’s disease, dementia or cognitive decline, or new-onset seizures should not be routinely tested for Lyme disease 1 It's crucial to follow current testing guidelines and use tests in accordance with their intended purpose to ensure accurate diagnosis and effective treatment of Lyme disease 1.
From the Research
Land to Order for Lyme
- The primary treatment option for Lyme disease is doxycycline, but it has several concerns associated with its use, such as killing beneficial bacteria and producing unwanted off-target effects in eukaryotic cells 2.
- Alternative therapies, such as piperacillin, have been identified as potential treatments for Lyme disease, with studies showing that it can eradicate B. burgdorferi at low-nanomolar concentrations without affecting the murine microbiome 2.
- Diagnostic tests for Lyme disease have varying levels of accuracy, with the Immunetics® C6 B. burgdorferi ELISA™ and the two-tier approach having superior specificity compared to other tests 3.
- The cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease has been evaluated, with results showing that empirical antibiotic therapy is recommended if the pretest probability is high, and two-step testing is recommended if the pretest probability is intermediate 4.
- The following strategies have been considered:
- No testing-no treatment
- Testing with enzyme-linked immunosorbent assay (ELISA) followed by antibiotic treatment
- Two-step testing with ELISA followed by Western blot and antibiotic treatment
- Empirical antibiotic therapy
- These strategies have been evaluated for different patient scenarios, including myalgic symptoms, rash resembling erythema migrans, and recurrent oligoarticular inflammatory arthritis 4.