Lyme disease is a bacterial infection caused by a spirochete, a type of bacteria, called Borrelia burgdorferi, which is passed to the patient by a tick bite. Lyme disease, also called active lyme borreliosis, has many symptoms, but skin symptoms, arthritis and various neurological symptoms are usually present. Examples include a reddish skin rash, head aches, neck pain, chronic fatigue, fibromyalgia, joint pains, emotional instability and mental confusion.

Unfortunately, standard laboratory testing is often unable to give clear results of whether a patient is infected or not. The standard serological test ELISA has the broadest detection rate but low specificity. Specificity can be improved with the Western Blot. The test with the highest specificity but with a fairly low detection rate is the PCR test. Borrelia infections are usually treated with antibiotics.

Lyme disease is often misdiagnosed as chronic fatigue syndrome, multiple sclerosis, fibromyalgia, rheumatoid arthritis, and many other autoimmune and neurological diseases, which leaves the infection untreated and allows it to further disseminate the organism. If the neurologic form of borreliosis is left untreated for years, it may lead to severe debility of the patient.

The MELISA^® technology can now be applied to diagnose active Lyme disease, especially in serologically and clinically unclear cases. To date, hundreds of patients have been tested and successfully treated. Laboratory Center Bremen in Germany does this testing routinely, so please contact Dr Elizabeth Valentine-Thon (evt@laborzentrum-bremen.de) at +49 421 4307 -305/206 if you want to be tested.

Dr Elizabeth Valentine-Thon's article "A novel lymphocyte transformation test (LTT-MELISA^®) for Lyme borreliosis" is published in Diagnostic Microbiology and Infectious Disease (scroll to the bottom of the page for abstract and to download article).

Frequently Asked Questions about Lyme disease (Lyme Borreliosis)

What is Lyme disease? Lyme disease, also known as Lyme Borreliosis, is caused by the bacterium Borrelia burgdorferi, which is a spirochete.

How is Lyme disease transmitted to humans? Lyme disease is a vector borne disease and transmitted to humans primarily through the bite of a tick that is infected with this bacterium. An infection with the bacterium is a prerequisite for developing Lyme disease. At the same time, not every infected person will develop the disease.

What are the symptoms of Lyme disease? After an incubation period of two to thirty days, the typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erthema migrans, which often takes a bull’s-eye appearance and is seen in 50-80% of Lyme disease patients. This represents “Stage I” of the disease. If untreated, infection can spread to the joints, the heart, and the nervous system, causing a large variety of symptoms which may persist over months or years (chronic Lyme).

How is Lyme disease diagnosed? Lyme disease diagnosis is based on symptoms and the possibility of exposure to infected ticks. Laboratory testing on the blood can then be preformed to confirm the infection (presence of antibodies).

How is Lyme disease treated? Patients treated in the early stages of the disease usually recover rapidly and completely with a few weeks of oral antibiotics. Patients treated during the late stages of the disease may require longer antibiotic therapy and may have recurrent symptoms.

What types of standard tests are available for Lyme disease? Conventional laboratory testing includes the serological test ELISA, which has a low specificity, and the Western blot has a higher specificity. Both tests look for Borrelia specific antibodies. These tests can give false negative results, especially in patients with early disease (Stage I) and therefore a misdiagnosis can occur. Lyme disease is often misdiagnosed as chronic fatigue syndrome, multiple sclerosis, fibromyalgia, rheumatoid arthritis, and many other autoimmune and neurological diseases, which leaves the infection untreated and allows it to further disseminate in the organism. If the neurological form of Lyme disease is left untreated for years it may lead to severe debility of the patient.

What is MELISA^® and how is it different? MELISA^® is a lymphocyte transformation test, which detects not antibodies but cellular immunoreactivity characteristic of active infections of Borrelia burgdorferi. The test improves laboratory diagnosis by confirming active disease in patients with clinical symptoms of Lyme. In addition, this test provides and an early marker for successful antibiotic therapy, while antibodies may persist for years in successfully treated patients.

What is needed to use the MELISA^®? If you believe you may have Lyme disease, you should immediately contact your general practitioner. In order to perform the MELISA^® test for Lyme disease, 20-30 ml of blood along with a special Request Form is needed.

How much does the MELISA^® cost and does insurance cover the test? The MELISA^® currently costs 160 euro. Many insurance providers will cover the cost of the test along with one round of oral antibiotic treatment; however, you should contact your insurance provider regarding your policy and benefits.

How common is Lyme disease in the UK? There are 500 confirmed cases of Lyme disease in the UK each year according to the Health Protection Agency (HPA). However, this does not necessarily reflect all the cases of the disease. HPA estimated that there could be up to 2,000 new cases occurring every year in the UK.

Who is at risk for Lyme disease? In the UK, Lyme disease is carried by the sheep tick, Ixodes ricinus, which can also feed on deer, birds, and other wild and domestic mammals. The tick is commonly found in woods, heath, and moorland, although it does not live exclusively in these habitats. People who live in the parts of the country where the tick is prevalent are at greater risk.

How can Lyme disease be prevented? Reducing exposure to ticks is the best defense against Lyme disease. If in a wooded area, always wear long pants and a long-sleeved shirt and use insect repellent with 20-30% DEET. Also, remove ticks promptly from clothes and perform a tick check before going indoors. If bitten, removed the tick as soon as possible to reduce the risk if infection.

A novel lymphocyte transformation test (LTT-MELISA^®) for Lyme borreliosis
Valentine-Thon E, Ilsemann K, Sandkamp M. Diagn Microbiol Infect Dis. 2006 Jul 27
Diagnosis of active Lyme borreliosis (LB) remains a challenge in clinically ambiguous, serologically indeterminant, and polymerase chain reaction-negative patients. Lymphocyte transformation tests (LTTs) have been applied to detect specific cellular immune reactivity, but their clinical application has been severely hampered by the poorly defined Borrelia antigens and nonstandardized LTT formats used. In this study, we describe the development and clinical relevance of a novel LTT using a validated format (MELISA^®) together with well-defined recombinant Borrelia-specific antigens. From an initial screening of 244 patients with suspected Borrelia infection or disease, 4 informative recombinant antigens were selected: OspC (Borrelia afzelii), p41-1 (Borrelia garinii), p41-2 (B. afzelii), and p100 (B. afzelii). Thereafter, 30 seronegative healthy controls were tested in LTT-MELISA^® to determine specificity, 68 patients were tested in parallel to determine reproducibility, and 54 lymphocyte-reactive symptomatic patients were tested before and after antibiotic therapy to assess clinical relevance. Most (86.2%) of the 36.9% (90/244) LTT-MELISA^® positive patients were seropositive and showed symptoms of active LB. Specificity was 96.7% and reproducibility 92.6%. After therapy, most patients (90.7%) showed negative or markedly reduced lymphocyte reactivity correlating with clinical improvement. This novel LTT-MELISA^® assay appears to correlate with active LB and may have diagnostic relevance in confirming LB in clinically and serologically ambiguous cases.

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