Unfortunately, there are major issues with this approach.
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.
In addition, there also is the issue of tick borne encephalitis: https://en.wikipedia.org/wiki/Tick-borne_encephalitis
Yeah, I would be vary of accuracy of such tests.
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.
"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."
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/
It's been 15 years since I worked on open source PCR machines, but has someone not figured out how to build a "one time use" disposable type qPCR test? A single test, not an instrument. There's no way these types of tests should be left up to lateral flow etc.
Lucira did that, but IMO it's quite wasteful. LAMP reactions don't need much, so it's best to make a cheap reader like Metrix or Pluslife so the tests can be less expensive.
> The vendor claims "lab-level accuracy" (conveniently omitting the actual accuracy numbers)
Hey, labs have QC failures all the time.
The standard isn't to avoid antibiotics until symptoms occur. The standard for a sufficiently attached deer tick in a high risk area is PEP:
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.
CDC recommends prophylaxis only if the tick is engorged. In my country, guidelines do not recommend prophylaxis at all (for better or worse - personally, I would take a single doxycyclin dose for a >24h high-risk tick bite, Lyme is no joke).
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?
CDC recommendation is more interested in preventing antibiotic resistance than in preventing Lyme disease for the patient. Obey CDC at your own risk
Antibiotics aren't free of risks to the patient either, including doxycycline. There's always a risk tradeoff.
100%. CDC is not a replacement for a trusted doctor