Picture taken by Laura Kara
By Tina Beaudoin, ND
AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE. LET GO OF THE MYTHS THAT LYME DISEASE IS ONLY AN EAST COAST PROBLEM AND THAT YOU ONLY HAVE TO BE CAREFUL WHEN YOU’RE IN THE WOODS.
Ticks carrying Borrelia burgdorferi (the spiral-shaped bacteria that causes Lyme disease) have been identified in all 50 states. While the black legged tick is the traditional vector for transmission, new tick species including the Lonestar tick and the a Ixodes pacificus (western black-legged tick) have also been shown to carry the bacterium.
A few preventative measures that you could do include spraying your clothing with insect repellent, wearing long sleeves and pants and tucking your pants into your socks. Your choice of insect repellents vary widely from insecticides like DEET to all-natural options that use essential oils like citronella, cedar, rosemary, eucalyptus and geranium. (I prefer these and they work just as well. Nantucket Spider is a wonderful tick spray found on Amazon) Lastly, perform repeated tick checks on your person/s and pets when outdoors and definitely a whole body check when back inside. (I also recommend having your property sprayed every season)
Become savvy on how to remove ticks using fine-tipped tweezers to grasp it as close to the skin’s surface as possible. Do not burn the tick or stress the tick with ointments and aggressive manipulation, as the contents deep in the tick’s digestive tract can spill into the wound more quickly. While, for many, the urge to dispose of the tick is strong, it is better to safely store it in case you want to send it for testing or closer examination. While you may opt to begin treatment immediately, you can concurrently send the tick to be tested for B. burgdorferi with a form from IGeneX, a Lyme specialty lab. Also, many county vector control boards also do tick testing for B. burgdorferi but the specimen needs to remain intact and moist (add a moist cotton ball and put the tick in a zipped bag).
Testing for Lyme disease is very complicated and faces many limitations including the very elusive nature of the tricky spirochete and its ability to hide in our cells, tissues, and behind biofilms, avoiding our immune system. Adding complexity, there are five subspecies of B. burgdorferi, over 300 strains worldwide, which further adds to the bacteria’s antigenic variability. Also, controversy still surrounds Lyme disease diagnosis and treatment.
INDIRECT TESTS FOR LYME DISEASE
| ELISA TEST | WESTERN BLOT TEST | IFA/IMMUNOFLUORESCENT ASSAY |
|---|---|---|
Detects IgM and/or IgG antibodies • Most commonly used screeening test for primary diagnosis, despite significant limitations • Many insurance providers require these tests to be ordered first • Misses 35% of culture proven Lyme disease Unreliable as screening test • 52% of patients with chronic Lyme disease are negative by ELISA but positive by Western blot |
Detects IgM and IgG antibodies • Generally more sensitive and specific than ELISA • Testing lab may be able to report if findings are consistent with early, late, persistent and/or recurrent disease • 20-30% of acute culture-proven Lyme disease remain seronegative on serial western blot sampling Should be performed by a lab that reads and reports on all of the bands related to B. burgdorferi • Including highly specific bands 31 and 34, which are not generally reported by commercial labs |
Detects IgM, IgG and IgA antibodies • Antibodies are detected - 2-3 weeks after infection • May remain elevated for a long time in some patients |
DIRECT TESTS FOR LYME DISEASE
| LYME PCR | LDA/LYME DOT BLOT ASSAY |
|---|---|
Detects the genomic and plasmid DNA of the Lyme bacteria • Can be performed on whole blood, serum, urine, breast milk, skin and CSF • Increased specificity to ID unusual strains of B. burgdorferi • Test can often be negative due to the bacteria's ability to "hide" behind biofilms • Standard PCR generally not sensitive enough due to the low numbers of bacteria present • Multiple sample types (whole blood and serum) improve sensitivity of test |
Detects antigens of Lyme bacteria in urine samples and cerebral spinal fluid/CSF • Can be useful when initial Lyme panel tests on blood samples are negative (including PCR) but symptoms for Lyme disease are present • Cross reactions may occur with other non-Lyme antigens so use caution |
Lyme literate practitioners generally rely on a combination of both direct and indirect tests to help diagnose Lyme disease. Direct tests look for the presence of antigens or nucleic acids of B. burgdorferi while indirect tests look for an individual’s immune response to this elusive invader.
Lyme testing is complicated and the purpose of this brief article to help practitioners to become a bit savvier on the different types of tests and the definite limitations of testing. If a patient comes into your office with Lyme labs, consider taking an extra moment to further scrutinize the type of tests ordered and explain to your patient the significant limitations and differences in testing methodologies. I would like to thank Igenex Inc. and the International Lyme and Associated Diseases Society/ILADS for their immense contributions in furthering the identification and treatment of Lyme disease and their online resources that helped shape the information provided in this article.
On an added note, paying attention and documenting all your signs and symptoms is one of the best ways to track and treat Lyme disease and it’s co-infections. Most Lyme Literate MD’s (LLMD) pay close attention to this. In my own acupuncture practice, I’m always leery of an underlying Lyme diagnosis if someone’s symptoms are not getting well after at least 6 treatments, especially if symptoms are moving around and if the patient is at high risk (spends time gardening, has a pet or spends time in the woods) I’ve been able to educate my patients and send them to the right doctors so that they can get the right treatment for their underlying symptoms. - Laura Shahinian Kara M.S.L.Ac.