Are there different types of Western Blot tests? Would Candida show up as reactive on a ELISA? I think I need to take a college course or something.

Ive done a lot of research yet I cant find a straight answer.

Lyme IgG/IgM Antibody Serology

The Lyme IgG/IgM Antibody Serology test is an enzyme linked immunoassay (ELISA) which indicates the presence of IgG and IgM antibodies to B. burgdorferi. The IgG antibody often persists long after symptoms have disappeared. The presence of antibody indicates exposure, not necessarily active disease. A positive or equivocal result must be confirmed by both IgG and IgM Western Blots.

Lyme IgM Antibody Serology

The Lyme IgM Antibody assay is another serologic test in ELISA format, and it detects the presence of IgM antibodies after exposure to an infected tick. IgM antibodies apppear early in response to infection, and this test may be positive two to six weeks following exposure. Because of the test's lack of specificity, a positive or equivocal result must be confirmed by an IgM Western Blot.

Lyme Western Blot

IgG Western Blot

The IgG Western Blot is a sandwich-type immunoassay performed in a manner that allows the antibody response to be visualized. It is a qualitative test and is generally more sensitive and specific than the ELISA.

IgM Western Blot

This test is a very sensitive indicator of exposure to B. burgdorferi. It may be positive as early as one week after a tick bite, and will usually remain positive for six to eight weeks after initial exposure. A positive IgM result with clinical history can indicate early Lyme disease, or even persistent infection in otherwise serologically negative individuals.

Antigen Detection

Lyme Dot Blot Assay (LDA)*

The LDA is an immunoassay for the direct detection of Lyme antigen in urine that reacts specifically to rabbit anti-B. burgdorferi antibodies. The rabbit antibodies are specifically targeted to the following B. burgdorferi antigens: 23kDA-25kDA (Osp C), 31 kDA (Osp A), 34 kDA (Osp B), 39kDA and/or 93kDA. If the Borrelia specific antigen(s) are present in the urine sample, a dot with a bluish-purple precipitate forms on the membrane. The limit of detection in urine spiked with sonicated B. burgdorferi is 12.5 ng/ml of urine.

Reverse Western Blot (RWB) for Antigen*

The RWB is an immunoassay for direct detection and identification of Lyme antigen in urine which specifically react with rabbit anti-B. burgdorferi antibodies. The rabbit antibodies are specifically targeted to the following B. burgdorferi antigens: 18kDA, 23kDA-25kDA (Osp C), 28kDa, 30kDA, 31kDA (Osp A), 34kDA (Osp B), 39kDA, 45kDA, 58kDA, 66kDA and 93kDA. If any of the Borrelia specific antigen(s) are present in the urine sample, bluish-purple bands are visualized on a membrane.

The RWB can be performed as a confirmation test on any presumptive positive LDA sample.

*Note: Urine antigen detection tests are currently not available in New York.

Neurological Symptoms

IgG and/or IgM Western Blot

Polymerase Chain Reaction

Detection of Borrelia burgdorferi with the Multiplex PCR

The multiplex polymerase chain reaction (PCR) is a very specific and sensitive assay for the detection of Borrelia burgdorferi-specific DNA in clinical specimens. Theoretically, the assay can be performed on any sample. B. burgdorferi-specific genomic and plasmid DNA are simultaneously selected, amplified, and detected. A negative result implies only that B. burgdorferi-specific DNA was not detected in the test sample. While the PCRs potential sensitivity is tremendous, the sample tested must contain at least one recoverable organism for the genomic assay, and pieces or blebs of antigen for the plasmid assay.

Which tests to perform?

Summary

There is a logical sequence in selecting laboratory tests to aid in the diagnosis of Lyme disease. Much like the hepatitis model, antigen is present early after initial infection. Later, there is an antibody response in about 70% of patients. IgM appears first and is followed by IgG. There are two different types of antibody assays: the ELISA and the Western Blot. The ELISA is a poor assay, with marginal sensitivity. The Western Blot is the more sensitive test.

Recurrent and persistent infections offer a unique diagnostic problem, since the IgG response may be absent. The IgM Western blot may be helpful for some patients with persistent disease, but care must be taken to rule out cross-reactions. During persistent or recurrent disease, assays that detect antigen can be useful.