Arizona Advanced Medicine Clinic

Lyme Disease Testing and Legislation

It seems a shame that legislation has to be passed requiring doctors and laboratories to tell their patients that the current state of conventional testing for Lyme disease is worse than inadequate.

The Lyme disease laboratory test requirements bill passed in Maryland on 05-10-16 requires labs and doctors to give patients a written statement which states that a negative test result does not necessarily mean that they do not have the disease.

News report can be viewed here: http://www.wmdt.com/news/more-local-news/maryland-passes-first-ever-lyme-disease-bill/39478004

I will be very interested to read what the Infectious Diseases Society of America has to say about this legislation.

Lyme disease (infection with Borrelia burgdorferi) is the most common tick-borne disease of the twenty-first century. Controversy exists over both diagnosis and treatment of this illness. It is sometimes difficult to diagnose with any medical certainty through laboratory testing, because of a multitude of reasons.

There is significant variability in clinical presentation. Since the organism can affect any organ of the body, symptoms may range from a skin rash alone to significant flu-like symptoms, to debilitating arthritis, or carditis, or encephalitis.

Test strategies are markedly different among the different laboratories, resulting in different results when the same blood is tested by different laboratories.[i] Certain bands on a Western blot test may be more frequently positive in certain species of the organism.[ii]

To complicate the picture, other tick-borne and even viral or mycoplasma diseases may be present concurrently. These are commonly known as “co-infection” and may include infection with Babesia, Bartonella, Ehrlichia, Anaplasma, in addition to a multitude of species of the Borrelia family. Infections with Coxiella burnetii are seen occasionally. Concurrent infections with mycoplasma, viruses, and other microorganisms are also seen. The symptoms are similar for most of the tick-borne diseases, so it may not be possible to distinguish one from another by clinical presentation. Blood transfusions and sexual intercourse may also be vehicles of transmission of any of the co-infections.

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[i] Ang CW1, Notermans DW et al. Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots. Eur J Clin Microbiol Infect Dis. 2011 Aug;30(8):1027-32. doi: 10.1007/s10096-011-1157-6.

[ii] Evans R, Mavin S, Ho-Yen DO. Audit of the Laboratory Diagnosis of Lyme Disease in Scotland. J Med Microbiol (2005), 54, 1139–1141

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