Understanding Lyme Tests

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.

The Enzyme-Linked Immunosorbant Serum Assay is the simplest, least expensive, easiest to perform, and most common Lyme test ordered. It is a test based on detecting the antibodies that our bodies make in response to being exposed to Lyme Disease, aka Borrelia burgdorferi. It is a preferred test by laboratories, not because it is more accurate than other Lyme tests, but because it is automated. It is a fast test, in other words, labs can turn over a quick profit with this test. This test is reported to only be 55% accurate. Would you test your family member for cancer or any other disease if it was only a 55% of getting it right?How ELISA test works is that it can be primed to be very specific for some of the spirochetes antibodies. This is done by taking a lab sample of the bacteria and breaking the sample down into fragments. These fragments, or know as antigens, are then embedded on the side of a reagent vessel like a test tube. Then the patient’s serum is added, and any free antibodies specific for the test strain will then bind to the antigens, which are linked to special enzymes that will change color when antibodies are present. The sample is continually diluted until the reaction no longer occurs and no color change can be detected. The sample is then reported as a dilution ratio, such as one part serum to 256 parts water, or 1:256.The ELISA test seems simple, but it has some major flaws. Borrelia species are polymorphic. That is, Borrelia species can significantly change its surface proteins enough during cell division as to evade our immune system, which may differ from laboratory strains enough to result in a false negative, even if antiBb antibodies are present. So until we can test for every strain these tests are pretty much useless.Note: There have been numerous *new* strains found in the last couple years. (In more then one country) The test cannot test for these. 

The first antibody our body makes in response to a foreign invader is usually immunoglobulin type M, abbreviated as IgM. This large antibody takes two to four weeks to be made in quantities large enough to be measured. It is best to test four weeks after exposure to an antigen. The IgM antibody will only stay in circulation for about six months, after that the levels of antibodies are usually too low to detect. If infection persists, this antibody may also persist. In general, a Lyme patient who consistently has detectable IgM levels is usually chronically ill, but its absence is not a indicator that you don’t have an infection.The problem is, most Drs do not even know this. I have been tested for Lyme Disease on a couple occasions and it was never in the time frame suggested for accurate results. This may lead to many false negatives.

The second antibody we make after the IgM is the IgG antibody. This antibody takes up to eight weeks to form, and is gone in less than one year. It peaks at about six weeks. This antibody crosses the placenta, so an infected mother can pass this antibody to her child. An IgG antibody titer in a newborn baby does not necessarily mean active infection. It does mean the mother has had exposure to the Lyme infection, and the baby must be carefully monitored for signs of the disease. This antibody remains the longest and is the foot soldier of the immune system. It attacks viruses, bacteria, yeast, toxins, and transplants. The IgG antibody can kill bacteria indirectly by tagging or marking the foreign invaders for destruction by the killer T-cells. Or, it can kill the bacteria directly by evoking compliment, a series of enzymes and proteins that will dissolve the intruder.

 

What the bands on the Western Blot mean

On the outer surface of the Lyme bacteria are various proteins. As they have been discovered, they have been assigned letters, such as outer surface proteins A, B, and C.

Each band is an antigen complexed (bound together) with an antibody made by the immune system, specifically for that antigen (part) of Borrelia burgdorferi.

18: An outer surface protein.

22: Possibly a variant of outer surface protein C.

23-25: Outer surface protein C (osp C).

28: An outer surface protein.

30: Possibly a variant of outer surface protein A.

31: Outer surface protein A (osp A). 34: Outer surface protein B (osp .

37: Unknown, but it is in the medical literature that it is a borrelia-associated antibody. Other labs consider it significant.

39: Unknown what this antigen is, but based on research at theInstitute of Health (NIH), other Borrelia (such as Borrelia recurrentis that causes relapsing fever), do not even have the genetics to code for the 39 kDa antigen, much less produce it. It is the most specific antibody for borreliosis of all.

41: Flagella or tail. This is how Borrelia burgdorferi moves around, by moving the flagella. Many bacteria have flagella.This is the most common borreliosis antibody.

45: Heat shock protein. This helps the bacteria survive fever. The only bacteria in the world that does not have heat shock proteins is Treponema pallidum, the cause of syphilis.

58: Heat shock protein.66: Heat shock protein.This is the second most common borrelia antibody.

73: Heat shock protein.

83: This is the DNA or genetic material of Borrelia burgdorferi. It is the same thing as the 93, based upon the medical literature. But laboratories vary in assigning significance to the 83 versus the 93.

93: The DNA or genetic material of Borrelia burgdorferi.

An lgM Western Blot must have two or more of the following three bands: 23, 39, 41. Conspicuously absent are the most important bands, 22, 23, 25, 31, and 34, which include OSPA, OSP-B and OSP-C antigens – the three most widely accepted and recognized Bb antigens. These antigens were the antigens chosen for human vaccine trials.

VaccinationA vaccine against Lyme disease, called LYMErix, was developed by GlaxoSmithKline. LYMErix was approved on the basis of these trials by the U.S.  and Drug Administration (FDA) on December 21, 1998. Following approval of the vaccine, hundreds of vaccine recipients reported they had developed autoimmune side effects. Supported by some patient advocacy groups, a number of class-action lawsuits were filed against GlaxoSmithKline, alleging the vaccine had caused these health problems. LYMErix was withdrawn from the U.S. market by GlaxoSmithKline in February 2002, in the setting of negative media coverage and fears of vaccine side effects.

Many of the people who were vaccinated against Lyme were testing positive afterwards on certain bands of the Western Blot. Because of this, the IDSA decided to remove certain bands from the Western Blot, even though they were Lyme specific. Many believe that is one reason the Western Blot gives many false negatives now. Many turn to the Laboratory called Igenex Labs, because they put the bands back in for testing.

Click here to read more on Igenex Labs.

These test are of the more specific of the diagnostic assays in that the PCR detects the genetic material of the organism. Instead of providing indirect evidence of infection by looking at the immune response, like the other tests, the PCR detects the genetic material itself. But, while a positive PCR result does not demonstrate definitively that current infection is present, it is strongly suggestive of current or very recent infection. Unfortunately the PCR assay is often negative when used conducted to assist in the diagnosis of Lyme disease. This could be because the genetic load in the specimen is below the detection level of the test. It may also be because the Lyme bacteria is well known to reside in the blood for only short periods of time. Lyme spirochetes are tissue tropic and may live in areas of reduced vascular circulation, so because of this the PCR assay of the blood or CSF may be negative.There are researchers out there working on better testing methods. Hopefully soon a more accurate one will become available.However there are certain labs that specialize in Lyme Disease. The one I refer people to is Igenex Labs out of California. If you contact them they will send you or your doctor a kit. This lab tests for more bands then traditional labs do making it more accurate. Click here to read more on Igenex Labs.