Lyme Disease: The Pitfalls of Laboratory Testing


John Drulle M.D.


Lyme Disease 1991: Patient/Physician Perspective from the U.S. and Canada

Lora Mermin, editor
pg. 34-35


Currently available commercial tests for Lyme disease provide indirect evidence of exposure to the Lyme bacteria. When someone is infected with the Lyme bacteria, the immune system responds by making specific proteins, called antibodies, whose role is to seek out the Lyme bacteria, attach to them and initiate the process of destruction. In most patients, these antibodies are unable to destroy the Lyme bacteria (population, addition by J. Gruber), which by methods which are not completely understood, may remain alive in the human body for many years, in spite of high "titers" or concentrations of antibodies.

The Western Blot is now commercially available for Lyme disease. Here various sized Lyme antibodies are allowed to migrate on a strip of filter paper. They separate into distinct bands, and serve as a 'fingerprint' for Lyme disease. This technique is wrongly thought to be a 'confirmatory test' for Lyme disease, which it is in AIDS. It may be useful to sort out false positive tests and in cases where the antibody titer is 'borderline'. Since its results depend on the presence of Lyme specific antibodies, the same factors which can cause a negative test may cause a negative 'Western Blot'.

  • The Cell Mediated Immunity Test (CMI) or T-Lymphocyte Stimulation Test, has also been used to make a laboratory diagnosis of Lyme disease. It attempts to determine if one's immune system has 'memory' of exposure to Lyme bacteria. It is currently done by Stony Brook University and several other research laboratoies. It costs more that $300 to do and is very labor intensive. It also has a high rate of false positive and false negative results. The most common errors made by physicians in interpreting these previously mentioned tests are:
    1. A negative test excludes the diagnosis of Lyme.

    It must be stressed that these tests do not correlate with symptoms and activity of the Lyme bacteria once antibiotics are initiated.


    The laboratory tests may be a useful adjunct in making the diagnosis, but negative results do not rule out the possibbility of the disease.

    Ticked off Tract--June 1991

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