How Accurate are Blood Smears for Borellia, Babesia and Bartonella?

you guessed right

its not a machine read test - so a great deal depends on who does the looking down the microscope and how long they spend -

for borrelia - its pretty much mute point - as we know that even though PCR can detect 1 organism in 0.5ml of blood - PCR only detects borrelia in the blood of 50% of infected patients - demonstrating its simply not in the blood to be seen most of the time.
then even if it were there - your chances of seeing 1 or two or even 100 organism in 0.5ml of blood ( which is enough to make approx. 20 smears) are basically non existent. borrelia also does not take stain well.

be aware though that lots of alternative doctors and amateur microscopy enthusiasts will tell you that they can see borrelia in darkfield microscopy easily - but again, via PCR and culture it has been established that the organism is simply not there to be seen in the blood in the vast majority of cases.

one exception may be other borrelia - like TBRF - in the acute phase i think these are much more numerous - so can be detected in the blood at that time point - but again - only reliably in the acute phase.

babesia - blood smear is used extensively - and can detect it - but the problem is again is the quantities likely to be in the blood - it can be present in high numbers in early acute infection and in very severe infection (as occurs in splenectomised patients, transplant patients immune suppressed by immunosuppressant drugs etc) - so it can be easy to find in these cases - but then parasitaemia typically drops in the chronic phase where it may be less than 1 in 1000 red blood cells infected (at this point its sequestered in the capillaries and venules rather than getting pumped around in the free blood) - then it becomes exceedingly difficult to get a clear yes/no - see my own experiments with blood smears in my thread on that for how hard it it to find anything clearly identifiable as Babesia - i have huge patience and perseverance - and can spend as much time as i like - and have done so on 100+ slides and i am still not clear either way - its that difficult !!

bartonella - is defo possible by thin blood smear with giemsa stain - but even when i was really quite sick - it was only detectable in 1 slide in 10 - and it took 1hrs per slide to properly review under the microscope ( bear in mind - a single field of view at 1000x magnification is somewhere around 0.1mm across so there are hundreds of individual views required to scan a slide fully) hence the 1hrs per slide and 10 slides - ie 10hrs of work just looking down the microscope ( not including drawing blood, making stain - staining slides etc ) which few if any commercial labs will do. and if they are not doing that then you will likely get false negatives.
bar tis however completely definitive once seen - rings of pale vacuoles inside red blood cells - appearing in clumps - so once seen is definitive as nothing else does that.

anyway - why the interest - haven't you established infections present multiple times over already - what more is to be learned ?

OK understand

again - i would just take the helicopter view - we know that the main challenge for all tests for these stealth organisms is that they are lower than ideal in terms of sensitivity,

that means they will miss some infections much of the time

that being the case - a person who is infected would expect some positive and some negative tests - when they test serially or with several different methods.

ergo -after 3 positive tests - unless you have done intensive Babesia protocols between the positive and negative tests - the most likely outcome is that Babesia is indeed present.

No?

Understand. I believe it’s simply a case of years dealing with the confusing and unknown.

Simply will treat as planned as see what happens. If no progress, then I have to believe the autoimmune is pushing without help.

Hardest thing to deal with is the lack of certainty, which we all have to cope with. Always have been a facts and fact finder. Was an investigative reporter in the big days of the newspaper. So when anything went to print, it had to be certain or you get sued.

Hard to get out of that mentality.

bluelyme said...
. the "amateurs there were using bsk cutures and acrind orange staining with hd darkfield. ...

yes, culture and then microscopy with some appropriate staining is indeed something different -

if you use culture to multiply the quantity of borrelia to high numbers over some weeks - Assuming there was at least some in the sample - then you can indeed see them - but that is not a blood smear test that the OP is asking about.

as to the rest - i think some people will always believe what they want to believe - ie that their red blood cells are full of microorganisms - or that borrelia are easy to see with a microscope - and they are of course free to do so.

i would only add that i have been pretty deep down that particular rabbit hole and while its true that when we are sick and seeking answers there is a kind of expectation and bias towards seeing pathogens in the blood - but i have found very little convincing evidence that the shapes and artefacts (that are definitely visible) are actually borrelia.

Whereas there is ample evidence that if you do those things to red blood cells you can reliably make things that look like wiggling threads( ie look like borrelia to some ) - eg by bursting red blood cells with saline solution as Professor Morten Laane described (he is Swedish by the way) but when analysed - it turns out they are in fact of human biological origin.
this is documented in the discussion thread on the topic on this forum.

to my knowledge to date there has not been a credible explanation for why PCR tests of patients blood - which can easily detect anything in the family borrelia at levels of 1 or 2 organisms per 0.5ml sample of blood - is negative in over 50% of infected patients confirmed by gold standard methods.
yet simple microscopy - with just time - or some lytic agent to break red blood cells is supposedly able to detect it in almost everyone........that simply does not add up

i don't say this to try and change your mind blue - more to encourage people to read that thread and understand both sides of the argument before assuming wiggling things under the microscope are actually borrelia.

BTW i do think that what happened to professor Laane was appalling - as he was attacked personally, sacked and his whole department was closed - all done in a most unprofessional way - when he was actually doing his best to help people - but that also does not mean his theories were correct.

Vimzor said...

Can't this be automated?

in principle i believe it could be
this type of task would actually suit a large language model AI type approach very well - as long as you could feed it sufficient positive and negative images to train on.
this type of pattern recognition has been used in medical imaging for some years - eg breast x-rays - and out performs human experts by quite some margin.

no lab that i know of is currently doing this though - i doubt there is a strong business case - as demand is low

i wonder if the machines that do complete blood counts - that currently count all the different red and white cells - and presumably do some form of automated smear and imaging - and could be adapted to do this.