What is the diagnostic procedure for suspected chronic Lyme disease?

Many people go through a true odyssey before finally being diagnosed with chronic Lyme disease. This is due to the fact that there is no single test that by itself reliably proves or excludes such a disease. Only the combination of different tests allows a statement whether the presence of chronic Lyme disease is probable, possible or unlikely.

A comprehensive diagnosis should clarify the following questions:
  • Is a chronic infection present at all?
  • If yes, is this active or inactive?
  • What consequences are detectable (immune system disorders, metabolic changes, systemic inflammation, regulatory disorders, etc.)?
  • Are there concomitant factors (co-infections, heavy metal contamination, vital substance deficiency)?

The medical history already provides initial indications of the presence of a multisystemic disease. Mainly the symptom pattern and its development so far as well as a possible temporal relationship between the first symptoms and remembered tick bites provide corresponding clues. However, it should be noted that a Borrelia infection can also be present even if the patient does not remember a tick bite or a bulls eye rash.

The first diagnostic step is usually performed by the general practitioner with the determination of antibodies against Borrelia.

The standard test procedure, the antibody determination, is intended to answer the question of whether the immune system has already had pathogen contact, i.e. whether an infection with Borrelia has occurred at all. This test can usually distinguish between an acute infection and an infection that occurred some time ago. However, the test does not give an answer to the question whether such an infection has healed or still persists.

A negative test result (no antibodies are found = seronegativity) definitely does not exclude an infection. Often, it are the clinically more severely ill patients who show no or an atypical antibody formation (exclusively short term antibodies = IgM). This may be due to genetic reasons (so-called HLA-DR1 association) or to a severe (infection-related) impairment of the immune system leading to a lack of antibody development. In the latter case, an initial positive detection of antibodies is found over time. Over the years, however, the titer decreases continuously to seronegativity. Such a course is often misinterpreted as a healing of the infection. This is contradicted by the parallel deterioration in the patient's state of health. These people fall through the diagnostic raster, because in the absence of antibody detection, further diagnostics are usually omitted. Unfortunately, this is partly due to legal regulations that prevent the statutory health insurance funds from covering the costs of further tests.

Other test methods are therefore necessary to detect a possible infection. Several methods are available for this purpose, not all of which are mandatory for every patient. However, as mentioned at the beginning, there is no single test that by itself can reliably exclude or prove an infection. Only the combination of different tests allows a largely reliable statement. The selection must be made according to diagnostic criteria and the expected costs.


Possible test procedures for pathogen diagnostics include, in order of application:

  • Antibody tests (ELISA, Western blot, recomBead test, immunofluorescence test, B16+ test) examine the response of the humoral (antibody-forming) immune system to a pathogen infection. Antibodies mainly reflect the immune memory and provide information on whether an infection has occurred at all. Statements about the activity of the infection or whether the pathogens against which the person has formed antibodies are involved in the disease process at all are often only possible to a very limited extent.

  • Activity tests (LTT = lymphocyte transformation test or the ELISPOT test) determine the cellular response of the immune system to a pathogen infection. Since the immune cells examined have only a very short life span (6-8 weeks), conclusions about the pathogen activity in the last 6-8 weeks can be drawn from their activation level.

  • The determination of the so-called CD57+ NK cells gives an indication (not proof) of the impairment of the immune system by a multi-infection event. Very low values are an indication of the ability of the pathogens to manipulate the immune system itself. The progression of CD57+ levels allows certain prognostic statements to be made.

  • A PCR test (from blood, urine, liqour or tissue biopsy) detects the genetic material (DNA) of the pathogens, but cannot distinguish between living and dead pathogens. In chronic infections, however, the PCR test plays only a minor role, since at least in the easily accessible body substances (blood, urine), pathogen DNA is usually no longer detectable.

  • In addition, there are other test methods that are scientifically much less proven and therefore controversial. They are therefore not suitable for the reliable detection of pathogens, but can provide initial or supplementary indications of an infection.

    • Bioenergetic diagnostics: Each element, each substance, each pathogen or each organ can not only be examined biochemically but also have a specific energetic vibration frequency. The detection of the specific oscillation frequency of a pathogen or a substance (e.g. heavy metals) provides indications that can complement comprehensive diagnostics.

    • Dark field microscopy: Disease-related changes in the blood (e.g. clumping of red blood cells) but also larger pathogens such as bacteria, parasites and fungi are partially visible in dark field microscopy. Corresponding images can sometimes say more than a thousand words.

    • Phage test: This detects virus-like particles (phages) that are specifically located on the surface of bacteria. Borrelia bacteria have different phages than Chlamydia or Yersinia or other bacterial pathogens. Simply put: If pathogen-specific phages are found, then the pathogen must also be in the body.

A Borrelia infection rarely comes alone. In most cases, the immune system has to deal with a whole range of other infectious agents. These include pathogens that are also transmitted by ticks or pathogens with which the patient has become infected by other means. Examples are:

  • Bacterial pathogens: Anaplasma, Bartonella, Chlamydia, Mycoplasma, Yersinia and others.
  • Viruses: Epstein-Barr, herpes, cytomegaly and others
  • Parasites: Babesia, toxoplasma, worms and others
  • Fungi: Candida, molds (aspergillos) and others.

Here, too, a selection must be made with regard to diagnostics based on the clinical probability of the presence of such a co-infection, the therapeutic consequence, and the costs.

In addition, the following examinations should ideally be performed for every infection-related multisystem disease:

  • Cellular immune status (provides information on immunocompetence, immune activation and immunotolerance)

  • Autoimmunity diagnostics (as a result of "confusion" of pathogen structures with the body's own tissues, the immune system may attack its own body = autoimmunity)

  • Heavy metal screening (mercury, lead, cadmium or aluminum are not only harmful to the organism on their own, they also induce biofilm formation in pathogens, a resistance mechanism that protects pathogens from heavy metals, from the immune system and, unfortunately, from antibiotics)

  • Vital substances diagnostics (serious chronic diseases lead to an increased need for vitamins, minerals and enzymes)

  • Regulation diagnostics (disturbances in the autonomic nervous system, the control center of all internal processes in the organism, represent an obstacle to therapy and must be recognized and treated accordingly)

  • Detection of metabolic changes which are typical for a multisystemic disease, such as dysfunctions of the mitochondria (the energy power plants of the cells), systemic inflammation, oxidative and nitrosative stress (free radicals) or specific hormonal and enzymatic metabolic disorders

Overall, the diagnosis of suspected chronic Lyme disease or another infection-related multisystem disease is very complex and therefore belongs in the hands of a specialist. Basically: As much diagnostics as necessary to find a holistic and promising therapy approach. However, no diagnosis should be made without a therapeutic consequence resulting from it. The final scope of the examinations to be performed will be determined during the initial appointment in the consultation.



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Dr. med. Frank Riedel
Karl-Marx-Straße 1 | 15926 Luckau
Tel.: 03544 2232
Fax: 03544 557282
E-Mail: info@riedel-luckau.de