New tools that could dramatically improve the diagnosis of Lyme disease are already available and should have a role nationwide, according to recommendations born out of a brainstorming conference at Cold Spring Harbor Laboratory.
Reporting in the current issue of Clinical Infectious Diseases, scientists underscored that newer, more precise diagnostic testing can be developed using off-the-shelf technology, providing results in less time, and with greater accuracy.
The key method of current testing is a double-step exam that may take as many as three weeks to reach a positive result.
“When a test is ordered by your doctor you expect a precise, unambiguous answer, and this may not happen with current Lyme disease testing,” said Dr. Steven Schutzer, a professor at Rutgers New Jersey Medical School and an expert in Lyme disease.
Schutzer led a meeting of top experts in the field at the Banbury Center of Cold Spring Harbor Laboratory in 2016. Their conclusions were published in the scientific journal this month.
What doctors want, according to Schutzer, is an accurate “positive” or “negative” result for routine cases of Lyme disease.
Two testing methods are highlighted in the scientific paper. Neither of them has a marquee name known to the public, but they represent state-of-the-art science refined in this century. One is called a single multiplex assay; the other is known as next-generation enzyme immunoassays. While both names may sound like scientific jargon, each can produce results with high precision, which could ultimately mean less worry for doctors and patients, Schutzer said. He added that additional tests, not in the paper, are also “right around the corner.”
Current diagnostic testing — in use since 1994 — searches for the antibodies a patient mounts to fight tick-transmitted bacteria. But the lengthy procedure makes it difficult for doctors to make expeditious treatment decisions, Schutzer said.
False positive results, for example, may result in unnecessary antibiotic therapy.
Patients also run the risk of getting sicker while waiting. Borrelia burgdorferi, the bacteria that cause Lyme disease, can flourish when test results are delayed or imprecise, causing the disease to affect major organs.
“The sooner you definitively diagnose it, the sooner you can start antibiotics,” Schutzer said. “And the earlier treatment is started, the more likely it is that you will eradicate it before Lyme disease can affect the heart, brain or nervous system.”
Lyme disease is defined by the Centers for Disease Control and Prevention as the most commonly reported vector-borne disease in the United States. Vectors are a broad category of disease transmitters: mosquitoes, fleas, flies, lice, mice and other rodents capable of conveying infectious agents to humans and animals.
Ticks transmit a wide variety of infectious microbes and the Lyme bacterium is the most prevalent. The CDC estimates that 300,000 people in the United States alone develop Lyme disease annually because of tick bites.
Rebecca Leshan, director of the Banbury Center at Cold Spring Harbor Laboratory, said Schutzer has led conferences on Lyme disease at the center for more than 20 years and has helped advance the understanding of the infection in the scientific community. She said the 2016 conference led to “strong recommendations.”
“There is really a strong need for this,” Leshan said of new diagnostic testing methods. “We are on Long Island and we are personally affected.”
Lyme disease is increasing worldwide, but in the United States, 95 percent of all infections occur in only 14 states, and New York is one of the leading hotbeds of infection, data from the Centers for Disease Control and Prevention show.
LYME DISEASE SYMPTOMS AND DETECTION
Lyme disease can emerge with a variety of disparate symptoms that initially might be mistaken as unrelated and noninfectious.
Some people have joint pain and headaches, and none of the symptoms that are considered hallmarks of the disease such as a “bullseye rash,” said Dr. Steven Schutzer, a professor at Rutgers University School of Medicine in New Jersey and an expert in Lyme disease.
The CDC estimates that 300,000 people in the United States alone develop Lyme disease annually because of tick bites. But Schutzer noted that some affected people have no recollection of even being bitten by a tick.
A blacklegged or deer tick is exceptionally tiny, some no larger than a poppy seed. Their presence may go unnoticed as they feed, embedded in the host’s skin for up to three days.
The CDC recommends laboratory testing for patients who have a history “of possible exposure to infected blacklegged ticks.”