Learn more about diagnosing lyme disease

Testing for Lyme Disease

Lyme disease is primarily a clinical diagnosis.  

Doctors who are experienced in treating the disease generally treat based on symptoms in an effort to prevent the development of the bacteria within the body.


Testing for Lyme disease in Alberta is a two-tiered approach using serologic (blood) tests:

Tier One - A screening test Lyme C6 enzyme immunoassay (EIA/ELISA) that looks for IgM and IgG antibody to B. burgdorferi, afzelii and garinii                
Tier Two - A confirmatory Western Blot ONLY if tier 1 is positive.

(In Canada these tests are on Borrelia burgdorferi strain B31) These tests examine one strain of Borrelia when many strains may be possible.

In reality, most Canadians only ever receive one tier, making the two-tiered system advertised a falsehood.


According to the International Lyme and Associated Diseases Society (ILADS), the ELISA screening test is unreliable. The test misses 35% of culture-proven Lyme disease and this amounts to less than 65% sensitivity, as not every Lyme patient is culture-positive. ILADS advocates that a screening test should have a sensitivity of 95% or greater, and therefore the ELISA is unacceptable as the first step of a two-step screening protocol. By definition, a screening test should have at least 95% sensitivity.


Diagnostic Criteria for Lyme in Alberta (AHS)
1. Exposure Criteria - Travel to a location where Lyme disease is known to be transmitted (endemic area) PLUS time spent in wooded, brushy or grassy areas
2. Clinical Criteria – erythema migrans (EM) rash
3. Laboratory Criteria – One of the following options must be positive:
               a. Two-tier serology interpreted according to established criteria (EIA/ELISA followed by Western blot)
               b. Molecular detection (e.g., PCR) for B. burgdorferi and other non-North American strains (e.g., B. afzelii and                   B. garinii)
               c. Culture for B. burgdorferi


The Public Health Agency of Canada’s former chief medical officer, Dr. Gregory Taylor, has publically stated concerns with knowledge gaps in Lyme disease and that Canada should do better. “We are sure it is underreported,” he said.


Considerations with Diagnostic Criteria (LDAA)
1. Exposure Criteria – Surveillance in Alberta relies heavily on tick samples being submitted by the general public. Until ongoing active surveillance is readily available, the LDAA is concerned about exposure to growing populations of ticks in the province. Ticks are carried by migratory songbirds so this is also an important consideration.
2. Clinical Criteria – studies have shown that around half of people with culture-proven Lyme disease do not recall any type of rash. If a person does get a rash, it can arise in various forms and sizes.
3. Laboratory Criteria – Two tiered testing procedure tests for one strain of Borrelia in a sea of strains worldwide. The 1st tier (EIA/ELISA) has been shown to miss many cases of culture-proven Borrelia infection.

Read the Alberta Health Services Notes for Clinicians on Lyme Disease



Out-of-Country Laboratory Testing Options


Stony Brook University Medical Center

Armin Labs

A Western Blot is available without the first tier EIA/ELISA screening test.  Some labs also test for more strains or Borrelia.

The Government of Alberta and many physicians do not accept test results like PCR and Borrelia culture, from laboratories outside of Canada, unless they use the same 2-tiered testing protocol used throughout Canada.

The Lyme Disease Association of Alberta (LDAA) does not endorse nor promote specific laboratories.


People with tick bites or undiagnosed symptoms may require additional testing for other tick-borne diseases and possible co-infections such as Babesia, Anaplasma, Ehrlichia and Bartonella.
The presence of a co-infection may lead to the probable infection with the Lyme spirochete additionally. If co-infections are untreated, their continued presence can prevent successful treatment of Lyme disease.


Thinking it Through

Current Canadian Guidelines based on the US CDC’s definitions need to be revised and updated. Consensus can be achieved by openly and transparently debating the complete spectrum of available peer-reviewed medical literature, and the Lyme Disease Association of Alberta puts emphasis on clinical diagnosis, improved testing, and better patient outcomes.
The Lyme Disease Association of Alberta (LDAA) attended the Conference to Develop a Federal Framework for Lyme Disease in May 2016 to contribute perspective on the issues facing Albertans with the existence of tick populations in our province. A draft "framework" has been released and Lyme advocates have called for its revocation.
The LDAA advocates for change with current testing practices and encourages the medical community to learn more about the challenges faced by patients and prospective patients of tick-borne disease/Borreliosis. LDAA funds research as available to improve future outcomes.

Please review SIGNS & SYMPTOMS 


Understanding Serologic (blood) tests
These tests do not detect the presence of the causative organism, Borrelia. They detect a patient’s antibody response.
How the test is performed: Antibodies, also called immunoglobulins, are specialized proteins produced by a type of white blood cell, called B-cells, that react to and attach to a foreign substance and are an important part of a functional immune system. Antigens are substances, usually proteins, produced by the pathogen (the infectious agent), in the case of Lyme disease, Borrelia burgdorferi, that induce a specific immune response in the infected individual. The EIA (or ELISA) are performed by taking either whole Borrelia burgdorferi cells that are lysed (opened or broken up) or a mixture of a purified Borrelia burgdorferi antigen(s) and reacting them with a patient’s serum. If the patient has produced antibodies to the antigens, they will be present in a patient's serum, and an enzyme or fluorescent labelled antibody reactive to human antibodies can attach to and be used to detect them. The Western Blot is performed by taking various antigens, separating them according to size (molecular weight) by an electrical current, then reacting them to a patient’s serum. Antibody reactions to the individual antigens are then detected and recorded.

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