Lyme disease blood test is used to determine if you have contracted Borrelia burgdorferi (B. burgdorferi), the bacterium that causes Lyme disease. Lyme disease tests are conducted with a routine blood draw.
While there are other species of Borrelia that cause Lyme disease, B. burgdorferi is the most common cause in the United States. Most antibody tests in the United States only test for B. burgdorferi, but other species-specific tests are available depending on a person’s travel history. Lyme disease is transmitted to humans through ticks that are infected with Borrelia.
Symptoms of Lyme disease include:
skin rash in the shape of a bull’s-eye Untreated, Lyme disease can affect your heart and nervous system.
Symptoms of advanced Lyme disease can include:
loss of muscle tone in the face
tingling in your hands and feet
shortness of breath. Lyme disease can be difficult to diagnose. Ticks are very small, and the bites are not always noticeable. Symptoms of the disease can vary from person to person. Not everyone experiences the classic “bull’s-eye” rash pattern around a tick bite.
It should be noted that testing is not always required to make a diagnosis. For people with a classic bulls-eye rash (Erythema migrans) living in a high risk area, testing is not recommended for diagnosis.
Your doctor will use the results of a Lyme disease antibody test, along with the report of your symptoms, to confirm a diagnosis.
What are antibodies?
Antibodies are proteins your body makes in response to foreign or harmful substances called antigens. Common antigens include:
Your body produces antibodies if you have contracted B. burgdorferi. These Lyme disease-specific antibodies will be present in your blood, and your test will be positive if you have the bacterial infection.
If you have never been exposed to B. burgdorferi, you will not have any Lyme disease antibodies in your bloodstream. In this case, your test will be negative.
However, there is a possibility of false positive results due to potential test cross-reactivity with other diseases including syphilis, autoimmune diseases, and Epstein Barr virus.
However, you may test negative for Lyme disease in the early days and weeks after contracting the infection. This is because your body has not yet produced a significant number of antibodies. You will usually test positive for Lyme disease starting at about 2 to 4 weeks after acquiring an infection.
Testing for Lyme disease at the laboratory
A series of laboratory tests can detect Lyme disease antibodies. These tests include:
ELISA: stands for “enzyme-linked immunosorbent assay,” which detects antibodies in your bloodstream
IgM antibody test: tests for the IgM antibody present in the blood when you have an infection
IgG antibody test: tests for the IgG antibody that fights bacterial infection
Western blot: a follow-up test that detects proteins and antibodies in the blood (the Western blot is only meaningful during the first 4 weeks of an infection)
The ELISA test is performed first. If results are positive or equivocal, a second test, IgM/IgG immunoassay or immunoblot is performed. It is no longer recommended to check IgM or IgG antibodies without a prior immunoassay.
Lyme disease antibody test procedure
The Lyme disease antibody test requires no advance preparation. A lab technician will swab the inside of your elbow with an antiseptic before drawing your blood. Your blood will be drawn from a vein in your arm using a small needle.
The blood draw should not be painful, though you might feel a slight prick when the needle is inserted into your vein.
The blood sample will be collected in a vial. The puncture site will be bandaged, if needed, after the needle is removed. After the blood draw, you are free to go home.
Risks of a Lyme disease antibody test
There are very few risks associated with the Lyme disease antibody test. Excessive bleeding is possible, but there may be an increased risk if you take blood thinning medications or certain anti-inflammatory drugs like:
Infection at the puncture site is also possible, but it’s unlikely. Keep the bandage in place until all bleeding has stopped and keep the area clean. Some people feel lightheaded after having blood drawn. Let the technician know if this is the case. You might be asked to sit for a few minutes before going home.
Following up after the procedure
Once you have Lyme disease, the antibodies remain in your blood. So even after you have been treated for the disease, you might still have positive blood tests.
Lyme disease is treated with antibiotics. Your doctor will discuss your course of treatment in detail if you test positive for the bacterial infection.
Signs and Symptoms of Lyme Disease
Lyme disease is an underreported, under-researched, and often debilitating disease transmitted by spirochete bacteria. The spiral-shaped bacteria, Borrelia burgdorferi, are transmitted by blacklegged deer ticks. Lyme’s wide range of symptoms mimic those of many other ailments, making it difficult to diagnose.
The blacklegged can also transmit other disease-causing bacteria, viruses, and parasites. These are known as coinfections (1). These ticks that transmit Lyme are increasing their geographical spread. As of 2016, they were found in about half the counties in 43 of 50 states in the United States.
Lyme is the fifth most reported of notifiable diseases in the United States, with an estimated 329,000 new cases found annually. But in some states, estimates suggest that Lyme disease is profoundly underreported. Some studies estimate that there are as many as 1 million cases of Lyme in the United States every year.
Most people with Lyme who are treated right away with three weeks of antibiotics have a good prognosis. But if you’re not treated for weeks, months, or even years after infection, Lyme becomes more difficult to treat. Within days of the bite, the bacteria can move to your central nervous system, muscles and joints, eyes, and heart.
Lyme is sometimes divided into three categories: acute, early disseminated, and late disseminated. But the progression of the disease can vary by individual, and not all people go through each stage.
Every individual reacts to the Lyme bacteria differently. You may have some or all of these symptoms. Your symptoms may also vary in severity. Lyme is a multi-system disease.
Here is a list of common signs and symptoms of Lyme disease.
The signature rash of a Lyme tick bite looks like a solid red oval or a bull’s-eye. It can appear anywhere on your body. The bull’s-eye has a central red spot, surrounded by a clear circle with a wide red circle on the outside.
The rash is flat and usually doesn’t itch. The rash is a sign that the infection is spreading within your skin tissues. The rash expands and then resolves over time, even if you’re not treated.
Thirty percent or more of people with Lyme disease don’t remember having the rash.
Even fewer people remember a tick attachment. Estimates range from 20 to 50 percent. The ticks in the nymph stage are the size of poppy seeds, and their bites are easy to miss.
The initial red rash usually appears at the site of the bite within 3 to 30 days. Similar but smaller rashes can appear three to five weeks later, as the bacteria spread through tissues. Sometimes the rash is just a red blotch.
The rash can also take other forms, including a raised rash or blisters (14).
If you do have a rash, it’s important to photograph it and see your doctor to get treated promptly.
Whether or not you see the tick bite or the classic Lyme rash, your early symptoms are likely to be flu-like. Symptoms are often cyclical, waxing and waning every few weeks.
Tiredness, exhaustion, and lack of energy are the most frequent symptoms. The Lyme fatigue can seem different from regular tiredness, where you can point to activity as a cause. This fatigue seems to take over your body and can be severe.
You may find yourself needing a nap during the day, or needing to sleep one or more hours longer than usual.
In one study, about 84 percent of children with Lyme reported fatigue. In a 2013 study of adults with Lyme, 76 percent reported fatigue.
Sometimes Lyme-related fatigue is misdiagnosed as chronic fatigue syndrome, fibromyalgia, or depression.
In some Lyme cases, fatigue can be disabling.
- Achy, stiff, or swollen joints
Joint pain and stiffness, often intermittent, are early Lyme symptoms. Your joints may be inflamed, warm to the touch, painful, and swollen. You may have stiffness and limited range of motion in some joints.
Pain may move around. Sometimes your knees may hurt, whereas other times it’s your neck or your heels.
Bursae are the thin cushions between bone and surrounding tissue.
The pain may be severe, and it may be transitory. More than one joint may be affected. Most often the large joints are involved.
People often attribute joint problems to age, genetics, or sports. Lyme should be added to that list, as these statistics indicate:
One study estimates that 80 percent of people with untreated Lyme have muscle and joint symptoms.
Fifty percent of people with untreated Lyme have intermittent episodes of arthritis.
Two-thirds of people have their first episode of joint pain within six months of the infection.
Use of anti-inflammatory drugs may mask the actual number of people with joint swelling.
- Headaches, dizziness, fever
Other common are headaches, dizziness, fever, muscle pain, and malaise.
About 50 percent of people with Lyme disease have flu-like symptoms within a week of their infection.
Your symptoms may be low-level, and you may not think of Lyme as a cause. For example, when fever occurs, it’s usually low-grade
In fact, it can be difficult to distinguish Lyme flu symptoms from a common flu or viral infection. But, unlike a viral flu, for some people the Lyme flu-like symptoms come and go.
Here are a few statistics from different studies of Lyme patients:
Seventy-eight percent of children in one study reported headaches
Forty-eight percent of adults with Lyme in one study reported headaches
Fifty-one percent of children with Lyme reported dizziness
In a 2013 study of adults with Lyme, 30 percent experienced dizziness
Thirty-nine percent of children with Lyme reported fevers or sweats
Among adults with Lyme, 60 percent reported fever in a 2013 study
Forty-three percent of children with Lyme reported neck pain
A smaller number of children with Lyme reported sore throats
- Night sweats and sleep disturbances
Sleep disturbances in Lyme are common.
Joint pain may wake you up at night. Your body temperature may fluctuate, and night sweets or chills can wake you.
Your face and head may feel flushed.
Here are some of the statistics from studies:
In a 2013 study, 60 percent of adults with early Lyme reported sweats and chills.
The same study reported that 41 percent experienced sleep disturbances.
Twenty-five percent of children with Lyme reported disturbed sleep
- Cognitive decline
There are many kinds and degrees of cognitive disturbances, and they can be scary.
You may notice that you have difficulty concentrating in school or at work.
Your memory may have lapses that weren’t there before. You may have to reach to remember a familiar name.
You may feel as though you’re processing information more slowly.
Sometimes when driving or taking public transportation to a familiar place, you may forget how to get there. Or you may be confused about where you are or why you’re there.
You might get to a store to shop, but entirely forget what it was that you were supposed to look for.
You might at first attribute this to stress or age, but the decline in capabilities may worry you.
Here are some statistics:
Seventy-four percent of children with untreated Lyme reported cognitive problems.
Twenty-four percent of adults with early Lyme reported difficulty concentrating.
In later Lyme, 81 percent of adults reported memory loss
- Sensitivity to light and vision changes
Bright indoor light may feel uncomfortable or even blinding.
Light sensitivity is bad enough for some people to need sunglasses indoors, in addition to wearing sunglasses outdoors in normal light.
Light sensitivity was found in 16 percent of adults with early Lyme.
In the same study, 13 percent reported blurry vision.
- Other neurological problems
Neurological symptoms can be subtle and sometimes specific.
In general, you may feel unsure of your balance or less coordinated in your movements.
Walking down a slight incline on your driveway might take an effort that it never did before.
You might trip and fall more than once, although this never happened to you before.
Some Lyme effects are very specific.
For example, the Lyme bacteria may affect one or more of your cranial nerves. These are the 12 pairs of nerves that come from your brain to your head and neck area.
If the bacteria invade the facial nerve (the seventh cranial nerve), you can develop muscle weakness or paralysis on one or both sides of your face. This palsy is sometimes mistakenly called Bell’s palsy. Lyme disease is one of the few illnesses that cause palsies on both sides of the face. Or you may have numbness and tingling on your face.
Other affected cranial nerves can cause loss of taste and smell.
A Centers for Disease Control and Prevention (CDC) study of 248,074 reported Lyme disease cases nationwide from 1992 to 2006 found that 12 percent of Lyme patients had cranial nerve symptoms.
As the Lyme bacteria spread through the nervous system, they can inflame the tissues where the brain and spinal cord meet (the meninges).
Some of the common symptoms of Lyme are neck pain or stiffness, headache, and light sensitivity. which alters your mental state, is less common.
These neurological symptoms occur in about 10 percent of adult individuals with untreated Lyme disease
- Skin outbreaks
Skin symptoms appear early in Lyme.
You may have unexplained skin rashes or large bruises without usual cause.
Skin outbreaks may be itchy or unsightly. They could also be more serious, such as B cell lymphoma.
Other skin ailments associated with Lyme are:
morphea or discolored patches of skin
lichen sclerosis or white patches of thin skin
parapsoriasis, a precursor to skin lymphoma