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Making the diagnosis

The Diagnosis is a clinical one - refer Burruscano

Since the introduction of ELISA and associated serological testing for IgG and IgM in the 1980's we have come to accept such results as a gold standard for the proof of any contracted infection. 

For Lyme disease, Mycoplasma and Chlamydia Pn we can unfortunately have positive PCR's and negative immunological findings. Such a scenario of course is abysmal if we are relying on the latter as a proof of diagnosis. As a reminder the polymerase chain reaction detects the absolute DNA sequencing of the organism you are looking for dependent upon proper validation of the primers. Further the spirochaete is not always or easily found in blood - the usual sample used. Recall the methods used to demonstrate Strep Viridans etc. It is not recommended that an ELISA screening test be relied on because it may be negative when the western blot is positive.

In the US the western blot is considered reliable only when performed by laboratories dedicated to that testing. Many smaller labs report negatives subsequently found to be positive at these "more competent" labs. There is even some controversy at the CDC Atlanta about testing and interpretation of the Western Blot.

In the US some 50 percent of Chronic Lyme sufferers are both serologically and PCR negative for the disease. For this reason it is a clinical diagnosis based on exposure, reaction at the time and manifesting symptoms or syndrome. This is possibly easier in the US as they have a migratory monoarthritic form of the disease predominantly.

In concluding a diagnosis one should use the terminology - Burrascano again

“unlikely”

“possible”

 or “highly likely”

of course an EM history and positive serology or PCR would be considered absolute