Test for Lyme Years Later – All You Need To Know

Lyme disease, caused by the Borrelia burgdorferi bacterium, is a tick-borne illness that can have serious long-term health consequences if not treated early. Early detection and prompt antibiotic treatment are essential for preventing disease progression, but in many cases, Lyme disease goes undiagnosed or untreated, especially if the hallmark erythema migrans rash is not present. 

Years later, symptoms such as arthritis, fatigue, and neurological issues can emerge, prompting the need for further testing. However, diagnosing Lyme disease years after exposure can be particularly challenging due to the nature of the infection and the limitations of current diagnostic tests.

Understanding Lyme Disease Progression

Lyme disease progresses through several stages, each with distinct symptoms.

Early vs. Late Lyme Disease

Early-stage Lyme disease, also known as localized infection, is typically characterized by the erythema migrans rash and flu-like symptoms. If untreated, the disease can disseminate to other parts of the body, causing facial palsy, meningitis, and arthritis. In late-stage Lyme disease, the bacteria can penetrate deeper into tissues, leading to chronic symptoms such as joint pain, neurological dysfunction, and cardiac issues. These late-stage symptoms may appear months or even years after the initial tick bite​. 

Challenges with Diagnosis Years Later

One of the major challenges of diagnosing Lyme disease years after initial infection is the ability of the bacteria to evade the immune system. The Borrelia bacteria can leave the bloodstream and hide in tissues such as joints, muscles, and the nervous system. This tissue migration makes it difficult to detect the bacteria through standard blood tests like the enzyme-linked immunosorbent assay (ELISA) or Western Blot. Over time, the body’s production of antibodies may also decrease, leading to false-negative results in these tests. Consequently, patients with chronic or late-stage Lyme disease may face significant delays in receiving a diagnosis​.

Standard Lyme Tests and Their Limitations

There are two standard Lyme Tests that are used to diagnose it: 

1.ELISA (Enzyme-Linked Immunosorbent Assay)

The ELISA test is commonly used as a first step in diagnosing Lyme disease. It detects antibodies produced by the immune system in response to the Borrelia burgdorferi bacteria, which causes Lyme disease. The test measures immunoglobulin M (IgM) and immunoglobulin G (IgG), with IgM indicating early infection and IgG representing longer-term immune responses. However, despite its widespread use, ELISA has significant limitations, particularly in detecting Lyme disease years after the initial infection.

Limitations of ELISA

One of the primary issues with the ELISA test for late-stage Lyme is that the Borrelia bacteria can migrate from the bloodstream into tissues, joints, and even the nervous system. Because the test detects antibodies in the blood, it becomes less reliable over time when the bacteria are no longer circulating in the bloodstream. At later stages, the immune system’s production of antibodies may diminish or become undetectable, especially if the infection has become chronic​. This can lead to false negatives in patients who still suffer from persistent Lyme disease symptoms but whose immune systems are no longer producing detectable levels of antibodies.

2. Western Blot 

The Western Blot test is typically used to confirm a positive ELISA result. This test detects specific proteins, or antigens, that are associated with Borrelia burgdorferi. It separates the patient’s blood proteins and then identifies whether antibodies have bound to certain Lyme-associated proteins. The Western Blot test is divided into two parts—IgM for recent infection and IgG for longer-term or past infections. Two IgM bands or five IgG bands on the Western Blot are required to be CDC positive for Lyme disease. 

Limitations of Western Bolt

The Western Blot has its own set of limitations, particularly for chronic or late-stage Lyme disease. Like the ELISA test, the Western Blot relies on the immune system’s ability to produce antibodies. In late-stage Lyme, the immune response can weaken, making the test less reliable. Over time, Lyme disease can suppress or evade the immune system, leading to undetectable antibody levels despite the continued presence of symptoms​. Additionally, the test’s sensitivity decreases as the infection moves from the bloodstream to deeper tissues like joints and the nervous system.

Both ELISA and Western Blot have a history of generating false-negative results, particularly for individuals with late-stage Lyme disease, making them imperfect tools for long-term diagnosis. This is why Lyme disease remains primarily a clinical diagnosis, with doctors relying heavily on patient history, symptoms, and risk factors in addition to test results.

Recommended Tests for Lyme Disease Years Later 

While a diagnosis of late-stage Lyme disease is primarily based on clinical evaluation, advanced diagnostic tests can play a significant role in confirming the presence of Lyme, especially in cases where traditional tests, like ELISA and Western Blot, fall short. Here are two modern testing options we recommend for patients who suspect Lyme years after initial exposure.

Test 1: IGeneX Lyme ImmunoBlot

The IGeneX Lyme ImmunoBlot is one of the most advanced and sensitive tests available for detecting Lyme disease. Unlike the standard Western Blot, which focuses on a narrow set of Borrelia burgdorferi proteins, the ImmunoBlot is designed to identify a broader range of Lyme species, including multiple strains of Borrelia, as well as co-infections. This is crucial because Lyme disease can vary significantly based on the region, and not all strains are detectable by conventional testing​.

What sets the IGeneX Lyme ImmunoBlot apart is its ability to detect both current and past infections. It does this by identifying specific protein bands associated with the bacteria, even in patients who may not have a robust immune response. This sensitivity is vital for individuals in the chronic stages of Lyme, where traditional tests like ELISA or standard Western Blot might return false negatives. Additionally, the test is more comprehensive, improving the chances of detecting infections that have gone unnoticed for years​. 

The test can help provide clarity for those suffering from symptoms that persist or reappear years after a tick bite. While no test is perfect, the IGeneX Lyme ImmunoBlot offers a more accurate picture of an individual’s exposure and immune response to Lyme disease over time.

Test 2: Lyme PCR (Polymerase Chain Reaction)

The Lyme PCR test, or Polymerase Chain Reaction, takes a different approach from antibody-based testing. Instead of measuring the immune system’s response, the PCR test searches directly for Lyme DNA in tissue samples, such as synovial fluid from joints or cerebrospinal fluid, making it more accurate for detecting the bacteria in chronic Lyme disease cases. 

PCR is particularly useful in late-stage Lyme because the bacteria often hide in tissues rather than the bloodstream. By amplifying tiny amounts of bacterial DNA, the PCR test can confirm an active infection, even when the immune system is no longer producing sufficient antibodies. This test is especially helpful in diagnosing Lyme-related arthritis or neurological Lyme, where the bacteria have moved into tissues like joints or the nervous system​. 

Final Words 

Testing for Lyme years after infection can be tricky due to the nature of the bacteria and the limitations of traditional tests.. However, more advanced options, like the IGeneX Lyme ImmunoBlot and Lyme PCR, offer hope for those still suffering and looking to determine if Lyme disease is playing a role in their chronic health issues. Always remember that Lyme disease is primarily a clinical diagnosis, and your doctor should consider your symptoms, risk factors, and test results together.