LIVE from ILADS: Tick Boot Camp reconnects with Nicole Bell, CEO of Galaxy Diagnostics, for a focused conversation about one of the biggest challenges in Lyme disease and tick-borne illness: getting an accurate diagnosis.
Bell breaks down the differences between antibody testing, antigen testing, and PCR-based direct detection while explaining why stealth pathogens such as Borrelia, Bartonella, and Babesia can be so difficult to find. She also introduces Galaxy’s BBB Direct Detect digital PCR testing, discusses emerging findings involving Babesia species, and explains why a negative antibody test doesn’t always tell the entire story.
For Bell, the mission is deeply personal. Her husband, Russ, initially tested negative for Lyme disease and was later diagnosed with Alzheimer’s disease before his family ultimately discovered tick-borne infections were part of his complex illness. That experience helped redirect Bell’s engineering and medical technology background toward improving diagnostics for other patients searching for answers.
This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.
Why Can Lyme Disease Testing Be So Difficult?
Bell begins by explaining one of the fundamental problems with diagnosing Lyme disease and other tick-borne infections: many of the pathogens clinicians are searching for can be difficult to detect.
Some occur at low levels in the bloodstream. Others may migrate into tissues or circulate intermittently.
Historically, much of tick-borne disease testing has therefore relied on indirect detection — looking for the patient’s immune response rather than directly detecting the organism.
Antibody testing can provide useful information, but Bell explains why interpretation can become complicated.
A patient’s antibody response can vary depending on factors including:
- Timing of infection
- Individual immune response
- Immune suppression or dysregulation
- Previous exposure
- Previous treatment
- Medications that suppress immune activity
- Cross-reactivity
- Whether an infection is current or historical
This is why Bell views antibody testing as one tool rather than the entire diagnostic toolbox.
Antibody Testing: Detecting the Immune Response
Antibody testing is an indirect testing method.
Instead of looking for Borrelia itself, for example, the test looks for evidence that the patient’s immune system has responded to it.
Bell discusses IgM and IgG antibodies and why timing matters.
IgM antibodies are generally associated with an earlier immune response, while IgG responses can take longer to develop. In Lyme disease, that delay creates a particular challenge because early diagnosis and treatment can be especially important.
Some infected patients may mount a strong measurable antibody response, while others may produce a weaker or delayed response.
Bell points to research showing how dramatically immune responses can differ even under controlled experimental conditions.
This creates an important distinction:
A test of the immune response is not necessarily the same thing as a test for the pathogen itself.
When Antibodies Don’t Tell the Whole Story
Bell uses her husband’s experience to illustrate the stakes.
Russ had likely been ill for years before his most significant symptoms emerged. By then, Bell says his immune system was dysregulated and his overall antibody levels were low.
His Lyme testing was negative, and his worsening cognitive symptoms ultimately led to an Alzheimer’s diagnosis.
There is also another side to antibody testing.
A person may have antibodies because of a previous infection even when the original infection is no longer active. That can make it difficult to determine whether persistent symptoms are associated with an ongoing infection, an undiagnosed coinfection, immune dysregulation, or another process.
Bell’s point is not that antibody testing has no value. It is that complex tick-borne illness may require more than one diagnostic tool.
Antigen Testing: Looking for Evidence of the Pathogen
The conversation then moves from indirect testing to direct detection.
One method is antigen testing.
Rather than measuring the immune system’s response, an antigen test searches for a component associated with the pathogen itself.
Bell discusses Galaxy’s work with a urine-based Lyme disease antigen approach designed to capture and concentrate a protein shed by Borrelia.
Why urine?
Bell explains that Lyme-causing Borrelia may not remain abundantly present in the bloodstream. A pathogen-derived protein, however, may be filtered through the kidneys and become detectable in urine.
Galaxy continues to work on direct-detection approaches to Lyme disease testing as it pursues broader clinical adoption and regulatory pathways.
PCR Testing: Searching for Pathogen DNA
Another form of direct detection is PCR testing.
PCR looks for genetic material from the pathogen rather than relying on the patient’s antibody response.
Galaxy uses PCR-based approaches for pathogens including:
- Borrelia
- Bartonella
- Babesia
But direct detection presents its own challenge.
These organisms may occur at extremely low levels in a sample.
A patient can be infected while very little pathogen DNA happens to be circulating in the particular blood sample collected that day.
That is where digital PCR, or dPCR, becomes especially interesting.
The Three B’s: Borrelia, Bartonella & Babesia
Bell introduces Galaxy’s approach to what Tick Boot Camp often calls the Three B’s:
Borrelia. Bartonella. Babesia.
As patient and clinician awareness of tick-borne illness has evolved, these three pathogens have become increasingly important to the conversation around complex cases.
Galaxy’s BBB Direct Detect digital PCR testing is designed to directly detect DNA from Borrelia, Bartonella, and Babesia.
Unlike an antibody test asking whether the immune system has responded to a pathogen, direct PCR testing asks a different question:
Can we find genetic evidence of the organism itself?
How Digital PCR Searches for Low-Abundance Pathogens
Bell gives a simple analogy for understanding digital PCR.
Imagine searching for a needle in a haystack.
Traditional PCR is trying to identify a tiny amount of pathogen DNA — the needle — among an enormous amount of human genetic material — the haystack.
Digital PCR effectively divides that haystack into thousands of much smaller piles and examines them individually.
That partitioning can make it easier to detect extremely small amounts of genetic material.
Galaxy also uses a culture-enrichment step for Bartonella. The blood sample is placed in an environment designed to encourage Bartonella growth before PCR analysis, increasing the amount of target material available for detection.
Learn more about Galaxy Diagnostics’ direct-detection technology and its approaches to Borrelia, Bartonella, and Babesia testing.
Why Are We Seeing So Many Coinfections?
Tick Boot Camp and Bell also discuss an observation that has become increasingly common in patient interviews: many people with complex chronic tick-borne illness aren’t reporting only Lyme disease.
Instead, patients frequently describe combinations involving the Three B’s and other infections.
Why?
Bell says several factors may contribute.
Diagnostic technology has improved. Clinicians have become more aware of coinfections. Ecological research indicates ticks can carry multiple pathogens.
But Bell raises another important possibility: patients carrying multiple pathogens may also be among those who become the sickest and therefore are disproportionately represented within chronic illness communities.
That distinction matters.
Observing many coinfections among severely ill patients doesn’t necessarily mean every tick-borne disease patient has the same microbial picture.
Bartonella, the Immune System & the Tipping Point
Bell discusses Bartonella as an example of the complexity surrounding infection and illness.
Exposure may be more common than many people realize, and Bartonella has multiple potential vectors and reservoirs.
Bell describes a hypothesis in which some people may harbor an infection while their immune system keeps it under control.
Then another infection, environmental exposure, significant stressor, or other immune-disrupting event may alter that balance.
A person who had previously remained relatively healthy may cross what Bell describes as a tipping point and begin experiencing significant illness.
This raises questions researchers are still working to answer.
Were multiple infections transmitted simultaneously?
Did they occur through separate exposures?
Was one infection already present before another destabilized the immune system?
Bell emphasizes that the answer may differ from patient to patient.
Emerging Questions About Babesia
Some of the most intriguing discussion in this interview involves Babesia.
Bell explains that research associated with the North Carolina State University team has identified Babesia species in complex patients beyond the organisms traditionally emphasized in U.S. human babesiosis.
She specifically discusses findings involving Babesia odocoilei and Babesia divergens-like organisms and contrasts those findings with expectations surrounding Babesia microti and Babesia duncani.
Bell also discusses the possibility of low-level parasitemia — infections involving pathogen levels that may be much lower than the classic severe presentation clinicians associate with babesiosis.
These emerging observations raise important research questions about Babesia species, their prevalence, their role in human disease, and whether existing diagnostic assumptions capture the full picture.
Bell is careful in the interview to distinguish between what Galaxy’s current assay detects and what researchers may suspect based on sequencing and related scientific work.
Nicole Bell’s Personal Mission
Bell’s work in tick-borne disease diagnostics grew out of an experience no family wants to have.
Her husband, Russ, developed neurological and psychiatric symptoms, including cognitive problems, anxiety and hallucinations. Despite Bell specifically requesting Lyme disease testing early in his illness, his initial test was negative and his diagnostic journey eventually led to an Alzheimer’s disease diagnosis.
Bell later documented her family’s experience in her memoir, What Lurks in the Woods.
Today, she brings her engineering background and personal experience together in an effort to improve the diagnostic tools available to clinicians and patients.
From MIT & Duke to Galaxy Diagnostics
Nicole Bell is CEO of Galaxy Diagnostics and an engineer with extensive experience in medical devices and diagnostics.
She earned bachelor’s and master’s degrees in Materials Science and Engineering from MIT and a master’s degree in Biomedical Engineering from Duke University. Before joining Galaxy, she worked in technology and medical-device development, including leadership roles involving diagnostic platforms and FDA submissions.
Bell became CEO of Galaxy Diagnostics in 2024, bringing together her professional background in engineering and diagnostics with the lessons learned through her husband’s illness.
The State of Lyme Disease Research
Bell is also the primary author of The State of Lyme Disease Research in the United States for the Center for Lyme Action.
The paper examines gaps in Lyme disease research and outlines recommendations involving fundamental science, diagnostics, prevention, treatment, and research infrastructure.
In this interview, Bell references one particularly important issue explored in that work: delays in Lyme disease diagnosis and treatment are associated with a greater risk of patients experiencing persistent symptoms.
Better testing isn’t simply about producing a more sophisticated laboratory report.
It’s about helping clinicians get patients appropriate answers earlier.
Key Topics in This Episode
Lyme disease testing, Lyme diagnostics, Nicole Bell, Galaxy Diagnostics, Borrelia testing, Bartonella testing, Babesia testing, Three B’s, BBB Direct Detect, digital PCR, dPCR, PCR testing, antibody testing, antigen testing, direct detection, indirect testing, stealth pathogens, Lyme disease antibodies, coinfections, polymicrobial tick-borne disease, low-abundance infections, Bartonella culture enrichment, Babesia microti, Babesia duncani, Babesia odocoilei, Babesia divergens, chronic Lyme disease, diagnostic delays, and tick-borne disease research.
About This LIVE from ILADS Interview
This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.
Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp’s traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the activity of one of the world’s major gatherings of Lyme and tick-borne disease clinicians, researchers, advocates, and innovators.
Explore all Tick Boot Camp LIVE from ILADS interviews.
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