Thread by @ilads_lyme

Joseph Burrascano, MD - Diagnostic Tools
#Lyme Clinical Presentation: nonspecific, viral-like symptoms that persist, & new ones appear. Then symptoms more focused on musculoskeletal, peripheral and central nervous systems, heart and skin. Muti-systemic & migratory. #ILADS2022

2/Burrascano: Sorting out the co-infections #NotJustLyme #Bartonella #Babesia #Ehrlichia #Anaplasma #Mycoplasma #ILADS2022

3/Burrascano: Types of tests
SEROLOGIES are indirect, B-cell based tests:
B-cells create antibodies and serologies measure these antibodies #ILADS2022

4/Burrascano: #Lyme IFAs and ELISAs: Usually reported as positive, borderline or negative; trade-off between sensitivity and specificity #ILADS2022

5/Burrascano: #Lyme Western blot and ImmunoBlot:
● Reports reactivity to individual antigens (“bands”)
● Open to practitioner interpretation, within validated guidelines
● Requiring fewer bands increases sensitivity but may sacrifice specificity
#ILADS2022

6/Burrascano: It is important to understand immune response when selecting #Lyme testing. #ILADS2022

7/Burrascano: #Lyme ImmunoBlots represent important advances in testing technology and replace other serological methods. Besides being more accurate, they also allow for detection of multiple species. #ILADS2022

8/Burrascano: #Lyme PCR detects presence of pathogen DNA- Blood, CSF, urine, tissues- direct test
● Sensitivity in blood samples is low due to circulating inhibitors
● Multiplex PCR is more sensitive
● Highly specific, so trust a positive result
#ILADS2022

9/Burrascano: #Lyme FISH test detects presence of pathogen RNA - direct test
● Can be designed to be genus-specific, increasing breadth of species detection
NOTE:
● RNA does not persist post-infection
● Able to detect pathogens even if embedded in biofilms
#ILADS2022

10/Burrascano: #Lyme Urine antigen detection
is a direct test. Usually a set of three samples is collected over five days; most will pre-treat with antibiotics during collection. Great for testing children and those who are needle-shy, #ILADS2022

11/Burrascano: “FDA Approval” is simply a licensing procedure- it is not intended to be a sign of test validity. All FDA-licensed Lyme test kits are based upon tick-derived lab strain B31, & not clinical specimens from actual patients (severely limits test sensitivity) #ILADS2022

12/Burrascano: #Lyme requires clinical diagnosis b/c 17% recall a bite (Texas Dept. of Health; Duchess Co. N.Y. Dept. of Health), 36% recall a rash (Texas Dept. of Health), Serologic testing may miss up to half the cases (less early) #ILADS2022

13/Burrascano: Paradoxically, the more ill patients are more likely to be seronegative for #Lyme due to immune complexes, immune suppression #ILADS2022

14/Burrascano: Borrelia rapidly disseminate after the tick bite. It can appear in CNS w/in hours to days. Spinal fluid serologies are terribly insensitive
• Spinal tap- in Lyme meningitis, only 9% had + CSF antibodies (Coyle, SUNY at Stony Brook) #ILADS2022

15/Burrascano: Erythema migrans
incidence may be <50%
• Can be atypical, are rarely circular
• the most common reaction is a small raised bump at the bite site that may persist for several days but not expand
• Disappears in days to weeks EVEN IF NOT TREATED!
#ILADS2022

16/Burrascano: #Lyme tests have not been improved in 30 years and are very insensitive. Sensitivity averages 49% for ELISA (range 29% to 75%) #ILADS2022

17/Burrascano: There are many #Lyme #Borrelia strains that are not covered by standard labs. #falsenegative #ILADS2022

18/Burrascano: Newer #Lyme immunoblot testing are more sensitive and specific #Lymedisease #ILADS2022

19/Burrascano: Also consider tick-borne relapsing fever #borrelia. #TBRF has been detected in 49 out of 50 states