Negativ Borrelia serologi utesluter inte en infektion!!

Det finns läkare som säger att testerna för borrelia är tillförlitliga, och att ett negativt resultat utesluter en infektion.
Är det så eller är det helt felaktiga slutsatser??

Sensitivities of the ELISAs   The results of the tests on samples from patients with Lyme disease are presented in Table 1. With the culture-confirmed group 1 sera (45 samples), the sensitivity of recomWell Borrelia IgG was 40.0 %, whereas that of Enzygnost Borreliosis IgG was only 33.3 %. recomWell Borrelia IgM showed a sensitivity of 46.7 %, whereas Enzygnost Borreliosis IgM was 66.7 % sensitive. Taken as a whole, the sensitivity of recomWell Borrelia was 57.8 %, that of Enzygnost Borreliosis was 71.1 %, while Quick ELISA C6 Borrelia showed a sensitivity of 55.6 %. The 16 sera that gave discrepant results when tested by the three ELISA kits were further analysed by all WB methods (i.e. recomBlot Borrelia, EcoBlot Borrelia and the in-house WB method).”

” False negatives appeared to be quite common, with a 56% rate found in some commercial kits by Luger and Krauss (1990). A false-negative rate of 70% was found in early Lyme disease cases using the ELISA test in one study, with 4-46% false-negative rates in later stage Lyme disease (Golightly, et al, 1990).”

”Serum tests using the C6-peptide ELISA do not appear to be as sensitive or specific as when testing CSF, with Skarpaas (et al, 2007) finding a 61% specificity”

”Vid misstanke om neuroborrelios – borrelia-serologi i blod kan varken bekräfta eller utesluta denna diagnos. För detta krävs lumbalpunktion med fynd av minst 5 leukocyter i liquor (mononucleär pleocytos), samt en typisk klinisk bild. Frånvaro av antikroppar (i blod och liquor) utesluter inte borrelia.”

”Surprisingly, only 57% of patients had a positive Borrelia serology, even though all had PCR confirmed disease. The serologic findings of our sample are shown in figure  3.  The  IgG  western  blot  exhibited  the  highest  degree  of  sensitivity  (58%). Only  43,52%  (37/85)  of  patients  had  both  a  positive  ELISA  test  and  a  positive Western blot, while in 10,85% (9/85) the positive ELISA result was not confirmed by the Western blot. In 24,70% (21/85) of cases the ELISA test remained negative despite a positive Western blot, even though, to be useful as a screening tool, the ELISA  test  should  theoretically  exhibit  higher  sensitivity.  These  results  question the often recommended two- tiered testing approach [3, 4, 7], since some patients with a negative ELISA test will still have a strongly positive Western blot. The lack of sensitivity of serologic testing for lyme disease has been described [8,9,  15,  16]  and  commercially  available  kits  are  not  standardized  and  produce dramatically different results in some cases.”// ”//

”We are told by manufacturers, health departments, and clinics that the Lyme ELISA tests are good and that they are useful, but in two blinded studies that tested laboratories accuracy, they failed miserably. In the latest study, 516 labs were tested. The overall result: 55% inaccurate! You are actually better off to flip a coin! (98, 99) ”

”Repeatedly, there have been patients who are seronegative for antibodies, yet culture positive. Despite this, our medical community is dependent on these tests and relies upon them as though they were 100 % accurate. No matter how bad the tests are, as long as we have them doctors will use them. This is why doctor Samual Donta, M.D., called for a complete ban of the Lyme ELISA test at the 1996 LDF Lyme Conference. He found that, in some cases, Lyme ELISAs were more than 75 % inaccurate, yet it was relied upon as though it were the last word – and all too often it is.”//

LP, Ryggmärgsprov:
” B burgdorferi antigen can be detected in CSF that is otherwise normal by conventional methodology, and can be present without positive                     CSF antibody. Since CSF antigen implies intrathecal seeding of the infection, the diagnosis of neurologic infection by B burgdorferi should not be excluded solely on the basis of normal routine CSF or negative CSF antibody analyses.”//

”It can be concluded from the present study that isolation of spirochetes from CSF is not suitable as a routine diagnostic test”//

”Spinal taps are not routinely recommended, as a negative tap does not rule out Lyme.  Antibodies to Bb are mostly found in Lyme meningitis, and are rarely seen in non-meningitic CNS infection, including advanced encephalopathy. Even in meningitis, antibodies are detected in the CSF in less than 13% of patients with late disease!”//



Vi kan trots att vi är lekmän konstatera att sensitiviteten är mycket  låg i alla tester och att negativa tester inte på något vis utesluter en borrelia infektion. Har du kronisk borrelia så är uppenbart risken ännu större att du får ett negativt resultat eftersom borrelian med tiden lurar immunförsvaret och då tillverkar man inte längre antikroppar vilket är det testerna letar efter.
Diagnos ska alltså sättas kliniskt alltså efter historia, tolka symtom, och patientens upplevelser.
Serologi, tester bör endast vara ett stöd för läkaren, samt med stor medvetenhet om att dom är långt ifrån tillförlitliga.

Complications of Lyme Disease: Morbidity and Mortality

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