Correctly diagnosing chronic Lyme disease is one of the most consistent problems doctors face. This unfortunate struggle is compounded by the fact that many clinics and medical professionals don’t recognize chronic Lyme as a legitimate disorder, in line with the views of the CDC (Centers for Disease Control and Prevention). Subsequently, misdiagnosis rates are high, as Lyme is consistently confused with other chronic degenerative diseases such as fibromyalgia, MS, and even other more serious complications like Parkinson’s or MND. Accurate testing tools are an important addition to the Lyme-literate doctor’s arsenal, and a new variation on the traditional ELISpot test is proving to be a major breakthrough in the diagnostic field. This test is called the LymeSpot, and it provides a much more accurate picture of where a patient stands in their battle against Lyme.
Lyme is a complicated disease; it’s not just as simple as saying you have or you don’t have it. For starters, it comes in two forms: acute and chronic. Acute Lyme disease is much easier to treat, but you have to catch it in the first few weeks. Unfortunately, the symptoms often resemble a simple flu, meaning it can be easily missed. After a few weeks, the acute symptoms will subside, and the disease will progress – over a number of weeks, months, or even years – to its chronic form. During this stage, new symptoms will appear, but the exact nature of these symptoms will vary from patient to patient. Generally, they will include some sort of joint and muscle ache and/or weakness, a constant sense of fatigue, and neurological issues like impaired memory and difficulty concentrating.
Acute Lyme disease can be diagnosed by assessing a patient’s symptoms, checking for the telltale bullseye rash, and confirming that the patient has been bitten by a tick or recently exposed to a tick-infested area. Chronic Lyme disease diagnosis requires a blood test. Previously this was done with an ELISpot, but issues arose with its accuracy; a not insignificant number of tests were returning as false negatives. Thus, a new method was required. The new LymeSpot was developed in Germany by AID, with support and patient samples from BCA-clinic, one of the most prominent and well-respected Lyme disease clinics in the world. This new test is far more accurate than previous incarnations of the ELISpot, and can tell doctors a lot about their patient’s current condition. But how exactly does it do this, and why is it more accurate?
The key is that the LymeSpot tests for two types of T-cell subsets as opposed to one. T-cells are a complex group of white blood cells, an intrinsic part of our natural immune system. In relation to this new Lyme test, the important thing to understand is that antigen-specific T-cells are formed as naïve T-cells in the bone marrow and activated upon encountering the antigen they are specific for. This happens at the beginning of an infection, during the first few days, to help the body fight off the infection. These antigen-specific T-cells come in multiple variants: helper cells, regulatory cells, effector cells, and memory cells. T-helper cells help to fight off the invading pathogen. They are active in the lymph node and are deployed to the site of the infection. Memory cells form once the immune system destroys their targets, meaning the bacterial load or viral load is reduced. The memory cells patrol the body after the infection is gone, preferably in the tissue in which the pathogen entered the body.
The LymeSpot is specifically concerned with these two antigen-specific T-cells, which produce unique cytokines. The helper cells produce interferon-gamma, known as IFN-gamma, while the memory cells produce interleukin-2, known as IL-2. (For more on this subject, read our separate article detailing why those two molecules are important to the diagnosis of Lyme disease.) By testing for these cytokines, doctors can accurately ascertain which stage a person is at with their specific case of Lyme disease. For example, if only IL-2 producing T-cells are discovered, it’s a pretty clear indication that the infection is cleared, as there are no helper T-cells present. However, if a test reveals both a mixture of IL-2 and interferon-gamma producing cells, then the patient’s status can accurately be diagnosed as “chronic controlled,” or the infection is being cleared and the pathogen load is getting lower. This indicates that the patient has fought off the disease in the acute stage – hence the antigen-specific memory cells – but continues to fight an incarnation of the same pathogen, hence the antigen-specific helper cells.
As it stands, BCA-clinic in Germany and Infectolab in the U.S. are the only two laboratories running this specific iteration of the ELISpot, making them the most accurate source of Lyme disease diagnostics so far. Previous tests have focused on antibodies, which give a fairly accurate but less specific view of a patient’s immune system. However, testing for antigen-specific T-cells represents a major breakthrough in Lyme disease treatment. The immune system is complicated, but it is inextricably linked to chronic Lyme, as a whole subset of symptoms is caused by inflammation, not solely infection. In fact, a patient can have relatively little trace of Lyme bacteria in their system, but still be very sick from the haywire immune response. Hopefully, these new diagnostic methods will lead to less instances of misdiagnosis, and forge a path to legitimization for this much-maligned but severely debilitating disease.