When it comes to chronic Lyme disease, diagnosis is always a major problem. Part of that problem is down to the fact that chronic Lyme symptoms are extremely variable, and often mimic the symptoms of other chronic diseases. This is what gives Lyme its nickname, ‘the Great Imitator’. The other half of the problem is that chronic Lyme is essentially an unvetted disease. The Centers for Disease Control and Prevention (CDC) in America won’t fully legitimise chronic Lyme, despite recognising Lyme disease in the abstract as a growing issue. This leads to uneducated medical professionals who often disregard chronic Lyme as a myth, or fail to recognise tell-tale signs. For Lyme-literate doctors, one of the best ways to test for the disease is through a blood test called the ELISpot. But how accurate is it?
Essentially a type of blood test, the ELISpot is not solely a Lyme-based technique. Doctors use ELISpot tests for a variety of different reasons, from vaccine testing to cancer research. The aim of the test is to deduce the frequency of cytokine secretion from a single cell. Cytokines are crucial proteins that help mediate and regulate immunity and other functions, acting as signallers for cells. An ELISpot can tell doctors whether a cell is producing a specific type of cytokine, allowing them to deduce treatment plans and effective countermeasures from the results. Because chronic Lyme is an issue involving bacteria infection, an ELISpot is, in theory, a good test to determine whether Lyme disease is present.
However, in practice, the ELISpot returns many false negatives. This is because Lyme does not only involve the immune response, but the inflammation response as well. Many of the primary symptoms experienced by patients involve pain in the joints and muscles, as well as crippling fatigue. These are caused by inflammation, not the infection as such; it’s the body’s response to the infection, which is at the root of the issues. It takes a mere trace amount of the original Borrelia burgdorferi infection for the immune system to keep trapping itself in this vicious circle of chronic inflammation. So when the ELISpot tests for Borrelia bacteria, the results may well come back negative, leading to confusion and frustration for patients and doctors alike. The ultimate result of this inaccurate testing is misdiagnosis, which can lead to years of physical and mental suffering for patients.
It is estimated that the ELISpot is 75% accurate in cases of predetermined Lyme, and 60% in all stages of the disease. This means that at least 25% of tests return a false negative, which is not a great rate of accuracy, all things considered. Fortunately, much in the same way that acute Lyme evolves into chronic, the ELISpot has also recently evolved. BCA-clinic supported the development of a new test, known as the LymeSpot. Based in Augsburg, Germany, BCA-clinic have been experts in Lyme for many years and understand both stages of the disease very well. They understood the ELISpot wasn’t functioning optimally and decided to work on a more precise method. The resulting LymeSpot test is far more accurate than its predecessor, and also extremely useful in that it can gauge what stage a patient is at in their Lyme disease.
It achieves this by testing for both inflammation and infection signs within the cells. Two different T-cells are involved in this process: one for attacking the invading bacteria, and one for ‘remembering’ the blueprint of the attack, ostensibly to better aid a rapid recovery in the future. For early Lyme patients, there will be a lot of attack cells, as the infection is new and the system will be doing its best to eradicate it quickly. For patients whose Lyme disease has recently turned chronic, there will be a mix of both cells, indicating that the memory cells are active, but the body is still trying to rid itself of the disease. For late-stage patients, only traces of the original bacteria might be present, giving a negative reading (this is where the traditional ELISpot falls down). However, there will be plenty of active memory T-cells in the results, indicating that the patient once suffered from a Lyme infection. That, coupled with the inflammation symptoms, can allow doctors to accurately deduce that the disease has effectively turned full-blown chronic.
The stage the disease is at matters hugely, as it will dictate the subsequent treatment path for the patient. The way that inflammation symptoms are treated differs hugely from the antibiotic-based approach that is effective against the infection proper. Often, a combination of the two is required. This is why initial accuracy in the testing stages is so critical for both patients and doctors alike. It’s also important to be able to return to this test and decipher how effective the treatment methods have been, using it as a measurement of sorts for patient progress. The issue of accuracy is just one small facet of the larger Lyme disease problem. The advancement of the ELISpot to the LymeSpot is great, but more needs to be done in order to legitimise Lyme to people and medical professionals all over the world. Only then will we be able to fight chronic Lyme disease on a level playing field.