Unfortunately, practicing physicians are poorly trained regarding laboratory medicine. I have to admit that I am not well versed in the intricacies of IFA, PCR, gene sequencing and other cutting edge lab tests. But I did learn a little something more years ago than I want to admit. Once upon a time I worked in the trenches of the old D.C. General Hospital/Georgetown division. Patients were regularly admitted producing copious sputum. At 3am the rag tattered interns performed gram stains for bacteria and AFB stains for TB. We even spun down blood samples carefully pipetting off the white blood cells, the buffy coat, and gram stained this, looking for bacteria in the blood. If we saw gram positive bacteria in chains we suspected Streptococcal infection (Strep pneumo). If we saw weakly staining gram negative rods we suspected H. flu. We used this preliminary data to guide or choice of antibiotics. We still didn't know for sure which germ the patient had until the culture came back. Fry labs makes a diagnosis based on a blood smear. They don't even have a gram stain. Sorry. You can't distinguish Mycoplasma from Bartonella from Ehrlichia with these stains. You can't get a culture. But now there is a high tech answer. The DNA from the spotted bacteria can be extracted. All bacteria have a segment of DNA called 16S. This segment can be sequenced with technology that would have been unimaginable to the interns at D.C General working at those ungodly hours. The sequencing can be compared to a compendium of the sequencing of all known bacteria. It is like a fingerprint. The bacteria can be definitely identified. No guessing. (Clongen)
Lyme tests: All Western Blots are not equal. State of the Art technology can give results which are extremely accurate.
PCR: I got my first + result from synovial fluid: Supersensitive PCR assay.
I might have to take back things I said about Lyme and PCR in the past.
PCR: New test for Bartonella: 20 strains.
PCR: New test for Babesia, expected soon: 15 strains!
PCR: Mycoplasma: Many positives. First give anti-Mycoplasma antibiotics to chase bacteria from intracellular hiding space.
Ehrilchia: PCRs good: Serology OK and much cheaper.
I am putting together new panels with Clongen which should be very helpful for LLMDS. Clongen has a full service, high tech lab with a huge test menu. I am afraid Tick borne infection profiles will swamp this small lab soon.