How Multiplex Testing Is Revolutionizing Tick-Borne Disease Detection: An Interview With Jason Barker, ND

Tick

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The growing threat of tick-borne diseases is placing immense pressure on patients, providers, and public health systems nationwide. With traditional diagnostic methods often falling short, particularly in detecting early-stage or coinfections, timely and accurate testing is more important than ever.

In this exclusive interview with Infection Control Today^® (ICT^®), Jason Barker, ND, clinical lab educator at Vibrant Wellness, discusses the diagnostic challenges that surround Lyme disease and other tick-borne illnesses, the limitations of current testing protocols, and how next-generation multiplex testing platforms are advancing the way we identify, monitor, and manage these complex infections.

Drawing on decades of experience in naturopathic medicine, clinical research, and integrative diagnostics, Barker offers a timely perspective on how innovation can better equip health care professionals to detect infections early, tailor treatment strategies, and prevent long-term complications.

ICT: Why is early and accurate testing for tick-borne diseases so critical, and what challenges do current diagnostic methods present for patients and providers?

Jason Barker, ND: Early and accurate testing for tick-borne diseases, especially Lyme disease, is critical because a delayed diagnosis can lead to more severe symptoms, long-term complications, and harder-to-treat infections.

Lyme disease, caused primarily by Borrelia burgdorferi, for example, can progress from flu-like symptoms and skin rashes early on to much more serious neurological, cardiac, joint, and possibly autoimmune manifestations if not detected and treated promptly.

• One major challenge is that up to 30% of patients never develop the hallmark “bull’s-eye” rash (erythema migrans), making clinical diagnosis alone unreliable. Additionally, the standard 2-tiered testing approach—an initial enzyme immunoassays (EIA) followed by a confirmatory Western blot has notable limitations:
• Low sensitivity in early disease: In the early stages of Lyme disease, antibody levels may be too low for detection by traditional tests, resulting in false negatives when intervention would be most effective.
• Subjective interpretation: Western blot results require visual interpretation of protein bands, which can lead to variability and false positives, particularly when evaluating IgM readings.
• Complex workflow and delays: The multistep nature of traditional testing increases turnaround time, which delays diagnosis and treatment.
• Limit of detection: Many conventional tests are designed only to detect Borrelia burgdorferi; however, ticks often carry multiple pathogens, such as Anaplasma, Babesia, and Ehrlichia, among others. Patients with coinfections may be misdiagnosed or receive inadequate treatment.

These diagnostic challenges not only delay care but also contribute to patient frustration and disease progression. That’s why more advanced, multiplex testing platforms, like Vibrant’s, are designed to improve clinical outcomes.

ICT: Can you explain the benefits and limitations of existing testing protocols, especially for diseases like Lyme, anaplasmosis, and babesiosis?

JB: Existing testing protocols for tickborne illnesses like Lyme disease, anaplasmosis, and babesiosis are based on different diagnostic technologies, each with its own strengths and limitations.

Some benefits of current testing protocols include:

• Established frameworks: The CDC-recommended 2-tiered protocol for Lyme disease (EIA followed by Western blot) has been in use for decades and provides high specificity in later stages of the disease.
• Availability: These tests are widely accessible through standard clinical laboratories.
• Validated for some stages: For Lyme disease, conventional tests are reasonably effective during the later phases, when (and if) antibody levels are higher.
• Molecular Tests (PCR): For pathogens such as Anaplasma phagocytophilum or Babesia microti, PCR can directly detect the pathogen's DNA during active infection, which is especially helpful early in the disease course.

Some common limitations include:

• Low sensitivity in early infections: For Lyme disease, antibody-based tests often fail to detect early-stage infections when antibodies haven't yet developed. Similarly, PCR for Babesia may miss cases of low parasitemia.
• Single pathogen focus: Most tests evaluate only 1 organism at a time. Yet, ticks frequently transmit multiple pathogens simultaneously, so patients with co-infections may not be fully diagnosed using single-target tests.
• Subjectivity and variability: Western blot interpretations can vary between labs and require trained personnel. Faint bands may be over-interpreted, leading to false positives.
• Slow turnaround: Some methods require multiple days or manual steps, which can delay treatment decisions.
• Limited Use of novel biomarkers: Most legacy assays use a narrow range of antigens or targets, missing newer, potentially more sensitive or specific markers.

In short, while existing protocols have provided a diagnostic foundation, they lack the speed, sensitivity, and breadth necessary to reliably detect early infections or co-infections. That’s why newer, multiplex, high-throughput platforms—such as Vibrant’s Tickborne 2.0—are redefining how we detect these complex and often overlapping infections.

ICT: What role could multiplex testing play in improving detection rates for co-infections, and how might this change the clinical management of tick-borne illnesses?

JB: Multiplex testing plays a transformative role in improving the detection of tick-borne coinfections—conditions where multiple pathogens (such as Anaplasma spp, Babesia spp, and Ehrlichia spp) are transmitted by a single tick bite. Traditional tests typically screen for just one pathogen at a time, meaning co-infections are often underdiagnosed or completely missed.

Vibrant’s ultra-high-density microarray platform, as described in the Scientific Reports paper, allows simultaneous detection of antibodies against dozens of specific antigens across multiple pathogens using just a small blood sample. This kind of multiplex testing offers several clinical advantages:

• Improved detection rates: By screening for a wide panel of tick-borne pathogens in a single test, clinicians can identify coinfections that might otherwise be missed, especially when symptoms overlap or present atypically.
• Tailored treatment: Coinfections often require different treatment strategies. For instance, antibiotics used to treat Lyme disease are often ineffective against Babesia, which may necessitate the use of antiparasitic medications. Early identification enables targeted, more effective treatment.
• Reduced diagnostic delay: A comprehensive, single-platform test reduces the need for multiple lab orders and follow-ups, expediting diagnosis and treatment.
• Better disease monitoring: Retesting over time on the same platform allows tracking of the immune response across all relevant pathogens, aiding in treatment assessment and relapse detection.

In short, multiplex testing modernizes the diagnostic approach to tick-borne illness. It aligns testing with the complex, real-world ecology of tick-borne disease and supports faster, more accurate, and more individualized care, ultimately improving patient outcomes.

ICT: How effective are current treatment approaches, and how does delayed or inaccurate diagnosis impact patient outcomes?

JB: Current treatment approaches for tick-borne diseases, such as Lyme, anaplasmosis, and babesiosis, can be highly effective when diagnosis is timely and accurate. Early Lyme disease, for example, typically responds well to a standard course of doxycycline or amoxicillin, with most patients recovering fully.

However, delayed or inaccurate diagnosis significantly worsens patient outcomes:

• Disease progression: In Lyme disease, untreated infections can progress from early symptoms (fever, fatigue, rash) to more severe complications, including neurological involvement (eg facial palsy, meningitis), cardiac issues (Lyme carditis), or arthritis.
• Chronic and persistent symptoms: Some patients go on to develop Post-Treatment Lyme Disease Syndrome (PTLDS), characterized by long-term fatigue, pain, and cognitive difficulties. While the cause is still under investigation, delayed diagnosis is a recognized risk factor.
• Inadequate treatment for coinfections: Coinfections, such as Babesia and Anaplasma, require treatments distinct from those for Lyme. If they go undetected, as they often do with single-pathogen testing, patients may not improve despite antibiotic therapy.
• Increased antibiotic use and misdiagnosis: Inaccurate testing can lead to over-treatment in some cases, or missed opportunities to treat the correct illness in others, contributing to prolonged suffering, more health care visits, and higher costs.
• Psychological and quality of life impacts: Misdiagnosed or undiagnosed patients often struggle with ongoing symptoms, leading to frustration, loss of productivity, and even being mislabeled with psychosomatic conditions.

Ultimately, accurate and early testing is not just a diagnostic concern—it’s a therapeutic one. The more precise and timely the diagnosis, the more effectively clinicians can intervene, tailor treatments, and prevent long-term consequences.

ICT: What are the most urgent gaps in tick-borne disease research today, and how could new findings help advance both testing and therapeutic solutions?

Despite growing public health concerns, tick-borne diseases remain under-researched relative to their impact. There are several critical gaps in current research that, if addressed, could dramatically improve both diagnostic and therapeutic approaches:

• Limited understanding of early immune responses: Most diagnostics rely on detecting antibodies, which take time to develop. This leaves a blind spot in the first few days to weeks after infection, when early intervention would be most effective. Research into early host immune responses, including T-cell signatures and innate immunity markers, could enable earlier and more accurate detection.
• Lack of validated biomarkers for coinfections: Coinfections are common, yet we lack comprehensive panels of validated antigens across all major tick-borne pathogens. Further research into pathogen-specific and cross-reactive biomarkers would enable the development of multiplex platforms, such as Vibrant’s Immunochip, that can detect multiple infections from a single sample.
• Incomplete knowledge of Post-Treatment Lyme disease Syndrome (PTLDS): PTLDS affects a significant minority of patients even after antibiotic treatment. Its mechanisms are poorly understood, ranging from persistent infection to autoimmune or inflammatory dysregulation. New studies exploring PTLDS biology could inform the development of better monitoring tools, prognostic markers, and even adjunctive therapies.
• Genomic and proteomic profiling of pathogens: Advances in sequencing and proteomics are beginning to identify novel, immunogenic proteins from Borrelia, Babesia, and Anaplasma. Incorporating these into next-generation diagnostic platforms could dramatically improve test sensitivity, especially for early or atypical cases.
• Underrepresentation of emerging or regional pathogens: Most research and testing focus on Borrelia burgdorferi, yet ticks can transmit other regionally prevalent organisms, such as Borrelia miyamotoi and Powassan virus. A better epidemiological understanding of regional tickborne disease ecology is essential for tailoring both diagnostics and public health responses.

Ultimately, translational research—like that behind Vibrant’s ultra-high-density microarray—will be key to closing these gaps. By accelerating biomarker discovery and integrating them into high-throughput platforms, we can develop faster, more accurate, and more personalized testing solutions that enable earlier treatment and improved outcomes.

ICT: From a public health standpoint, how can innovation in diagnostics help curb the rising incidence of tick-borne diseases in the US?

JB: Innovation in diagnostics is a critical lever for addressing the rising tide of tick-borne diseases in the United States, which now affects hundreds of thousands of people annually and continues to expand geographically due to climate change, land-use shifts, and increased human-tick interactions.

From a public health perspective, advanced diagnostics can serve as an early warning system, an intervention tool, and a strategic planning resource:

• Early detection leads to early intervention: Faster, more accurate testing—especially during the early stages of infection—means patients can begin treatment sooner. This reduces the risk of long-term complications, lowers health care costs, and prevents the cycle of misdiagnosis and chronic illness that burdens both individuals and the system.
• Broader surveillance and improved reporting: Next-generation platforms, such as Vibrant’s ultra-high-density microarray, enable the simultaneous detection of multiple tickborne pathogens. This enhances the ability to track not only Lyme disease, but also emerging and co-circulating infections, such as Babesia, Ehrlichia, and Borrelia miyamotoi. Comprehensive data from these platforms can inform real-time epidemiology and guide public health responses.
• Faster response in emerging hotspots: Traditional diagnostics often lag behind geographic shifts in tick populations. Multiplex platforms, because they can rapidly incorporate new markers, allow labs to adapt quickly to regional outbreaks or new pathogens. This agility is vital as tickborne diseases spread into previously low-risk areas.
• Public education and preventive awareness: Accessible, accurate testing empowers both patients and providers. When people receive a clear diagnosis and understand the specific pathogen involved, it improves trust in testing and promotes behaviors such as early treatment, tick avoidance, and follow-up care. Raising awareness during key months (such as Lyme Disease Awareness Month in May) is even more effective when backed by modern tools and actionable results.
• Reduced burden on the health care system: Misdiagnosis and long-term management of untreated or mismanaged tick-borne illnesses place a heavy burden on primary care, specialists, and mental health services. Diagnostics that clarify the picture upfront lead to fewer doctor visits, less unnecessary testing, and more efficient use of health care resources.

In short, innovation in diagnostics not only benefits individual patients but also strengthens the entire public health infrastructure. By making testing faster, broader, and more precise, we can shift from reactive to proactive management of tickborne disease in the US.