The most reliable method of diagnosing Lyme disease is a clinical exam
supported by laboratory tests. In cases where the "bull's eye" rash is present
in conjunction with a fever or the patient saw the tick, treatment can begin
without any further tests.
The laboratory tests available are the Western blot and ELISA, but neither is a
reliable indicator: test results vary between labs and within the same lab,
sero-negative results are frequent.
Polymerase chain reaction (PCR) tests for Lyme disease may also be available to
the patient. A PCR test attempts to detect the genetic material (DNA) of the
Lyme disease spirochete, where as the Western blot and ELISA tests look for
antibodies to the organism. PCR tests are also susceptible to false-positive
results.
In cases of chronic Lyme disease, diagnosis is often clinical and must take all
factors into account (tick bite exposure, symptom history, etcetera). Positive
diagnosis will continue to be problematic until a more reliable test is
developed.
The severity and treatment of Lyme disease can be complicated by simultaneous infection with other tick-borne diseases, also known as coinfections, bacterial load and immune suppression in the patient.
The disease is rarely fatal in and of itself. Chronic Lyme can cause severe disability and morbidity.
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