Am I right to be skeptical about this Lyme diagnosis?

The Lyme diagnosis is for a 72 year old female who was diagnosed with Rheumatoid Arthritis within the last year and was diagnosed with Fibromyalgia approximately 15 years ago. Within the last six months, she has developed chronic dizziness/lightheadness, extreme fatigue, difficulty thinking clearly, and hand tremors which come and go. An MRI showed white matter lesions that were not present in an MRI from seven years ago, but subsequent analysis of her cerebrospinal fluid and evaluation by a neurologist turned up no evidence of any major neurological problems. Her primary care doctor, however, has diagnosed her with late stage Lyme disease and prescribed two months of IV antibiotics based on the following results from her CSF testing:

*All 10 IgG bands Absent
*P41 IgM Absent
*P39 IgM Present (A)
*P23 IgM Present (A)

...and a Protein Electrophoresis/Immunofixation A/G Ratio of 1.3

The patient has previously had two ELISA tests (one by this particular doctor several years ago and one by her rheumatologist within the last year), both of which were negative. Given the across the board negative IgG antibody numbers, the fact that RA is known to create false positive results in IgM, and the fact that IgM tests aren't typially used to diagnose cases where the symptoms have been present for more than 30 days, I'm skeptical of the diagnosis. Am I missing something?

Somewhat Skeptical said...
The Lyme diagnosis is for a 72 year old female who was diagnosed with Rheumatoid Arthritis within the last year and was diagnosed with Fibromyalgia approximately 15 years ago. Within the last six months, she has developed chronic dizziness/lightheadness, extreme fatigue, difficulty thinking clearly, and hand tremors which come and go. An MRI showed white matter lesions that were not present in an MRI from seven years ago, but subsequent analysis of her cerebrospinal fluid and evaluation by a neurologist turned up no evidence of any major neurological problems. Her primary care doctor, however, has diagnosed her with late stage Lyme disease and prescribed two months of IV antibiotics based on the following results from her CSF testing:

*All 10 IgG bands Absent
*P41 IgM Absent
*P39 IgM Present (A)
*P23 IgM Present (A)

...and a Protein Electrophoresis/Immunofixation A/G Ratio of 1.3

The patient has previously had two ELISA tests (one by this particular doctor several years ago and one by her rheumatologist within the last year), both of which were negative. Given the across the board negative IgG antibody numbers, the fact that RA is known to create false positive results in IgM, and the fact that IgM tests aren't typially used to diagnose cases where the symptoms have been present for more than 30 days, I'm skeptical of the diagnosis. Am I missing something?

Welcome SomewhatSkeptical.

I’ve not heard that RA can cause false positives for lyme??

And that is not correct that positive IgM isn’t used to diagnose lyme for symptoms over 30 days.

I was IgM positive 14-15 months after symptoms started... many of us get a positive IgM years later.

Dr J (well known LLMD ) wrote that a late IgM positive represents a continuing reactivation of the infection.

Elisa tests aren’t good tests.

As jb1994 stated - 2 weeks of abx won’t be enough.

I recommend she seeks out a Lyme Literate dr

Somewhat Skeptical said...
A long-term infection with a negative IgG result?
.

Yes - that’s what I had - positive IgM and negative IgG

I don’t know anything about the RA and false positives.

Somewhat Skeptical,

I read your post earlier and looked at the study you referenced. I’m no scientist and am not a research expert either, so I hesitated to comment, hoping someone else would provide a clear answer of what I was thinking in a more scientific way. Hopefully someone still will.

My impression is the doctors who did that study must believe that ELISA and Western blot results are accurate, as that is what they based their conclusions on. They also believe IGG and IGM are only positive at specific times and are indicative of either past exposure or acute infection.

This line of thinking sounds like the IDSA. Those who belong to ILADS (often referred to as LLMD’s - Lyme literate medical doctors) believe differently.

Like I said, I’m not a research guru, so I don’t have links to provide you with the verification of what I am referring to. Hopefully those who do will see this and speak up.

From my understanding, bands 39 and 23 are both borrelia specific. Nothing but borrelia (Lyme disease) will cause those bands to be positive.

If you want a better test I would order an Igenex test and then bring it to your general practitioner and have them take her blood. Then send it to the Igenex lab in California for testing. This is going to be q more sensitive test.

at that age if she can manage the herx then she will feel better , see www.cpnhelp.org for stratton protocol which clears white matter lesions . same as lyme treatment. rocephin is a great anti inflammatory and may act on mycoplasma which may be at the root of "RA" . see dr david martz and dr neil spector story after under the 8 ball documentary and then well discuss skepticism....