Diagnosis of chronic Lyme disease

The easiest and most reliable way, after a bite, is to test the removed tick itself for Borrelia. This PCR-test (Polymerase Chain Reaction) only takes a few days. If it is positive, it is advisable to have an early start with antibiosis, even when no erythema migrans is present.
Borrelia burgdorferi can trigger cellular (T-cell), as well as humoral (B-cell) immune responses. First, the body answers with a strong T-cell reaction. The B-cell reaction, i.e. the creation of specific antibodies only starts after a few days or even weeks. This explains the difficulties in the laboratory diagnostics. As in the beginning of the infection no antibodies are being build, the disease cannot be proven this way. In this stage, if an erythema migrans occurs, an antibiosis, if executed properly, will most likely be successful. In this case no, or only low antibody levels, will emerge at a later time.

The diagnosis of Lyme is essentially threefold:

1. Clinical Symptomatology

When there are clinical signs, e.g., rash (erythema migrans), aseptic meningitis, optic neuritis, arthritis, an appropriate differential diagnosis must be pursued to exclude
▪    multiple sclerosis (MS)
▪    rheumatic diseases
▪    lupus
▪    chronic fatigue syndrome
▪    fibromyalgia
▪    myasthenia gravis
▪    chronic mononucleosis and
▪    stress related diseases
On a clinical basis, ‘chronic fatigue syndrome’ or ‘fibromyalgia’ cannot be readily distinguished from chronic Lyme Disease. But often Lyme Disease may be the cause of fibromyalgia or chronic fatigue.
We use a symptom check list known as the ‘Burrascano Score’ (download here).
This is a questionnaire trying to evaluate the probability of the presence of Lyme disease.

2. Laboratory testing for Borrelia

The most reliable way to prove borrelia is in the blood or other fluids (urine, liquor, etc.). Requisite is, though, that there really are borrelia in the sample. If the test is negative that does not mean there are no borrelia. It only says that there were no borrelia proven in that specific sample. Unfortunately, it does not prove that there are no borrelia bacteria located in other parts of the body, or intracellular.
Additionally, the PCR (Polymerase Chain Reaction) test is used to analyze B. burgdorferi DNA/RNA. Samples can be taken from serum, liquor, synovial fluid, urine, blood and plasma, as well as tissue.

The most common tests used are:

ELISA (Enzyme Linked Immuno Assay)

Usually, the first test used, ELISA searches for borrelia specific antibodies in the patient’s serum. Unfortunately, the result is often negative although the patient was in contact with borrelia. Therefore it is advisable to use further testings when clinical evidence exists.

Western-(Immuno)blot

This specifically tests the activity of antibodies. According to studies there is a correlation between  the number of bands on the IgM or IgG Western Blot and the duration of the infection or the spreading in the body.

LTT (Lymphocyte Transformation Test)

The LTT does not prove the existence of antibodies, but makes use of the reaction of the immune system on the borrelia antigene to detect them or their components.
It is not clear yet if all borrelia species can be detected, so this test may under certain circumstances give a false negative.

PCR (Polymerase Chain Reaction)

As this test verifies borrelia specific DNA, the DNA must be present in the sample for the test to prove positive. As the borrelia in different stages gather in various locations, or are completely absent in another spot, the chance to catch them in the sample is about 30-50% and thus not any better than the other testing methods. However, if the test is positive, an acute infection with borrelia is highly probable. In general: negative test results do not mean there is no Lyme. The clinical picture is more important.

3. Inflammation Parameters

CD56/57-Test with chronic Lyme-Borreliosis
Borreliosis infections are accompanied by changes in the cellular immune response.
An indicationwould be the reduced number of the so-called „Natural Killer Cells“ (NK; CD3- CD56+) This inflammation parameter measures normal CD57-values in acute Lyme-Borreliosis and other diseases, whereas patients with chronic Borreliosis infections more often have values lower than 60 CD57 + NK-cells/ml blood. The cause is the suppression of the immune system. The CD57 inhibition delays and impedes the healing process. On the other hand, some people have a reduced immune system and therefore are at a high risk for chronic borreliosis infection. A lowered CD57 especially occurs in patients with neurological disorders but less obvious with soft tissue and skeletal system infestation.
The CD57- reduction lasts until healing is achieved with antiobiotics or other therapies. A lower CD57- number is a measurable signal of an active, chronic Borreliosis infection and a possible indicator for therapy success.
A Borreliosis therapy has been successful when the CD57-numbers go back to normal.

CXCL13-Test

It has been found that in the cerebrospinal fluid the CXCL-13 marker is an early indicator of neuro borreliosis if the level is significantly elevated. Under treatment, the level falls quickly and thus allows to differentiate an active infection from residual titers. The residual titers could be positive even years after a successful treatment. In the near future, this test will be available at St. Georg since we started a cooperation with two German Universities.

Dark Field Blood Analysis

This is a visual test that provides a variety of important information.
From just one drop of blood a special microscope shows the condition of the erythrocytes, leucocytes and thrombocytes. Metabolic waste products, candida and toxins can be detected, as well as heavy metals, electrosmog and, after all, borrelia.

V.C.S.-Test (Visual Contrast Sensitivity Test)

The VCS test is not a true laboratory test to prove the existence of borrelia. It is a visionary test that has been used for long in the USA to recognize toxic contamination and the follow-up of the elimination of the toxins.
In the same way it works with Lyme. The borrelia form endotoxins that cause nerve damages in many patients. The optic nerve is particularly susceptible. Even though the patient often doesn’t even realize any damage, the VCS test is sensitive enough to prove a reduced contrast vision. This is a common phenomenon with chronic Lyme. The VCS test is a non-invasive tool that can assist in the diagnosis and measure therapy success of chronic borreliosis.