Lyme Disease Tests

Results from a Lyme disease test are exceedingly unreliable. This is due to the fact that during certain stages of the disease, no antibodies can be detected in an infected patient. A Lyme disease test with more accuracy is sorely needed.

Two tests are currently used to detect Lyme infection: the Western Blot analysis, which is used to identify particular antibodies, and the ELISA, a more general antibody test. However, both tests are notoriously inaccurate. Both test for antibodies, which complicates the detection of Lyme bacteria.

"The commercial testing that's available is, in a word, terrible. It has coin toss sensitivity, which means if you flip a coin you get the same results as doing a commercial test," says Dr. Raphael Stricker, former ILADS president, who treats Lyme patients at his clinic in San Francisco.

"And these are the FDA-approved tests that are always being touted by the ISDA. The only reason that FDA approval is needed for those tests is in order to make money off them, to market them commercially. And that's what people don't understand. They think that somehow FDA approval means that the test is better, but it's really not true. The only reason to get FDA approval for a Lyme disease test is if you want to make money off it," says Dr. Stricker.

"In contrast to these really lousy commercial tests, there are some labs that specialize in testing that does much better, that is much more sensitive," Dr. Stricker explains. "Unfortunately, those labs have been bashed by the IDSA as being inaccurate. And that's another problem that we have with making the diagnosis, because if you have someone who is chronically ill and you do a Lyme disease test that misses half the cases, chances are, you're not going to make a diagnoses and the person is not going to get treated."

Patients can take a Lyme disease test one week and get a positive result, and take the same test two weeks later and result in a negative. The confusion is due to the nature of the Lyme bacteria, which is highly adaptive and bent on survival within a threatening environment.

Lyme disease bacteria: A stealth pathogen with a bag of tricks

The medical research community that labors to unlock the mysteries of Lyme recognizes the spirochetal Lyme bacteria to be a sophisticated and complicated organism. It is known as a stealth pathogen because it can literally change shapes. Further, it may cloak itself in order to evade the immune system. The spirochete is a recognizable spiral or corkscrew shaped bacteria. However, a spirochete can take other forms.

"If you're looking for evidence of an infection in tissue you want to see the bug," says Dr. Alan MacDonald, a molecular scientist at the leading edge of Lyme research, "and if you're looking for the bug and you only look for spiral forms, you may miss the other forms, forms that are granular or rounded cyst forms or L-forms."

Dr. MacDonald is currently pioneering a broader understanding about the Borrelia burgdorferi bacterium. He and other Lyme researchers have observed that not only does the Lyme bacteria change shapes, it also has the adaptability to group together into colonies and hunker down inside a protective wrap called a biofilm.

As Dr. MacDonald explains, "biofilm is like a gelatinous wrapping around colonies of bugs which keep the antibiotics from getting into the center to kill the bugs that are there."

"The body's immune system and antibiotics are hostile to the bug. The bug must pull out its bag of tricks of different things to help it survive under those conditions," he says. Biofilm is apparently one of its best tricks, as it "has potential to protect the bugs inside the film from outside hostile environments, including antibiotics."

One decent Lyme disease test

As two different standards of care currently exist for Lyme disease treatment, an unreliable Lyme disease test often results in the prolonged agony of patients caught in the controversy over treatment protocol. Many patients find themselves needing to choose and begin a Lyme disease treatment during a highly stressful time in their life. To make matters worse, the decision-making process is further hindered by the brain fog that commonly accompanies Lyme.

New tests are on the horizon. According to Dr. JoAnne Whitaker, patients should ask their doctors about the Q-RiBb, a Lyme disease test devised and patented by the Bowen Research Laboratory in Florida, US. Supposedly, it is highly specific for the Lyme bacteria, as it has been developed to detect antigens, not antibodies. Therefore, its developers claim that it is more reliable and quicker than either the Western Blot or the ELISA in diagnosing Lyme.

Doctors who follow the Lyme disease treatment guidelines of ILADS are educated about the tricky nature of testing. Currently, ILADS specialists agree that when a patient presents with symptoms characteristic of Lyme or its co-infections, it is prudent to begin treatment regardless of the results of a Lyme disease test. Nothing less than untold human suffering is at stake.

"I did a study a few years ago where the average number of doctors the patient had seen was nine, or eleven or something," says Dr. Stricker. "They go from doctor to doctor and they all scratch their head and say 'gee, I don't know what this is, it can't be this, it can't be that, we've done the million dollar workup.' They've had tests that I've never even heard of, and they're still sick, and nobody knows what's wrong with them. It's a huge mystery. It's a big, big mystery.

"And you know, you do one decent Lyme disease test, and listen to the patient's symptoms, and get the history, and you can figure it out, usually."



Raphael Stricker, MD, oral communication, April 30, 2008

Alan MacDonald, MD, oral communication, April 6, 2008

JoAnne Whitaker, MD, FAAP, oral communication, August 2006