Episode 613: New Lyme Disease Test Detects 3 Infections at Once – Dr. Jennifer Miller | LIVE from ILADS
What if one blood test could detect Lyme disease, Bartonella, and Babesia at the same time—without relying on the body's antibody response?
In this LIVE from ILADS interview, Tick Boot Camp co-host Rich sits down with Dr. Jennifer Miller, PhD, of Galaxy Diagnostics to discuss a new generation of direct detection tests designed to help doctors identify Lyme disease and other difficult-to-detect vector-borne infections.
Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, the conversation explores why conventional Lyme disease testing can miss infections, how Borrelia may interfere with antibody development, and how digital PCR technology can search for Borrelia, Bartonella, and Babesia DNA in a single blood sample.
Dr. Miller explains how Galaxy Diagnostics developed a digital PCR assay that divides a blood sample into approximately 26,000 individual reactions, increasing the analytical ability to detect small amounts of pathogen DNA.
She also announces that the assay became commercially available in March 2025 and explains how patients can work with their healthcare providers to access testing.
For patients who have experienced years of diagnostic uncertainty, this conversation offers an encouraging look at emerging technologies that could help improve the diagnosis of Lyme disease and associated infections.
Meet Dr. Jennifer Miller, PhD
Dr. Jennifer Miller, PhD is Vice President of Clinical and Scientific Operations at Galaxy Diagnostics, a laboratory specializing in diagnostic testing for difficult-to-detect vector-borne infections.
Her work focuses on developing and validating diagnostic technologies for pathogens such as Borrelia, Bartonella, and Babesia.
Dr. Miller has extensive experience researching vector-borne pathogens and translating laboratory discoveries into clinical diagnostic tools.
During the interview, Rich mentions a previous conversation with Galaxy Diagnostics CEO Nicole Bell, who helped introduce him to the company's work.
Dr. Miller discusses returning to Galaxy Diagnostics and working with its scientific team to develop more sensitive direct detection methods.
Their shared goal is to provide clinicians with better diagnostic tools while helping patients avoid unnecessary delays, repeated testing, and prolonged uncertainty.
Why Lyme Disease Testing Can Miss Infections
Rich begins by addressing one of the most frustrating challenges facing the Lyme disease community: patients can experience significant symptoms while repeatedly receiving negative laboratory results.
He asks Dr. Miller to explain why Lyme disease testing remains difficult and what researchers are doing to improve it.
Dr. Miller begins by describing two fundamentally different approaches to infectious disease testing.
Indirect testing looks for the body's immune response to a pathogen.
Direct testing searches for material associated with the pathogen itself, such as its proteins or genetic material.
Understanding the difference is important because these tests answer different questions.
Indirect Lyme Disease Testing: Looking for Antibodies
Most commonly used Lyme disease blood tests are indirect tests.
They look for antibodies produced by the immune system after exposure to Borrelia, the bacteria responsible for Lyme disease.
Dr. Miller uses a simple analogy to explain the limitations of antibody testing.
An antibody is like a sign left behind by someone who visited a location.
The sign says:
“I was here.”
But it doesn't tell you whether that visitor is still present or whether they left months or years earlier.
Similarly, Lyme disease antibodies may remain detectable after an infection has been treated.
A positive antibody test therefore does not necessarily establish that a person currently has an active infection.
Conversely, someone with a recent infection may not yet have produced enough detectable antibodies for a test to become positive.
This creates a diagnostic window during which early Lyme disease can be missed.
For more information about testing limitations, explore Tick Boot Camp's Lyme disease testing resources.
Sensitivity, Specificity, and Cross-Reactivity
Dr. Miller explains that diagnostic tests are evaluated using two important measurements.
Sensitivity describes how effectively a test identifies people who have a particular condition.
A test with inadequate sensitivity may produce false-negative results.
Specificity describes how effectively a test identifies people who do not have that condition.
A test with inadequate specificity may produce false-positive results.
She also discusses cross-reactivity, which occurs when an antibody recognizes a target that resembles something other than the intended pathogen.
Dr. Miller compares antibody testing patterns to a barcode.
Different parts of the barcode represent responses to different proteins.
However, some proteins may be shared across related organisms or resemble proteins from other infectious agents.
This can complicate test interpretation.
She emphasizes that both the biological behavior of Borrelia and the design of the assay influence how well a test performs.
IgM vs. IgG: Understanding the Immune Response
Rich asks Dr. Miller to explain why different antibody classes matter when diagnosing Lyme disease.
IgM Antibodies
IgM antibodies are commonly associated with the early immune response.
Dr. Miller describes IgM as a broad responder that can recognize certain targets before the immune system develops a more refined response.
This broad recognition can be useful during early infection but can also contribute to cross-reactivity.
IgG Antibodies
IgG antibodies commonly develop as the immune response matures.
Through biological processes known as affinity maturation and class switching, the immune system can produce antibodies that recognize specific targets more effectively.
Dr. Miller explains that the timing and quality of these responses can affect the performance of antibody-based diagnostic tests.
However, neither IgM nor IgG results alone can reliably determine whether Borrelia remains actively present after treatment.
How Borrelia May Interfere With Antibody Development
One of the most scientifically interesting parts of the conversation explores how Borrelia may influence the immune system.
Dr. Miller discusses research suggesting that Borrelia infection can disrupt processes involving B cells, the immune cells responsible for producing antibodies.
She explains that an effective antibody response involves several steps.
First, the immune system recognizes a pathogen.
Next, B cells begin producing antibodies.
Over time, the immune response can become more refined, generating antibodies that bind more effectively to their targets.
Dr. Miller describes how Borrelia may interfere with these processes.
She uses an analogy involving rooms and doors.
Imagine that a B cell needs access to different rooms to develop and improve its antibodies.
In her analogy, Borrelia interferes with access to those rooms, disrupting the processes needed for antibody maturation.
This may help explain why some immune responses to Borrelia develop differently than expected.
Dr. Miller also discusses how these effects could influence the transition from IgM to IgG antibodies.
These mechanisms remain an active area of scientific investigation, and experimental findings do not mean that every patient with Lyme disease experiences the same immune dysfunction.
Direct Detection: Looking for the Pathogen Itself
Rich then asks Dr. Miller to explain the alternative to antibody-based testing.
Rather than measuring the immune response, direct detection methods look for evidence of the pathogen.
Dr. Miller describes two approaches being developed or offered by Galaxy Diagnostics.
Urine Antigen Testing
An antigen is a molecule associated with a pathogen, often a protein.
Dr. Miller explains that Galaxy has developed testing designed to detect certain Borrelia antigens shed into urine.
The goal is to identify pathogen-associated material without relying on antibody production.
PCR Testing
Polymerase chain reaction, or PCR, detects specific sequences of genetic material.
For Lyme disease, PCR testing attempts to identify Borrelia DNA.
However, Borrelia can be difficult to detect in blood because the organism may circulate at very low concentrations.
Dr. Miller explains that Galaxy's newer approach uses digital PCR, a technology designed to improve the detection of small amounts of genetic material.
Direct detection has important limitations as well. A negative result does not necessarily exclude infection, and detecting DNA does not automatically establish that live organisms are present.
Digital PCR: Finding the Needle in 26,000 Haystacks
One of the interview's most memorable explanations involves searching for a needle in a haystack.
Rich recalls how Nicole Bell described Galaxy's digital PCR technology.
Traditional PCR can be compared to searching for a tiny needle in a large pile of hay.
Digital PCR divides the sample into thousands of smaller sections, making it easier to identify a target when very little genetic material is present.
Dr. Miller explains that Galaxy's assay partitions a sample into approximately 26,000 individual reactions.
Each partition is analyzed for the presence or absence of specific pathogen DNA.
Rather than analyzing everything in one reaction, the technology evaluates thousands of smaller reactions.
This can improve analytical sensitivity under appropriate conditions.
However, the technology cannot detect pathogen DNA that is absent from the collected sample or present below the assay's detection threshold.
One Blood Test for Borrelia, Bartonella, and Babesia
The biggest announcement in the interview concerns Galaxy's ability to investigate three major pathogen groups using one blood sample.
Borrelia: Lyme Disease and Relapsing Fever
Borrelia includes bacteria responsible for Lyme disease and certain forms of relapsing fever.
Dr. Miller explains that Galaxy's assay is designed to recognize genetic sequences shared across different Borrelia organisms.
This includes targets associated with Lyme disease Borrelia and relapsing fever Borrelia.
Bartonella: A Difficult-to-Detect Bacterial Infection
Bartonella is a group of bacteria associated with several human illnesses.
Different Bartonella species can cause different clinical manifestations, including cat-scratch disease and certain bloodstream infections.
Dr. Miller discusses how genus-level genetic targets may help identify members of the Bartonella group without requiring a completely separate assay for every species.
Babesia: A Tick-Borne Parasite
Babesia is a group of parasites that infect red blood cells.
Babesiosis can cause fever, chills, fatigue, anemia, and potentially serious complications, particularly in vulnerable patients.
Dr. Miller explains that Galaxy's assay can investigate Babesia genetic material alongside Borrelia and Bartonella.
The ability to test for all three pathogen groups in one sample may provide additional information when clinicians suspect overlapping infections.
It does not mean every person with Lyme disease has all three infections or that every patient requires testing for all three.
What Is Genus-Level Detection?
Rich asks Dr. Miller whether Galaxy's assay can detect different species and strains within each pathogen group.
Dr. Miller explains that the test uses genetic targets shared by members of a particular genus.
She compares this to recognizing a family rather than identifying each individual cousin.
For example, different Bartonella species may share genetic sequences that allow them to be recognized as belonging to the same broader group.
By targeting those shared sequences, an assay can potentially detect multiple related organisms.
This approach may broaden detection while reducing the need for separate targets for every species.
However, genus-level detection does not necessarily identify the exact species or strain responsible for an infection.
Actual coverage depends on the assay's design and validation.
Why Testing for Multiple Infections Matters
Rich discusses how Tick Boot Camp interviews have increasingly featured patients reporting diagnoses involving multiple tick-borne or vector-borne infections.
He explains that earlier conversations often focused primarily on Borrelia.
More recently, patients have frequently discussed Bartonella and Babesia alongside Lyme disease.
Dr. Miller agrees that clinicians sometimes need to investigate more than one possible infection because symptoms can overlap.
For example, fatigue, headaches, and other nonspecific symptoms may occur with several different illnesses.
Testing for multiple pathogens may help clinicians narrow their differential diagnosis when a patient's history supports that evaluation.
She also emphasizes the financial consequences of repeatedly visiting providers and undergoing separate tests.
Better diagnostic tools could potentially help streamline this process.
However, the prevalence of co-infections varies by geographic region, exposure history, and pathogen. The experiences of podcast guests should not be interpreted as evidence that most Lyme disease patients have all three infections.
Can Direct Testing Distinguish a Past Infection From a New Infection?
Rich shares his history of numerous tick bites over several decades.
He explains that one of his concerns about antibody testing is its inability to reliably determine when an infection occurred.
Dr. Miller agrees that prior infections can complicate interpretation because antibodies may persist long after the original exposure.
She discusses how direct detection may provide different information by searching for pathogen-associated genetic material rather than antibodies.
This could be especially useful when evaluating someone with a history of previous tick-borne infections and new symptoms.
However, a positive PCR result does not always distinguish live infection from residual DNA, and a negative result cannot exclude every active infection.
Clinical history, examination findings, and other testing remain important.
Galaxy's Digital PCR Test Became Available in March 2025
Rich asks when patients will be able to access the new technology.
Dr. Miller shares that Galaxy's digital PCR assay had already completed laboratory validation and became commercially available in March 2025.
She explains that the laboratory operates under clinical laboratory quality requirements and that the scientific team had worked extensively to validate the assay.
She expresses excitement about making the technology available to healthcare professionals investigating difficult-to-detect infections.
Commercial availability and laboratory validation are important milestones, but they do not establish that the assay can detect every infection or that it outperforms all other diagnostic methods in every clinical situation.
Independent clinical performance data remain important when evaluating new testing technologies.
Can Patients Order Galaxy's Digital PCR Test Directly?
Rich asks a practical question that many listeners will have.
Can patients order the test themselves, or does a healthcare professional need to request it?
Dr. Miller explains that, at the time of the interview, the test required an order from a practitioner.
Galaxy Diagnostics provides educational resources that patients can share with their healthcare professionals.
These include information about available tests, scientific literature, frequently asked questions, and provider ordering procedures.
Patients interested in learning more can visit Galaxy Diagnostics.
Current test availability, ordering requirements, and pricing should be confirmed directly with the laboratory.
Could Better Lyme Disease Testing Reduce Healthcare Costs?
Dr. Miller discusses the financial and emotional burden of diagnostic uncertainty.
Patients may spend years visiting multiple healthcare professionals, undergoing repeated tests, and searching for explanations.
Each additional appointment can create expenses, delays, and frustration.
She hopes that improved direct detection technologies will help clinicians make more informed decisions sooner.
Rich emphasizes the importance of making diagnostic testing more accessible and efficient for patients.
The conversation reflects a shared goal: reducing the time people spend searching for answers and helping them access appropriate care.
Whether any specific new test reduces costs or improves long-term patient outcomes requires further study.
The Future of Lyme Disease Diagnostics
Dr. Miller describes Galaxy's work as part of an effort to develop the next generation of direct detection tools.
She believes technologies such as digital PCR may help address limitations associated with antibody-based testing.
The conversation also highlights the importance of scientific collaboration, continued validation, and patient-centered research.
Rich expresses hope that accurate and affordable testing will eventually become more accessible to people living in regions where tick-borne diseases are common.
For patients who have experienced diagnostic uncertainty, the development of new testing approaches offers reasons for cautious optimism.
Key Takeaways
- Conventional Lyme disease testing has limitations. Antibody tests may miss early infections and cannot reliably distinguish past exposure from current infection.
- Direct and indirect tests answer different questions. Indirect tests measure immune responses, while direct tests search for pathogen-associated material.
- Borrelia may affect antibody development. Dr. Miller discusses research into how infection can interfere with B-cell function and antibody maturation.
- Digital PCR uses thousands of reactions. Galaxy's technology partitions a sample into approximately 26,000 individual reactions.
- One sample can be tested for three pathogen groups. The assay targets Borrelia, Bartonella, and Babesia.
- Genus-level detection may identify multiple related species. The approach targets shared genetic sequences rather than every strain individually.
- Relapsing fever Borrelia is also part of the discussion. Galaxy designed its assay to investigate a broader range of Borrelia organisms.
- The assay became commercially available in March 2025. Dr. Miller describes the laboratory's validation and launch.
- Practitioner ordering was required at the time of recording. Patients can review Galaxy's resources with their healthcare providers.
- Better diagnostics could reduce uncertainty. Continued research is needed to determine how emerging tests affect patient care and outcomes.
About This LIVE from ILADS Interview
Recorded at the 2025 International Lyme and Associated Diseases Society Conference in San Antonio, Texas, this conversation features Dr. Jennifer Miller, PhD, of Galaxy Diagnostics, discussing advances in Lyme disease and vector-borne infection testing.
Rich and Dr. Miller explore the limitations of antibody testing, the science of immune responses, urine antigen testing, digital PCR, and the ability to investigate Borrelia, Bartonella, and Babesia in a single blood sample.
Discover additional interviews with scientists, physicians, and diagnostic innovators through Tick Boot Camp's LIVE from ILADS podcast series.