IgM and IgG: Dr. Kinderlehrer's interpretation

Hi -- I have had Lyme symptoms for over 10 years (fatigue, skin rash) and so got a test done at IgeneX.

Question 1: I've been reading Dr. Kinderlehrer's book "Recovery from Lyme Disease" that chronic Lyme patients (not just recent Lyme infections) can see IgM positive. Can anyone here confirm this? fwiw, this is my result from IgeneX:

IgeneX Lyme ImmunoBlot IgM (positive -3 bands)
Band 23 ++
Band 31 +
Band 34 -
Band 39 -
Band 41 +
Band 93 +

IgeneX Lyme Immunoblot IgG (negative - only one band)
Band 18,23,28,30,31,34,39 -
Band 41 +
Band 45,58,66,93 -

Question 2: Dr. Kinderlehrer also says that a positive band 31 in the Immunoblot is 100% specific for Lyme. Can anyone confirm this?

Thanks!

hungrycactus said...
Hi -- I have had Lyme symptoms for over 10 years (fatigue, skin rash) and so got a test done at IgeneX.

Question 1: I've been reading Dr. Kinderlehrer's book "Recovery from Lyme Disease" that chronic Lyme patients (not just recent Lyme infections) can see IgM positive. Can anyone here confirm this? fwiw, this is my result from IgeneX:

IgeneX Lyme ImmunoBlot IgM (positive -3 bands)
Band 23 ++
Band 31 +
Band 34 -
Band 39 -
Band 41 +
Band 93 +

IgeneX Lyme Immunoblot IgG (negative - only one band)
Band 18,23,28,30,31,34,39 -
Band 41 +
Band 45,58,66,93 -

Question 2: Dr. Kinderlehrer also says that a positive band 31 in the Immunoblot is 100% specific for Lyme. Can anyone confirm this?

Thanks!

Yup - I was told by two Lyme docs that IGM can be a new infection or an older but still active infection.

You have several bands that are Lyme specific,

this question comes up quite a lot - here is what i wrote before:

one of the main problems with serology based tests( all tests measuring antibodies) for lyme - is that you are measuring a secondary effect - ie "how is the patient’s immune system behaving?"

not a direct test "can we see the bacteria?"

in Lyme - there are countless studies showing that the very thing you are measuring ( how the patients immune system is responding) is itself disrupted by the lyme infection - and as a result it no longer functions the way its expected to - and does not produce the pattern of IgG or IgM antibodies that are expected in most* other infections.

in all other disciplines this flawed approach would be classed as crazy logic and thrown out the window
in lyme testing there are few alternatives - and so we are kinda stuck with it - even though it is flawed.

for example - there are papers finding that around 20% of patients with confirmed lyme infection by culture ( gold standard test method but rarely used) NEVER produce ANY detectable anti-lyme antibodies at all. So this makes it clear that lyme interferes with normal expected antibody production.

more often with lyme disease - and what you will often see if you read other people’s accounts here on the forum is:
- there is general poor sensitivity of basic C6 ELISA tests ( this is the general first line test used in many countries - and looks for only one antibody) – as a result often just a negative result is reported and no further tests done.
- and on western blots - some kind of random selection of a few IgG and IgM antibodies or a few indeterminate - rarely the full suite of antibodies that many conventional doctors insist on for a positive diagnosis.

the main reason for this is the immune disruption mentioned above

however, borrelia also have a key feature v few other microbes have - in that they change the proteins expressed on their outer surface regularly - it is these outer surface proteins that the immune system reacts to and makes antibodies to - so this means the immune system has to keep relearning how to recognise them and then make new antibodies to the latest outer surface protein - this is the explanation for reoccurring IgM antibodies in chronic lyme infection.

there is ongoing confusion where people, including doctors, apply general rules of thumb learned from testing other simpler organisms to borrelia - which have altogether different biology - and it is in fact the most complex bacteria with the largest genome of any bacteria so far discovered by quite some margin - and so those simplistic explanations used as rules of thumb for much simpler organisms do not fit borrelial infections well at all.

*I say most as, in many chronic bacterial infections (especially those in the co-infection group) expected antibodies are often not present after 6 months - the mechanisms for this are also not clear in all cases, but likely due to some immune evasion or immune suppressive effects the organisms have developed over the millennia to aid their chronic infection survival strategy – after all killing the host is no good for survival - and getting mopped up by the host immune system is no good either - so they have to find something in between. That in between way involves some form of manipulation of the host immune system by the microbe in all chronic infections.

Igenex has a test that is similar to the iSpot



IGXSpot

I think it’s around $400

It’s apparently better than the western blot (according to two Lyme docs I asked)

https://lymedocs.com/igenex-spot-lyme-test/