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Laboratory diagnosis and other investigations

First

The standard test for Lyme is an ELISA test for IgA,G and M, then if positive the well known Western Blot for both IgG and IgM. The former is next to useless here in Australai. The latter is a complex immuno-electrophoretogram and is thus weight dependent for the different bands of Borrelia protein. Under Medicare the Elisa must first be positive to continue to the Western Blot. There are unfortunately differing interpretations to what is a positive finding. The Burruscano document says you should see the 41 kd then any single one at least of 18,23,24,25,31,34,37,39,83 or 93 bands for a diagnosis.

In Australia they are always negative so I don't bother ordering them. I have some patients who have sent their blood overseas and have returned positive findings. Western Blot tests for Burgdorferi and not Garinii. In Australia we may have an intermediate strain (Prof Tim Roberts, Microbiology, Newcastle University). This could go a long way to explaining the mixed results we see in Australia.

If you need a thorough understanding of Western Blot refer here. I am unable to reference this but it is clearly written by a medical practitioner who treats Lyme. It is a deidentified handout used in practices in the US. I will gladly acknowledge rightful ownership to whoever produced this if anyone wishes to claim it. It is an excellent resource.

Remember if a serological test is positive it demonstrates exposure only and not necessarily current infection.

Second

The PCR. As would be expected with this test, a positive finding is an absolute confirmation of the organism's DNA in the body and thus a diagnosis. The laboratory I use for this follows this up with full sequencing for confirmation and this is done at a NATA accredited lab.

Lastly

For a full investigation of a new patient consider these laboratory investigations  

Blood PCR for Borrelia (Burgdorferi and Garinii)
Western Blot IgG and M (will only detect Burgdorferi)
LSM and CD57 - see specific page for CD57 test
FBC ESR and CRP
 Biochem profile
Rh factor ANF DNA ENA’s
TFT’s
Early morning cortisol
Skin biopsy for any hand rash – ACA Acrodermatitis chronica Atrophicans
Then testing for co infections
Chlamydia Pn by blood PCR and sero
Mycoplasma by blood PCR and sero
HHV6,  EBV, CMV, Coxsackie,  Rickettsiae, Parvo  serology
Peripheral blood smear Giesma or Wrights stain for intra erythrocyte parasites (Babesia)
If contracted overseas check for Bartonella, Anaplasma and Erlichia