Posted by gmays 19 hours ago
The vendor claims "lab-level accuracy" (conveniently omitting the actual accuracy numbers), but the test is a lateral flow test, which means its Limit of Detection is going to be orders of magnitude worse than molecular tests. Tick tests do not require FDA clearance, so their claims are most likely unreviewed.
Existing lab tests for ticks are almost universally based on PCR.
Ticks are small (especially nymphs) and extracting enough material can be tricky even for molecular testing, so I can't imagine an LFT test working terribly well, especially for nymphs, which are responsible for a lot of Lyme infections due to being easy to miss.
The other, bigger problem is that the test result is mostly useless.
The risk of Lyme transmission from an infected tick ranges rougly from <1% for a fresh bite (<24h) to ~10-25% once the tick is engorged (72h+). A positive tick test result would be insufficiently predictive of Lyme disease transmission on its own to justify taking antibiotics in most cases in the absence of other symptoms.
And you can't trust negative results either due to limited sensitivity, so you can't rule out transmission either.
In my opinion, tests like this can lead to worse overall health outcomes due to unnecessary treatment or withholding prophylaxis from someone who otherwise qualifies.
The infected unfed ticks have few spirochetes in them. The numbers grow by two orders of magnitude as they feed - the reason why old bites are much more dangerous than the fresh bites.
Even smaller and less noticeable are the larvae. And I know I learned that they cannot transmit the disease, because they only do so, if they have biten an infected animal before - so I never worried about small ticks, but apparently new research indicates, that this is wrong.
"However, newer research suggests that some pathogens, including Borrelia miyamotoi, may be transmitted from the adult female tick directly to her offspring.
This means larval ticks may already be infected before their first bite."
https://danielcameronmd.com/larval-ticks-borrelia-miyamotoi/
Hey, labs have QC failures all the time.
Lyme post-exposure prophylaxis (PEP) is a single dose of doxycycline (200 mg for adults, or weight-adjusted for children) taken within 72 hours of removing a high-risk blacklegged tick bite to prevent Lyme disease.
However, guidelines universally recommend against testing ticks. For instance, IDSA says this:
> Knowing tick characteristics (ie, species, life stage, and an assessment of the degree of blood engorgement) is helpful for anticipatory guidance and in determining if antibiotic prophylaxis to prevent Lyme disease is appropriate [127]. Tick identification is available in most commercial laboratories and at some local health departments. Studies from the United States and Europe have shown that detecting B. burgdorferi sensu lato in Ixodes spp. ticks, however, poorly predicts either subsequent disease (0–12.4%) [126, 128–133] or asymptomatic seroconversion (0–4.7%) [126, 129, 130, 132, 134]. This is likely due to a variety of factors that influence the likelihood of transmission and the observation that most Ixodes spp. ticks discovered by patients have been attached for <48 hours [61, 62, 135].
(https://www.idsociety.org/practice-guideline/lyme-disease/)
The point is that the test is likely not useful to reliably inform any sort of prophylactic treatment, especially if the risk of transmission is high enough to warrant prophylactic treatment in the first place, in which case the PEP is indicated regardless of the tick test.
Sure, it modifies the prior probabilities, but what's the clinical significance of that?
Here in the UK, Lyme traditionally been a marginal problem (tick bites aren't) but we now have such rapid climate change, along with rapidly increasing wild deer and boar populations, that some areas in the UK are becoming risk zones on more or less the same level of risk as some US regions.
Alas the difference here is that education has not caught up to the USA: very few people have any grasp of the risk of Lyme because the high risk zones are, by and large, not well known, and they don't always correlate that well with the basic risk of acquiring a tick.
I think most specialists in the UK think this is likely to lead to a pretty big increase to infections before people learn, so maybe this sort of tool will help offset that.
I walk a lot in an area with some wild deer and boar, and I would love to have one of these in my cupboard as a precaution. Would be great to see them in supermarkets in high risk areas, too.
There is a more severe risk around rabies. We basically do not have it in the UK or Ireland; it has been eliminated for over a century except a tiny incidence of a virus in the same family in bats. But because we have essentially eradicated it, doctors do not often think to ask about it, even in people who have travelled, which led to someone suffering awfully last year.
And since a dog bite or even a fox bite in the UK or Ireland carries literally zero risk of rabies, those who are bitten or scratched while travelling abroad do not have it uppermost in their mind.
About 20 years ago my gran got to the facial palsy stage of Lyme's before it was even considered and diagnosed by a visiting locum doctor who'd grown up in another country.
Antibiotics were given, her face recovered (albeit slowly).
It's a horrendous disease.
A few thousand cases every year now, when the first indigenous case ever properly recorded in the UK was only in 1986, and it's not like in the USA where really wide areas are high risk. Some of the pockets of highest risk Lyme in the UK are no more than a few miles across.
Nurse stations and pharmacy clinics are great at properly removing ticks if you know you have been bitten, and from there you will now get good advice about Lyme.
But a system that has no endemic experience of Lyme is just not going to test for it. Because it's remote, and people are usually unaware they have been in risk areas, and often unaware they've even been bitten.
England in comparison is much more built up.
We do have Lyme disease here unfortunately. I know someone who has it.
(There are more voles in the UK than mice, as it goes. Outnumber them by about thirty million or something. Fairly recently acquired trivia for me, but it turns out that if you see a mouse scurrying in the wild in the UK, away from houses, it's a bit more likely to actually be a vole.)
Genetic studies and museum tick specimens prove the bacteria existed in North America for thousands of years before the lab was built. Whether there was gain of function done on it is not publicly verified.
COVID lockdowns changed us and we're a bit more outdoorsy.
But mostly it is the deer population. There are now four times as many wild deer in the UK as there were before the first indigenous case of Lyme was detected. From under half a million to well over two million over that timeframe.
In the south east around where I am, wild boar are now a potentially significant vector in the high risk areas, too — we've gone from literally zero to a couple of thousand wild boar in the same forty-year period of time just in the 20 miles around me. They apparently can carry upwards of a hundred without suffering.
LymeAlert, which will sell for about $50, is designed to detect the presence of Borrelia burgdorferi, the pathogen known to cause Lyme disease, in a tick.
The test kit, which remains effective for up to 12 months, is simple to use. After carefully removing the tick with either tweezers or a tick-removal tool, you place it into the kit’s “Tick Crusher.” The grinder pulverizes the tick’s chitinous exterior, exposing the internal contents where the Borrelia burgdorferi is located. A patent-pending buffer solution readies the sample for testing. The user then inserts a test strip into a slot in the grinder. The strip’s chemically treated nitrocellulose paper functions as an immunochromatographic assay that can detect the presence of Borrelia burgdorferi.
I'd written a longer reply about my time last year in upstate NY, but what I wrote was "tinted"... so the shorter version: within just a 2 month stay I did find infected ticks on me (submitted to testing - I was happy with nyticks.org). Everytime the cat came into the house, first step was always to get out the tick mitt and brush off the ticks from the cat. And it felt weird how Lyme was normalised there, almost like a phase of life it's assumed you go through, having to take months off work due to crippling pain and paralysis until the meds work. Coming from Australia, none of this felt "normal".
That said: it's a truly beautiful place. Outdoor recreation seems to be "what you do" out there... but when it's that beautiful, it'd be a shame not to take advantage of it. Even though I'm not much of a nature person or a hiker.
> After carefully removing the tick with either tweezers or a tick-removal tool, you place it into the kit’s “Tick Crusher.” The grinder pulverizes the tick’s chitinous exterior, exposing the internal contents where the Borrelia burgdorferi is located
Like others, I was interested in the article because of Lyme and other diseases. Ticks really do suck.
I appreciate all the science-y comments though I understand very little. I appreciate comments about personal experiences with ticks, getting bitten, and getting sick.
I’m left with this: If this test is not really a viable solution (or at least one solution) to the problem of the unaffordability of visits to the doctor, what is a better solution. I would put all options on the table and move things like universal health care to the “working on it but not helpful right now” pile of solutions.
What would be way more useful is a quick blood test (pin prick type à la thernos) that could diagnose early for treatment.
> "If you have an embedded tick where there’s a chance of infection, then go to your doctor and get a dose of antibiotics as a prophylactic, just to be on the safe side." ...I would be eating antibiotics 5 months per year each year of my life. I've had 13 ticks this summer, and it's the least I've ever had in a summer ever I think. I sometimes go over a 100 on a summer. But I've just had Lyme's disease once confirmed, but before that I had anti-bodies (which I got to know through a research project i participated in).
There's a lot of research on ticks going on in Finland, and I participate in two citizen science projects* this summer; for one I collect the ticks and send them to the researchers, the other project I just post observations.
I quickly realized it was a hassel to submit to both projects every time I found a tick on me or the cats. So I used Claude Code to build my own self-hosted app that stores my profile, location etc and submits my findings to both of the projects. Simple and nice litte project. I have a thought of publishing the app in some form, but haven't thought about it much.