Lyme disease test

First of all it has to be said that a Lyme disease test is only carried out if there is a justified suspicion. A suspicion exists in case of certain symptoms that indicate the disease. The most common test and the gold standard is a cerebrospinal fluid test, also called liquor puncture.

A hollow needle is used to puncture the area of the lumbar vertebrae and spinal fluid is removed. Care must be taken to ensure sterile working conditions, as otherwise infections can be carried over into the spinal cord and brain, which can lead to encephalitis or meningitis. In addition, punctures must be made sufficiently far down in the lumbar spine area (approximately between the third or fourth lumbar vertebrae) so as not to injure the spinal canal.

In addition, a blood test must also be performed. Now the values of the antibodies against the borreliosis pathogen in the blood and in the cerebral fluid are compared. On the one hand the antibodies of the immunoglobulins M or G (IgM and IgG) can be measured.

The antibodies differ in that the antibodies IgM increase first during an infection and IgG only after a longer time, when the disease has become chronic. A certain ratio of antibodies in the blood and the cerebrospinal fluid is calculated. This ratio, which is calculated, is also called CSF-serum index or specific antibody index. The ratio should be less than 2, everything above this indicates an increased number of antibodies against the borreliosis pathogen in the cerebral fluid and thus a borreliosis disease.

Recognize Lyme disease

To detect Lyme disease is sometimes more difficult than expected. It can happen that Lyme disease is only recognised in its late stages, because the affected persons cannot remember a tick bite and typical symptoms or these did not occur characteristically. The problem is that the disease can rest in the body for years without symptoms before it breaks out again.

If you notice the redness described above and even a tick bite may be remembered, you should definitely consult a doctor! Further very characteristic symptoms are the asymmetrical paralysis of the facial nerves, va. the facial nerve and meningitis. Here too, a possible Borrelia infection must be considered immediately! Further unspecific symptoms of Lyme disease can be joint pain, long lasting tiredness, skin inflammations and flu symptoms. In case of long lasting joint pains that do not respond to treatment or skin inflammations that cannot be classified, a Lyme disease in its later stages should also be considered as a cause.

Other indications

Other signs that can be seen in the cerebral fluid are an increased number of white blood cells, an increased protein content, an increased lactate value (lactic acid) and a reduced sugar content in the cerebral fluid. These parameters indicate a bacterial infection and are therefore not specific for the Lyme disease infection. More decisive, however, is the above-mentioned antibody detection.

It must be said that this test, which is often used as a gold standard, can also give false negative results in a Lyme disease diagnosis, i.e. an infection is present, but no antibodies have been produced by the body and therefore the test would not indicate an infection. Therefore it is very important not to overlook the clinic of the affected person. In spite of a negative test, a typical symptomatology, such as wandering blush, must be treated!

In addition, the Lyme disease test is still applicable years after the tick bite. On the other hand, in the case of joint pain with inflammation, a joint puncture can also be carried out and thus the cultivation of the bacteria after sampling can be used as evidence. If the tick is present on site, which is usually not the case after removal until the symptoms appear, one can test whether the borreliosis pathogen can be detected in the tick.

In this case the tick must be sent to a laboratory. If the tick is infected, this does not mean that the person bitten has also been infected. However, the longer the tick bites the body, the greater the probability of transmission.

Therefore it is important to remove the tick as soon as possible when it is noticed. This is a more complicated method, as the infected tick and the patient must be tested again. Here, certain white defence cells (lymphocytes) are detected, which are specific for surface proteins (antigen) of the borreliosis pathogen.

After blood collection, the lymphocytes are centrifuged and separated from the other cells in the blood. Then the antigen of the borreliosis pathogen and the nutrient solution are added and a culture of the lymphocytes is prepared. By adding a radioactively labelled amino acid to the DNA production, the thymine, one can observe whether the lymphocytes are specific for an antigen on the Lyme disease pathogen.

However, the test still produces many false positive and false negative results. This means that infected persons are not recognized and non-infected persons are wrongly measured as infected. One reason for this is that the test is very complex and demanding.

Furthermore, the test is also relatively expensive. It is supposed to have determined that an infection with borreliosis leads to an altered immune defence. This indicates for example a lower number of natural killer cells in Lyme disease.

The CD-57 surface protein is found on natural killer cells that are activated. And exactly these are supposed to be particularly reduced in a Lyme disease infection. Thus, the reduction of these cells can be detected by the surface protein.

A blood sample is also taken for the Lyme disease test. In this test, fluorescence-labelled (substances that trigger a light reaction) antibodies against the CD-57 antigen are brought into contact with the blood sample and thus the detection is made. However, false positive or negative results can also occur here.

This can be due to the fact that the Natural Killer Cells are reduced by another disease or the immune response can be very variable. In this case defence cells called monocytes are examined. After contact with the borreliosis pathogen, these cells should react to the pathogen faster than the first time.

The monocytes are filtered out of the blood sample and brought into contact with the borreliosis pathogen. However, the method is still in research and its efficiency has yet to be clearly proven in studies. – Further tests are the LTT test (lymphocyte transformation test):

There is also the CD-57 test. – The latest test in the field of Lyme disease diagnostics is the Spirofind Test.