240 – The Lyme Test
Video on Lyme Testing Difficulties: http://www.kake.com/news/headlines/95079714.html
From Dr. Burrascano:
DIAGNOSING LYME . Is a clinical diagnosis- look for multisystem involvement . 17% recall a bite; 36% recall a rash . 55% with chronic Lyme are sero-negative . Spinal tap- Only 7% have + CSF antibodies! . ELISAs are of little value- do Western Blots . PCRs- 30 % sensitivity at best- requires multiple samples, multiple sources
CD-57 COUNT (Natural Killer Cells) . Low counts seen in active Lyme . Reflects degree of infection . Can be a screening test . Can be used to track treatment response . Can predict relapse . Commercially available and covered by insurance!
WESTERN BLOT IN LYME . Reflects antibody response to specific Bb antigens- they are reported as numbers called “bands” . Some bands are seen in many different bacteria- “nonspecific bands” . Some bands are specific to spirochetes . Some bands are specific to Bb . Positive blot contains bands specific for Lyme . Specific: 18, 21-24, 31, 34, 37, 39, 83 & 93 . Spirochetes in general: 41 . Nonspecific: All others! . The more specific bands that are present, the more sure the diagnosis
NOW THE BAD NEWS! PITFALLS OF THE WESTERN BLOT . Very difficult to produce and interpret a western blot . Bands do not easily line up . Appearance affected by subtle changes in temperature and chemistry of the test system . The specific strain of Bb used to produce the antigens may not match the strain the patient has!
HOW DO YOU MAKE THE DIAGNOSIS? . Lyme is a clinical diagnosis . Even the best Lyme tests are only an adjunct . Use the ILADS point system
Excerpted from PRWeb ( Posted: 2/16/2010 )
The ELISA and Western Blot tests are the most common tests currently used to confirm the presence of Borrelia burgdorferi (Bb) antibodies. The first step calls for a test such as the ELISA to be conducted. If positive, a Western Blot test is done in hopes of confirming that Lyme antibodies exist. However, even if Lyme antibodies exist, it does not mean that the patient has Lyme disease.
Further complicating matters is the fact that antibody tests can confuse Lyme antibodies with antibodies created by other complications in the body, including antibodies created in reaction to bacteria other than the Bb organism. This means the majority of the results of the ELISA and Western Blot tests are not completely accurate. It also means that it is common to receive false positive and false negative results when using the ELISA or Western Blot tests. In other words, a negative test result cannot guarantee that Lyme antibodies do not exist. Conversely, a positive test result cannot guarantee that a patient actually has Lyme antibodies in his/her system. In both cases, accurate positive antibody test results does not mean that a patient has active Lyme bacteria in their system.
However, then it starts to get complicated. That’s because Lyme is a very evasive bacteria and unlike other bacteria, getting an ‘accurate positive’ test is complicated, even controversial. There are various tests for various stages, the laboratory work has to be very precise, and there are many roads that lead to false conclusions. Other infections that are present can also alter the effectiveness of test results.
The fact is there is no Lyme disease test available today that is 100 percent accurate to rule out or confirm the infection. False positive results and false negative results are very common. Dr. Braccia uses the following tests in his practices and encourages all Lyme patients become more familiar with them.
The Lyme PCR Test is the gold standard for Lyme disease testing accuracy
The PCR test is not well known but very accurate. The Polymerase Chain Reaction (PCR) test confirms that Lyme bacteria are present in the body. The PCR test is relatively new. It is designed to confirm that Lyme bacteria DNA are present. A positive PCR test almost always guarantees that a patient has Lyme disease, if the laboratory work has bee performed properly. Dr. Braccia observes, “A negative PCR doesn’t prove a patient doesn’t’ have Lyme however there are PCR strategies that assist in the test confirmation. Another factor that must be taken into consideration is do the fact that PCR test results often vary depending upon which lab performs the test. Therefore it’s important for the physician to use a lab that is accurate in their analysis.
The Lyme C6- Peptide ELISA Test is the newest entry in Lyme disease testing accuracy. The Lyme C6 Peptide ELISA is very different that the earlier Lyme ELISA test. It was developed at Tulane University and available since 2000. It can confirm exposure in more that 60% of patients. The chance of a false positive result in under 1%. While this new test when positive can confirm that an individual is infected with Lyme disease, unfortunately there is still no test clinically available that when negative proves that an individual does NOT have Lyme disease.
One last thought on more testing confusion is Lyme disease Co-infections.
Testing for Babesia, Anaplasma, Ehrlichia and Bartonella (other tick-transmitted organisms) should be performed. The presence of co-infection with these organisms points to probable infection with the Lyme spirochete as well. If these co-infections are left untreated, their continued presence increases morbidity and prevents successful treatment of Lyme disease.
According to the Centers for Disease Control and Prevention, 27,444 cases of Lyme disease were reported in 2007. It is spread by black-legged ticks, also known as deer ticks, and is most common in Connecticut, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Delaware, Pennsylvania, New York and Wisconsin, according to the CDC.
The Haverford Wellness Center in Havertown, PA, under the direction of Domenic Braccia D.O. is dedicated to the accurate diagnosis and reasonable treatment of Lyme disease and other tick borne diseases. Dr. Braccia and the staff of the Haverford Wellness Center are fully equipped and capable of managing all aspects of Lyme disease and the other tick borne diseases from prevention and management of early disease to the most complex diagnostic and therapeutic cases especially for patients in PA, NJ and DE. These cases include treatment failures, and late stage Lyme disease patients who have been ill for many years. For more information visit: www.HaverfordWellness.com
New DNA Lyme Screening
Lyme Disease Test Labs
Igenex Labs (see U.S. certifications)
Sao Palto, California
Clongen Labs, Germantown, Maryland
Stony Brook University Medical laboratory, New York
Mt. Laurel, NJ
(Test tick also, Medical Diagnostic Laboratories (MDL)
Specialty Laboratoriesclick here)
Santa Monica, CA
Laboratory Corporation of America