Lyme Disease Basics: Prevention and Testing
An ounce of prevention is worth a pound of cure. Let go of the myths that Lyme disease is only an east coast problem and that you only have to be careful when you’re in the woods.
Ticks carrying Borrelia burgdorferi (the spiral-shaped bacteria that causes Lyme disease) have been identified in all 50 states. While the black legged tick is the traditional vector for transmission, new tick species including the Lonestar tick and the a Ixodes pacificus (western black-legged tick) have also been shown to carry the bacterium.
A few preventative measures that you could share with your patients include spraying your clothing with insect repellent, wearing long sleeves and pants and tucking your pants into your socks. Your patients’ choice of insect repellents vary widely from insecticides like DEET to all-natural options that use essential oils like citronella, cedar, rosemary, eucalyptus and geranium. Lastly, perform repeated tick checks on your person/s and pets when outdoors and definitely a whole body check when back inside.
Become savvy on how to remove ticks using fine-tipped tweezers to grasp it as close to the skin’s surface as possible. Do not burn the tick or stress the tick with ointments and aggressive manipulation, as the contents deep in the tick’s digestive tract can spill into the wound more quickly. While, for many, the urge to dispose of the tick is strong, it is better to safely store it in case you want to send it for testing or closer examination. While you may opt to begin treatment immediately, you can concurrently send the tick to be tested for B. burgdorferi for $68 from IGeneX, a Lyme specialty lab. Also, many county vector control boards also do tick testing for B. burgdorferi but the specimen needs to remain intact and moist (add a moist cotton ball and put the tick in a zipped bag).
Testing for Lyme disease is very complicated and faces many limitations including the very elusive nature of the tricky spirochete and its ability to hide in our cells, tissues, and behind biofilms, avoiding our immune system. Adding complexity, there are five subspecies of B. burgdorferi, over 100 strains in the USA, and 300 strains worldwide, which further adds to the bacteria’s antigenic variability. Also, controversy still surrounds Lyme disease diagnosis and treatment.
Here are just a couple of the ways that Lyme disease contradicts the generally accepted norms of infectious disease:
IgM antibodies can be made for 25 years
20-30% of those infected do NOT make antibodies.
Lyme literate practitioners generally rely on a combination of both direct and indirect tests to help diagnose Lyme disease. Direct tests look for the presence of antigens or nucleic acids of B. burgdorferi while indirect tests look for an individual’s immune response to this elusive invader.
Lyme testing is complicated and the purpose of this brief article to help practitioners to become a bit savvier on the different types of tests and the definite limitations of testing. If a patient comes into your office with Lyme labs, consider taking an extra moment to further scrutinize the type of tests ordered and explain to your patient the significant limitations and differences in testing methodologies. I would like to thank Igenex Inc. and the International Lyme and Associated Diseases Society/ILADS for their immense contributions in furthering the identification and treatment of Lyme disease and their online resources that helped shape the information provided in this article.
- Donta, S.T. Late and chronic Lyme disease. Med Clin North Am. 2002 Mar;86(2):341-9
By Tina Beaudoin ND