Monday, June 15, 2009

My basic panel of tests ordered for the evaluation of suspected tick borne disease

The diagnosis of Lyme disease is made on clinical grounds. Nonetheless, these are routine test- I suppose standard tests, ordered for many of my patients suspected of having tick borne illness-
CBC
Chem panel-CMP
Sed rate
CRP
C3a and C4a
B12 and folic acid
Vitamin D: hydroxy 25 and didroxy 1,25
CD57- if covered by insurance
ANA
Rheumatoid factor
Bartonella antibody panel
RPR- HIV and hepatitis screen where appropriate
Babesia antibody panel: microti and WA1- although the name has been changed to duncani, Labcorp and Quest only know it by this name
Ehrilchia antibody panel plus Anaplasmosis
Lyme ELIZA C6 peptide index
Lyme Western Blot: 14IgM and 14 IgG bands- if the patient cannot afford the test I will first obtain the 13 blot test- I still get many positives
Wet mount examination of patient's blood
Only the expanded Lyme Western Blot and the Wet mount need to be performed by specialty labs

If further co-infection testing is required then Babesia species and Bartonella species by PCR may be obtained. A FISH test exists for Babesia- I have not generally ordered this test

Mycoplasm fermentans is a tick borne organism. It can only be demonstrated by PCR. An antibiotic active against Mycoplasm species should be given first to increase yield. Alternatively, a Mycoplasma species PCR may be ordered- this has a higher yield. It may demonstrate the presence of non-tick borne tissue organisms. I do not generally order this test

Another other non tick borne organism which I sometimes test for is Chlamydia pneumonia. This is an antibody test. PCR is also available- but is rarely positive

Fluids such as synovial fluid are tested for Lyme antibodies, C6 peptide index and Lyme PCR

Testing for viruses, such as EBV does not change my therapy- these tests only cause confusion- so I do not order them

Patients with fatigue- nearly everyone, gets a sleep study- sleep disorders are incredibly common in this group of patients

Patients with cognitve issues get brain MRI and SPECT scan

This is my basic set of tests for many patients

7 comments:

Asquirrelygirl said...

I am interested in making an appointment but I cannot located any of your contact information.

Hua said...

Hi,

Interesting stuff. Didn't know this was how testing was done. Thanks for sharing.

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Laura said...

What is the significance Of the B12 and Folic Acid testing?

Shandy Monte said...

How do you know the difference between Lyme and Autoimmunity??

tj said...

i would like to schedule an appointmant with you. please send your contact information.

mom07 said...

i am interested in making an appointment with you and would like to know where you are located, hours and how long it takes to get an appointment with you and your fees.

Shawn said...

I'm assuming a LOW sed rate is an indication? Dr. Paul Cheney mentions a low Sed Rate is an indication of elevated NO.