Specializing in Lyme Disease and Associated Tick-Borne Diseases
Over 20 Years Experience
IGeneX Inc.
What You Should Know About Lyme Disease
What Is Lyme Disease?
How Is Lyme Disease Diagnosed?
Lyme disease is a world-wide infectious disease caused by microscopic bacteria carried by tiny ticks.
Lyme disease is a clinical diagnosis. This means that the physician
makes the diagnosis using your clinical history and symptoms. If a
physician observes an EM rash, a diagnosis of Lyme disease will be
made. If a rash is not seen by a physician, laboratory tests are often
needed to help with the diagnosis.
B. burgdorferi, a spiral bacteria that
causes Lyme disease, seen through
a microscope.
How Is Lyme Transmitted?
There are several species of deer ticks across the US that become infected with the spiral bacterium, Borrelia burgdorferi. Unsuspecting
humans and animals walking through woodlands and brushy areas
may be bitten by a tick and never know it. The tiny ticks, some the
size of poppy seeds, may stay on your body for hours to days. The
tick engorges itself with blood. If infected, the spirochete is transmitted to the bloodstream of the person or animal during the bite.
Can Ticks Be Tested?
Not all ticks are infected with the spirochete bacterium, B. burgdorferi. If the tick was saved, it can be tested by our laboratory for the
presence of the Lyme bacteria using a test called PCR. We also test
ticks for Babesia, Ehrlichia, Bartonella henselae and Rickettsia (Rocky
Mountain Spotted Fever). These pathogens are also carried by ticks. A
Tick Test Request Form is available on our website.
What If I Suspect Exposure?
Early recognition is important. If you find a tiny tick attached to
your skin, if you were in a known tick-infested area, or if you have
symptoms described herein, see your physician.
What Are The Symptoms?
A characteristic red bulls-eye rash (EM) at the site of the bite is present in less than 40% of patients. The rash may appear within days to
weeks after the bite, but could be hidden in hairline or underarms.
EM RASH - caused by B. burgdorferi usually appears days or
weeks after the tick-bite, whereas
rashes caused by other bacteria
present in the tick usually show
up immediately.
Some patients report flu-like symptoms, fever, aches, fatigue, neck
stiffness, jaw discomfort, muscle pain and stiffness, swollen glands,
and red eyes. Symptoms may appear, disappear and reappear at
various times. Nervous system abnormalities include memory loss
and partial facial paralysis (Bell’s palsy). Migratory joint pains, and
pains in the tendons, muscles and bones may occur later in the
disease. Arthritic symptoms, if present, usually affect the large joints
like the knees.
From left to right: Larvae, Nymph, Female, Male Tick. Tick
in Nymph stage is the size of a poppy seed.
Are There Other Tick-Borne Diseases?
The same tick that carries the bacteria that causes Lyme Disease, can
also carry other pathogens. The most common are Babesiosis, Ehrlichiosis, Bartonellosis and Rickettsiosis (Rocky Mountain Spotted fever).
It is estimated that up to 25% of the ticks that cause Lyme disease may
transmit one or more of these other diseases. Babesiosis is like malaria
with the symptoms of acute disease being fever, chills, vomiting and
fatigue. It is usually self-limiting except in Lyme patients and those
who have undergone splenectomy. There are two forms of Ehrlichiosis: Anaplasma phagocytophila (HGA) and HME (Human Monocytic
Ehrlichiosis). HGA is primarily on the East coast, upper Midwest and
California. HME is primarily in the Southeast, lower Midwest and
Southwest, with cases reported in CA, NJ, NY, and WI. These acute
diseases may have symptoms of fever, chills, vomiting and fatigue and
require prompt antibiotics. Subclinical forms of these diseases may be
present in patients with Lyme disease.
Specializing in Lyme Disease and Associated Tick-Borne Diseases
What Tests Are Available?
Tests Offered
Several tests are available for a diagnosis of Lyme disease. These
include direct and indirect tests. Indirect tests look for the patient’s
immune response to B. burgdorferi. Direct tests look for the
presence of B. burgdorferi antigens or nucleic acids.
Borreliosis (Lyme Disease)
Indirect Tests – Lyme Serology Tests
(ELISA, IFA, and Western Blots)
The LYME ELISA test measures B. burgdorferi IgM and/or IgG
antibodies in patient’s serum sample. The sensitivity and specificity
of these tests is about 70%.
The LYME IFA (performed as part of a Lyme Panel) detects IgG,
IgM and IgA antibodies against B. burgdorferi. Antibodies to B.
burgdorferi are detected about 2-3 weeks after infection and may
remain elevated for a long time in some patients.
The LYME WESTERN BLOTS (IgG and IgM) detect antibodies
to B. burgdorferi, the causative agent of Lyme Disease. In some cases,
the testing laboratory may be able to say that your “picture of Lyme
antibodies” is consistent with early, late, persistent and/or recurrent
disease. Unlike other diseases, IgM antibodies may persist for a very
long time. Antibodies can be detected within one month of infection (usually IgM) and can be up to 25 years after an initial infection
(IgG only; IgG and IgM; or IgM only). About 20% -30% of patients
never make antibodies. Some patients with a “normal immune
system” may not have made antibodies at the time of testing. Thus,
the presence of antibodies alone does not make a diagnosis of disease.
Over 20 Years Experience
•IgG/IgM/IgA Screen (IFA)*
•IgG/IgM and IgM Antibody ELISA
•C6 Peptide
•IgG Western Blot and IgM Western Blot
•31 kDa Epitope Test*
•Lyme Dot Blot Assay (LDA)*
•Multiplex PCR for urine, whole blood, serum, CSF
•Multiplex PCR for Miscellaneous samples (ex: Skin biopsy,breast milk)*
Other Tick-borne Diseases
About 30% of the Lyme patients are co-infected with one or more
of the following tick-borne pathogens – Babesia, Anaplasma,
Ehrlichia, Bartonella or Rickettsia. We offer immunofluorescent
assays (IFA) for detection of pathogen specific antibodies in patient
serum samples and PCR tests for detection of pathogen specific
DNA in blood and cerebral spinal fluid (CSF) samples. In addition,
we offer FISH (Fluorescent In Situ Hybridization) tests for direct
detection of Babesia and Bartonella on blood smears. Unlike Giemsa
staining, these FISH tests are highly specific.
–Babesiosis
•B. microti IgG/IgM Antibody
•B. duncani IgG/IgM Antibody*
•Babesia PCR Screen
•Babesia FISH (RNA)
–Ehrlichiosis
Direct Tests
The LYME DOT BLOT ASSAY (LDA) detects antigens of Lyme
bacteria in urine samples. There is cross reaction to some of the
pathogens present in urine samples. This test can be performed on
urine samples and cerebral spinal fluid.
The LYME MULTIPLEX PCR (Polymerase Chain Reaction) Test,
a highly specific and sensitive test, detects the presence of the DNA
of the Lyme bacteria. The PCR test is often the only marker that is
positive in all stages of Lyme disease. The test can be performed on
blood, serum, urine, CSF and miscellaneous fluids/tissues. Unfortunately, Lyme bacteria like to “hide” in the body, therefore, PCR can
often be negative. Studies performed on different sample types
suggest that performing PCR on multiple sample types improves
assay sensitivity. Therefore, in the Lyme Panels, PCR on whole
blood and serum is included to improve sensitivity.
For patients with clinical symptoms of Lyme disease who test
negative by the IFA Screen or IgG/ IgM Western Blots, the PCR
on serum and whole blood, or the LDA/Multiplex PCR Panel on
urine may be appropriate. There are physician developed antibiotic
protocols to enhance the sensitivity of the LDA.
Anaplasma phagocytophilum (HGA):
•IgG/IgM Antibody
•PCR
Human Monocytic Ehrlichia (HME):
•IgG/IgM Antibody
•PCR
–Bartonellosis
•B. henselae IgG/IgM Antibody
•Bartonella PCR
•Bartonella FISH*
–Rickettsiosis
•Rickettsia rickettsii/typhi IgG Antibody
•Rickettsia PCR (Only R. rickettsii PCR will be reported
for NY residents*)
*Not yet available for NY Residents
Central Nervous System
Borrelia, Bartonella and Rickettsia can cause neurological symptoms.
Patients with neurological symptoms may test negative on clinical
samples such as whole blood, serum or urine. Therefore, pathogen
specific PCR or LDA should be performed on cerebral spinal fluid
(CSF).
How to Order Tests
LYME PANELS have been put together to provide cost savings to the patient when more than one
test is ordered. The Panels are listed on our Patient Test Requisition Form, including Co-Infection
Panels for certain regions of the country you live in or may have visited. This information can be
found on our website at www.igenex.com.
Specializing in Lyme Disease and Associated Tick-Borne Diseases
Over 20 Years Experience
Miscellaneous Testing
What Is The Treatment?
IGeneX, Inc. offers the CD57* test and Chlamydophila pneumoniae
IgG* and IgA* ELISA tests as part of a testing menu for chronic
diseases. The CD57 test measures CD57 killer cells in patients’ EDTA
whole blood samples. The CD57 killer cell count can be very low in
patients with chronic diseases.
It is reported that Lyme disease can be treated successfully with
antibiotics if caught early in the infection. Prevention is the best
cure for infection. Patients whose disease is caught late often need
to be on antibiotics for longer periods of time. There is controversy
among physicians as to the length of treatment. ILADS physicians’
feel treatment should continue for 2 months after patient’s symptoms improve. Ehrlichiosis is often treated with many of the same
antibiotics used for Lyme disease. Babesiosis is often treated with
Mepron and Zithromax. Many physicians believe that they need
to treat the Babesiosis before treating Lyme disease to achieve
clinical success.
Therefore, for patients with a low CD57 count, Lyme disease and C.
pneumoniae infection should be included in differential diagnosis.
C. pneumoniae can cause acute respiratory disease, but it can also
persist in some patients with chronic respiratory conditions and
cardiovascular disease.
How Can Lyme Disease Be Prevented?
Wear long sleeve shirts and long pants when going into tick country.
Light colors are best so ticks can be easily seen. Tuck pants into
socks and spray the clothes with a known tick repellent. After being
in an area known to harbor ticks, check skin and all hair areas
thoroughly. Remove ticks promptly. Check pets carefully, they are
a source of entry for ticks into the house. Deer hunters need to
spend extra time checking their gear before bringing it into autos
and homes.
How Do You Remove A Tick?
1. Use tweezers or forceps.
2. Grasp the tick mouthparts close to the skin.
3. Avoid squeezing the tick, which may spread infected
body fluids.
4. Pull the tick straight out. Do not twist. Do not attempt
to burn the tick.
5. Save the tick (you may want to have it tested for
B. burgdorferi or other tick-borne diseases).
6. Wash your hands with soap and water.
7. Apply antiseptic to bite site.
*Not yet available for NY Residents
For any questions regarding this information or inquiries on testing at IGeneX, please contact
Customer Service at 800-832-3200. You may also contact us at customerservice@igenex.com.
IGeneX Inc.
795/797 San Antonio Rd. Palo Alto, CA 94303 800/832.3200 650.424.1191 Fax 650.424.1196