Bands 41 & 93

hello and welcome!

one of the main problems with serology based tests 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 detect the bacteria?"

in Lyme - there are countless studies showing that the very thing you are measuring with serology ( 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 / immunoblots - 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 - which have altogether different biology (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.

… and welcome to the forum.

SDraised said...
Thank you!! Do you know why IgeneX would say it’s negative if only those two bands are positive? (I saw this on sample lab reports and in other posts) My test was through quest and I want to do IgeneX but I cannot justify the cost if I will get the same results and be negative.
This is all so very confusing and I am appreciating all of these forums to help!

I’m thinking because band 41 CAN be something else (as I posted above) ……. BUT LLMD’s often do a clinical diagnosis (based on history, symptoms…etc)
Also other diseases are ruled out. I had some symptoms of other diseases - and my regular Dr. tested me and all were negative.
(Sjogrens, lupus , Rhumatoid Arthritis… etc)
Her (and I) never even thought about Lyme disease.

i know its more comfortable to have a clear lab test results - positive or negative - but the realities are the lab testing is just not good enough for that at present - in stead as above - we are forced to make a judgement based on the overall picture.

the fact that you
-have a known tick bite
-have lyme symptoms
-have a clear positive result for another tick borne infection (statistically raises your chances of having another tick borne infection - eg lyme )

are all highly suggestive of lyme disease and would be enough for most LLMD's to treat

if you are trying to get a conventional medicine approved positive test with a view to getting insurance to cover treatment - as i understand it, even if tests are positive - appropriate treatment in the USA ( assuming thats where you are based) is unlikely via conventional infectious disease docs.

if its for your own peace of mind - that's is also a tricky path - as the same issue with test technology applies - but i would advise testing via non serological methods - or via several different methodologies

often several tests are made each using a different technology / approach so that if they all align towards a positive result you can then have greater confidence its a true positive - but in general sensitivity is a much greater issue than specificity - ie you are 5-8x more likely to have a false negative than a false positive according to most studies on serological based tests.

*galaxy have just released a lyme nanotrap test - which i would expect to be pretty good
*lymphocyte transformation tests do not rely on antibodies - but are also problematic in chronic lyme
*CD57+ cell counts can be another useful indicator - as often low in chronic lyme (occasionally high)

also - some labs use different strains of borrelia spirochete antigens to make their test from - eg the tickplex test used by Armin labs germany - uses antigens from B. Alfzelli and B. Garinii which are common in - but not limited to Europe

relapsing fever group spirochetes can present with lyme symptoms and often require separate tests.

as you can see - while testing for many diseases today is so sensitive and specific ( above 99% in both) we treat the tests as essentially black or white results - such tests simply do not exist for Lyme disease