Lyme disease (also known as Lyme borelliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. Lyme disease is a notifiable disease in Ireland since 2012. The infection is confirmed by blood tests which look for antibodies to Borrelia burgdorferi produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease.
Laboratories in Ireland generally follow the standard approach to Lyme diagnostics which is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other spirochaete infections including syphilis, and certain viral infections including glandular fever. In addition, sera from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results.
Testing which is performed abroad may be performed in laboratories which have not met National or International Accreditation (Quality Standards). These tests may be more likely to give a “false positive” result. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. Irish laboratories have their own quality assurance methods to make sure the tests are working correctly as well as being accredited by the Irish National Accreditation Body to perform the test correctly.
If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Rare and Imported Pathogens Laboratory (RIPL) Service of Public Health England Porton which uses a two-tier system recommended by American and European authorities. This involves a screening serological test followed by a confirmatory serological test. All clinical (and other) laboratories must undergo continuous quality assurance to ensure that the quality of the diagnostics they provide is maintained at the highest international level for human diagnostics. This two tier approach gives a great degree of certainty around the diagnosis of Lyme. All testing in Ireland is confirmed by the RIPL.
Lyme disease is a well-recognised infection, which is familiar to GPs and hospital specialists (especially those specialising in Infectious Diseases, Neurology, Dermatology Cardiology and Microbiology). Accordingly, such specialists would be very familiar with how to manage such patients, and as a result, all physicians deal with Lyme disease, as they would with any other infectious disease for which they have responsibility. As testing and treatment for Lyme borelliosis is widely available in all major hospitals in Ireland there is no need for people to travel to other EU Member States for diagnosis or treatment.