Read this Now!: The MA Lyme Commission Report on Lyme Disease was released on February 28th, 2013 after much struggle to do so. Thank you to the entire commission and the governor of MA for making this possible!


Lyme Testing

All text written by Lisa Hilton from What is Lyme

Lyme Disease is a spirochetal disease that is passed from ticks or in utero. It has become an epidemic in the United States, Canada, and Europe and is on every continent. There is a lot of controversy surrounding Lyme Disease. One of the problems is that the testing for Lyme Disease and the other tick borne infections, known as co-infections, is very inaccurate.

The testing for Lyme is a two tier testing method. First your doctor will order an ELISA, and if that comes back positive, then your doctor will order a Western Blot. Unfortunately Lyme Tests have been found to be very inaccurate. I am going to write about what I have learned in the last six years studying Lyme Disease and why we should not rely on these tests. Even the CDC admits that Lyme diagnosis should be a clinical one, and that the tests are not to be relied upon.

Why Lyme Testing is 
Not Always Accurate

There is a great deal of controversy surrounding Lyme disease testing. One problem is the way the tests are primed to recognize laboratory strains of Bb, rather than wild types. There are so many strains and labs can only detect a small number of them. Also Lyme spirochetes can hide in the human bodies DNA, and fool the immune system into thinking it isn't there. So, no antibodies are produced, resulting in negative tests since the test only looks for anitbodies instead of the bacteria itself.

Because of the difference in the two antibodies, two separate tests are available to test for their presence. Therefore, a physician must specify whether or not a patient should have an IgM or IgG Western Blot, or an IgM or IgG ELISA test. This is where things get tricky. Physicians do a two tiered test. First they do an ELISA then they move on to the Western Blot only if the ELISA is positive. Which makes no sense since it is not sensitive at all.

Elisa Test

The Enzyme-Linked Immunosorbant Serum Assay is the simplest, least expensive, easiest to perform, and most common Lyme test ordered. It is a test based on detecting the antibodies that our bodies make in response to being exposed to Lyme Disease, aka Borrelia burgdorferi. It is a preferred test by laboratories, not because it is more accurate than other Lyme tests, but because it is automated. It is a fast test, in other words, labs can turn over a quick profit with this test. This test is reported to only be 55% accurate. Would you test your family member for cancer or any other disease if it was only a 55% of getting it right?

How ELISA test works is that it can be primed to be very specific for some of the spirochetes antibodies. This is done by taking a lab sample of the bacteria and breaking the sample down into fragments. These fragments, or know as antigens, are then embedded on the side of a reagent vessel like a test tube. Then the patient's serum is added, and any free antibodies specific for the test strain will then bind to the antigens, which are linked to special enzymes that will change color when antibodies are present. The sample is continually diluted until the reaction no longer occurs and no color change can be detected. The sample is then reported as a dilution ratio, such as one part serum to 256 parts water, or 1:256.

Test Results are Read As Follows

< or = 0.90 negative


0.91 – 1.09 equivocal


> or =1.10 positive


The ELISA test seems simple, but it has some major flaws. Borrelia species are polymorphic. That is, Borrelia species can significantly change its surface proteins enough during cell division as to evade our immune system, which may differ from laboratory strains enough to result in a false negative, even if antiBb antibodies are present. So until we can test for every strain these tests are pretty much useless.

Note: There have been numerous *new* strains found in the last couple years. (In more then one country) The test cannot test for these. 

Western Blot

This is a blood test. To understand what the blood test tests for you must understand a little about Immunoglobulin type M and G.

IgM: This is the first antibody our body makes against infection is the immunoglobulin type M (IgM).  This antibody takes four to eight weeks for there to be  enough quantities to be measured or detected, and only lasts for about six months then usually drops to a low level that cannot be detected. If  you have a consistent positive IgM, this is an indicator of chronic infection. 


IgG: This antibody start at about four to eight works weeks to form and is gone in less then a year. This antibody is like the ‘forefront fighter” of the immune system. It can kill bacteria by attacking it directly, or it can tag it so when killer T cells come along, it will be marked for them to kill.

The Western Blot essentially makes a map of the different antibodies the immune system produces to the bacteria. The map separates the antibodies by the weight of their respective antigens and are reported in units called kilo daltons or kDa.  A Western Blot will report what bands are positive. It will report bands 22, 23, 25, 31, 34, 39, and 41 kDa. Each of these bands represents an antibody response to a specific protein found on the spirochete. The 41 band indicates an antibody to the flagella 41 kDa protein and is nonspecific. The 31 kDa band represents the OSPA protein and is specific for just a few species of Borrelia, as is the 34 band OSPB, and 23 kDa OSPC.


Some bands are Lyme Specific, some are not. For example, band 41 can represent Lyme spirochetes or gum disease spirochetes. Here is a general list of what each band means.

On the outer surface of the Lyme bacteria are various proteins. As they have been discovered, they have been assigned letters, such as outer surface proteins A, B, and C.

Each band is an antigen complexed (bound together) with an antibody made by the immune system, specifically for that antigen (part) of Borrelia burgdorferi.

18: An outer surface protein.

22: Possibly a variant of outer surface protein C.

23-25: Outer surface protein C (osp C).

28: An outer surface protein.

30: Possibly a variant of outer surface protein A.31: Outer surface protein A (osp A).

34: Outer surface protein B (osp B).

37: Unknown, but it is in the medical literature that it is a borrelia-associated antibody. Other labs consider it significant.

39: Unknown what this antigen is, but based on research at the National Institute of Health (NIH), other Borrelia (such as Borrelia recurrentis that causes relapsing fever), do not even have the genetics to code for the 39 kDa antigen,much less produce it. It is the most specific antibody for borreliosis of all.

41: Flagella or tail. This is how Borrelia burgdorferi moves around, by moving the flagella. Many bacteria have flagella.

This is the most common borreliosis antibody.

45: Heat shock protein. This helps the bacteria survive fever. The only bacteria in the world that does not have heat shock proteins is Treponema pallidum, the cause of syphilis.

58: Heat shock protein.

66: Heat shock protein.

This is the second most common borrelia antibody.

73: Heat shock protein.

83: This is the DNA or genetic material of Borrelia burgdorferi. It is the same thing as the 93, based upon the medical literature. But laboratories vary in assigning significance to the 83 versus the 93.

93: The DNA or genetic material of Borrelia burgdorferi.



For Positive Results you must have:

An lgG Western Blot must have five or more of these bands: 18, 21,28, 30, 39, 41,,45, 58, 66 and 93 kDa.


An lgMAn lgM Western Blot must have two or more these three bands: An lgM Western Blot must have two or more these three bands: 23, 39, 41. Western Blot must have two or more these three bands:


 

All text written by Lisa Hilton from What is Lyme