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DIAGNOSIS SYMPTOMS INFECTION PROCESS TREATMENTS LYME FACTS DELUSIONAL FACTS
GENERAL INFORMATION LABORATORY TESTS STANDARD TREATMENTS ADDITIONAL TREATMENTS

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LABORATORY TESTS

What pathogens should be tested mainly!

Bacteria Fungus Protozoa Virus
Anaplasma Aspergillus Babesia Cytomegalo (CMV)
Bartonella Candida Epstein-Barr (EBV)
Chlamydia pneu. Common Molds Hepatitis A-B-C 
Lyme-Borrelia
MLV-XMRV
Mycoplasma
Rhizobium radiobacter  - - -

 

What else to test?
Full blood profile (CBC)
Hormonal level (Thyroids, DHT)
HPA-Stress-Axis
C-Reactive protein
Homocystein, Albumin and iron level
Red blood cell count
ACE levels  and Calcitonin
Electrolyte balance
Diabetes mellitus
Sputum respiratory tract and function
Eye infection and function
Gastro-intestinal infection
Urological infection

 

Laboratory diagnostics

Laboratory diagnostics of the Borrelia infection, requested by a physician experienced with Lyme disease, are always indicated when a patient's complaints or clinical findings are compatible with a Lyme infection. Serological testing results, for the purpose of evaluating the success of therapy, are not meaningful for chronic Lyme, therapy success must be judged clinically.

Under strictly scientific criteria, the cultural proof of Borrelia infection can only be demonstrated through pathogen DNA-identification by polymerase chain reaction (PCR) methods. The proof of Borrelia DNA by means of PCR nuclear confirmation is likewise of high importance.

Borrelian serology is the basis diagnostic for the question of whether a Borrelia infection could be present; however the testing methods presently on the market, the enzyme-linked immunosorbent assay (ELISA) and immunoblot (Western blot) a test for immunoglobulins, or antibody proteins, signified by the initials IgG and IgM, are not standardized. Therefore, findings from these two methods can be compared only at the lowest common standards among them, and crossreactions caused from other pathogens with similar cell surface proteins can happen!

The investigation of the presence of Borrelia-specific antibodies is possible only by means of immunoblot. With suspicion of one Borrelia infection, the IgG and IgM immunoblot Borrelia test should be required in all cases. The laboratory to which samples are referred must be required to express results in Borrelia serology inclusive of immunoblot for Borrelia. Even so, these tests can show negative results that do not exclude a true infection. One reason for a negative result can be that the antigen spectrum in an immunoblot assay did not match identically the antigens found in ELISA results.

Borrelia ELISA and immunoblot are two different test methods, which correlate to a considerable degree with one another, but with different results in some cases. Negative serology does not exclude a present Borrelia infection, and even in the absence of antibodies, the need for treatment must be considered urgent. Seronegativity can be caused by early but inadequate antibiotic treatment, therapies with immunosuppressants, higher cortisol levels, exhaustion of the immune system, hidden pathogens, and a genetic disposition.

On the other hand, positive serological findings just mean that the patient acquired a Borrelia infection somewhere, at some point, with older infections evidenced by IgG and more recent ones by IgM. It is not possible to decide whether this infection is latent or active by a unique serological investigation. That can be decided only by the treating physician on basis of an individual patient's clinical process and symptoms.

The table below shows different Borrelia protein antigens/antibodies which can be detected by serology.

 

Protein antigen

Antigen description of antibodies Specifity Description

p14, 18

- highly specific Known from B. afzelii as immunogenic

p19

OspE (outer surface protein E) unknown -

p21

DbpA (Decorin binding protein A) highly specific

Decorin binding protein particulary on skin and tissue cells of the host

p22, 23, 24, 25

Osp C (outer surface protein C) highly specific

Most important IgM response marker of an early infection stage. Known are 13 different OspC-types

p26

OspF (outer surface protein F) unknown -

p29

OspD (outer surface protein D) highly specific -

p31

OspA (outer surface protein A) highly specific

Known are 7 different OspA-types which defines different species

p34

OspB (outer surface protein B) highly specific

Antibody appears more in a later infection stage

p39

BMPA (Borrelia membrane protein A) highly specific

Antibody appears more in an early infection stage

p41

Flagellin-protein unspecific

Primary and early appearing IgM antibodies. Cross-reactions with other kinds of spirochete and bacteria with flagella are possible

p58

- highly specific -

p60

Hsp6 unspecific

Antibodies which often might be present also with other bacterial infections

p66

Hs unspecific

Antibody reaction to any bacterial infection

p75

Hsp (heat shock protein) unspecific -

p83, 100

- highly specific

Antibodies mainly present in a later infection stage

VlsE

VMP (variable major protein) like sequence expressed highly specific

VlsE protein is expressed only in the host. IgG-Antibodies might be present already in an early infection stage.

 

What can you do if tests were seronegative?

Current guidelines for diagnosing Lyme disease include a two-tier testing algorithm: an enzyme-linked immunosorbent assay (ELISA) for detecting anti-Borrelia antibodies, followed by immunoblot confirmation of positive ELISA results. There are so many strains (70) and labs can only detect a small number of them. Also Lyme spirochetes can hide in the human bodies as cysts, 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 antibodies 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.

B. afzelii : preference for skin and tissue (Lymphozytom, ACA), genospecies with specific association to rodents Erythema migrans

B. garinii: preference for central nerval system, genospecies with specific association to birds Neuroborreliosis

B. burgdorferi sensu stricto: preference for joints, central nervous system (USA) Arthritis, Neuroborreliosis

B. valaisiana Cerebrospinal Fluid central nervous system, genospecies with specific association to birds and lizards

B. spielmanii Erythema migrans

In Europe are five different genotypes have been described: the original B. burgdorferi called burgdorferi sensu lato, B. burgdorferi sensu stricto, B. garinii, B. afzelii, B. valaisiana, and B. lusitaniae. Pathogenicity for humans remains uncertain for B. valaisiana and B. lusitaniae.

Neuroborreliosis, the most serious manifestation of disseminated Lyme disease has become the most frequently recognized tickborne infection of the nervous system in the United States and Europe. B. garinii, B. afzelii, and B. burgdorferi sensu stricto are confirmed causes of neuroborreliosis. 

http://wwwnc.cdc.gov/eid/article/10/9/03-0439_article.htm

http://aem.asm.org/content/69/5/2825.full

Check also news on Lyme Disease Research Center

 

Common Tests for Lyme Disease and Coinfections:
Bowen The Bowen test might be only an alternative along with other tests using the Bowen Q-RIBb (Quantitative Rapid Identification of Borrelia). Bowen testing is not a validated method approved by FDA to diagnose Lyme disease. Don`t use it, there are many contraddictions using this test. 
CD-57 The CD-57 subset or CD-57 counts measures a specific subset of the natural killer cells (NK-cells) when Lyme is active. The CD-57 count is suppressed only by Borrelia. It is not used as a diagnostic tool, but as marker to reflect the degree of Lyme infection. You can run the test at the beginning of a therapy and repeat it a few months later to determine the effectiveness of any treatment. Low CD 57 occurs in chronic Lyme or when the disease has been active for over one year. Below 20 indicates a heavy infection. 0-60 is typical for chronic Lyme disease. Above 60 indicates an improvement, and the counts of 200 indicates a normal condition or no infection.
Chemokine-CXCL13 CXCL13 is measured in cerebrospinal fluid (CSF) and serum and it is an important disease activity marker related to B-cells and the chemoattractant CXCL13 e.g. in acute neuroborreliosis.  It is also an important mediator in the inflammatory cascade associated with the polyspecific intrathecal B cell and the humoral immune response in the pathogenesis and diagnosis of multiple sclerosis (MS) that manifests itself by MRZR reaction (response to neurotropic viruses)
ELISA Enzyme-Linked Immunosorbent Assay test for the presence of a specific protein using antibodies in the test kit. The protein is produced from the activation of the introduced DNA.
IgM IgM (Immunoglobulin M) is a basic antibody that is produced by B cells. It appears as first antibody in response to an initial exposure to an antigen. IgM antibodies are mostly present during an acute stage of infection. Done by Western Blot or ELISA
IgG IgG (Immunoglobulin G) antibodies are mainly present as secondary immune response after an older or longer ongoing infection. They correspond to a maturation of the antibody response. Done by Western Blot or ELISA
LTT-MELISA Lymphocyte-Transformation-Test have been applied to detect specific cellular immune reactivity of lymphocytes, the natural killer cells (B-cells, T-cells). The clinical application of LTTs is due to the poorly defined Borrelia antigens and nonstandardized LTT formats questionable.
PCR Polymerase Chain Reaction test for the presence of a specific DNA sequence, which must be recorded in the DNA-database and prepared in reference material.
T-Cellspot (Elispot) It measures the cellular defence (T-Cells) and shows an exposition in intracellular stages, newer or older infection. Elispot test method is not approved by FDA and still disputable but good as second diagnostic tool.
Western Blot Western blotting (IgM/IgG) is a technique used to identify and locate proteins based on their ability to bind to specific antibodies. It can analyze any protein sample whether from cells or tissues.
LABORATORIES ADVANCED LABS (T-cell spot, ELISA) http://www.advanced-lab.com
IGENEX (Western blot IgM/IgG) http://www.igenex.com
FRYLABS (PCR, Western Blot IgM/IgG) http://www.frylabs.com/staff.php
LabCorp  (CD-57, Western Blot IgM/IgG) https://www.labcorp.com
Pharmasan Labs (Western Blot, ITT, Cytokines) http://www.pharmasan.com

M-R-O Author

GENERAL INFORMATION LABORATORY TESTS STANDARD TREATMENTS ADDITIONAL TREATMENTS
DIAGNOSIS SYMPTOMS INFECTION PROCESS TREATMENTS LYME FACTS DELUSIONAL FACTS

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THANKS A LOT THE AUTHOR MARC NEUMANN.