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.”// ”// http://www.grin.com/en/e-book/166179/prolonged-antibiotic-therapy-in-pcr-confirmed-persistent-lyme-disease

”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.”// http://www.lymeneteurope.org/info/the-complexities-of-lyme-disease

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.”// http://www.neurology.org/content/45/11/2010.short

”It can be concluded from the present study that isolation of spirochetes from CSF is not suitable as a routine diagnostic test”// http://www.ncbi.nlm.nih.gov/pmc/articles/PMC269647/pdf/jcm00051-0081.pdf

”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!”// http://www.lymenet.org/BurrGuide200810.pdf

 

SLUTSATS

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

  1. Ackerman R. Rehse,Kupper B, Gollmer E, Schmidt R.  Chronic neurologic manifestations of erythema migrans borreliosis. Ann NY Acad Sci 1988:539:16-23
  2. Broderick JP, Sandok BA, Mertz LE. Focal encephalitis in a young woman 6 years after the onset of Tertiary Lyme Disease. Mayo Clin Proc 1987;62:313-316
  3. Chancellor MB, McGinnis DE, Shenot PJ, et al. Urinary dysfunction in Lyme disease. Journal of Urology, 1993;149(1):26-30
  4. Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient with chronic Lyme disease. American J Clin Pathol 1989;91(1):95-97
  5. Coyle PK. Borrelia burgdorferi antibodies in Multiple sclerosis patients. Neurology 1989;39:760-761
  6. Coyle Patricia K., Neurologic Complications of Lyme Disease. Review Article, 106 references. Rheumatic Diseases of North America, Nov 1993;19(4):993-1009
  7. Coyle Patricia K., Neurological Lyme disease: Is there a true animal model? Editorial Annals Neurology 1995 38(4):667-9
  8. Coyle Patricia M.D. Ph.D.  Lyme Disease, Mosby Yearbook ISBN 1-55664-365-9
  9. Coyle PK, Krupp LB, Doscher C, Amin K. Borrelia burgdorferi reactivity in patients with severe persistent fatigue who are from a region in which Lyme disease is endemic. Clin Infect Dis  January 18, 1994;1:524-7
  10. Coyle PK, Krupp LB, Doscher C. Significance of reactive Lyme Serology in Multiple Sclerosis. Ann Neurol 1993;34(5)745-7
  11. Coyle PK, Schutzer SE, Deng Z, Krupp LB, Bellman AL, Benach JL, Luft BJ. Detection of Borrelia burgdorferi antigens in antibody negative cerebrospinal fluid in neurologic Lyme disease. Neurology 1995;45(11):2010-2015
  12. DeKoning J, Hoogkamp, Korstanje JAA, van der linde MR, Crjins HJGM. Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease. J Infect Dis 1989;160:150-153
  13. Garcia, Monco JC, Coleman JL. Antibodies to Myelin Basic Protein in Lyme disease. J Infect Dis (Letter) September 1988;158(3):667
  14. Garcia, Monco JC, Fernandez, Villar B, Benach JL. Adherence of the Lyme Disease Spirochete to the Glial Cells. J Infect Dis 1989;160(3):497-506
  15. Garcia, Monco JC, Fernandez, Villar B, Alen JC, Benach JL. Borrelia burgdorferi in the CNS: experimental and clinical evidence for early invasion. J Infect Dis 1990;161:1187-1193
  16. Garcia, Monco JC, Fernandez, Villar B, Rogers RC, Szczepanski A, Wheeler CM, Benach JL. Borrelia burgdorferi and other related spirochetes bind to galactocerebroside. Neurology 1992;42:1341-1348
  17. Garcia, Monco JC, Beldarrain G, et al. Borrelia meningitis mimicking meningeal lymphoma. Neurology 1994;44:2207
  18. Gasser R, Dusleag J, Beisinger E, et al. Reversal by ceftriaxone of dilated cardiomyopathy caused by Borrelia burgdorferi infection. [Letter/Comments] Lancet, August 1, 1992;340(8814):317-18, From  Lancet May 9, 1992;339(8802):1174-5 
  19. Gasser R, et al. Early antimicrobial treatment of dilated cardiomyopathy associated with Borrelia burgdorferi, [Letter]  Lancet, August 1992;340(8825):982 
  20. Goodman JL, Sonnesyn SW, Holmer S, Kubo S, Johnson RC.: Seroprevelence of Borrelia burgdorferi in patients with severe heart failure, evaluated for cardiac transplantation at the University of MN. 
  21. Abstract. Goellner MH, Agger WA, Burgess JH, Durray PH.  Hepatitis due to recurrent Lyme Disease. Ann Intern Med  1988;108:707-708
  22. Grafman J, Litvan I, et al. Cognitive planning deficit in patients with cerebellar atrophy.  Neurology 1992;42:1493-96
  23. Gustafson JM, et al. Intrauterine transmission of Borrelia burgdorferi in dogs. Amer J Vet Res 1993;54(6):882-90
  24. Hobisch G, Klade H, Kersten A, et al.  Vascular Engagement in Lyme Borreliosis: Evaluation of Alpha-Actin Expression in Smooth Muscle Cells. Abstract # 162  V International Lyme Borreliosis Research Conference, Arlington, VA, 1992
  25. Johnston YE, Durray PH, Steere AC, et al. Spirochetes found in synovial microangiopathic lesions. Amer J Pathol  1985;118:26-34
  26. Kaell AT, Volkman DJ, Gorevic PD, Dattwyler RJ. Positive Lyme Serology in Subacute Bacterial Endocarditis. JAMA Dec 12, 1990;264(22):2916-2918
  27. Klein J, Stanek G, Bittner R, Horvatt R, Holzinger C, Glogar D. Lyme borreliosis as a cause of myocarditis and heart muscle disease. European Heart Journal 1991;12(Supplement D):73-75
  28. Kirsch M, Ruben FL, Steere AC, Durray PH, et al. Fatal Adult respiratory Distress Syndrome in a patient with Lyme disease. JAMA 1988;259:2737-2739
  29. Kollilowski HH, Schwendeman G, Schulz M, et al. Chronic Borrelia encephaloradiculitis with severe mental disturbance: Immunosuppressive therapy  vs. Antibiotic therapy. J Neurol 1988;235:140-142
  30. Lavoie Paul E.  Borrelia burgdorferi in the blood of three (SLE) and chronic Lyme patients. Abstract and Lecture handout St. Paul Lyme Disease Coalition of MN Lyme Borreliosis research Symposium. Minneapolis MN *
  31. Liegner Kenneth. Global Cerebral Atrophy in Lyme Borreliosis. Abstract 55B Arlington Virginia International Lyme Disease Symposia *
  32. MacDonald, Alan B. Gestational Lyme Borreliosis. Rheum Dis Clin North America 1989;15(4(:657-672
  33. MacDonald, Alan B, Gestational Lyme Borreliosis and a Rationale for a Prospective study of Sudden Infant Death Syndrome (SIDS). 1989; Rheumatic Disease Clinic of North America 1989;15(4):657-677
  34. MacDonald AB, Benach JL, Burgdorfer W.  Stillbirth Following Maternal Lyme Disease.  New York State Journal of  Med 1987
  35. MacDonald AB, Berger BW, Schwan TG. Clinical implications of delayed growth of the Lyme disease spirochete, Borrelia burgdorferi. Acta Tropica 1991;48:89-94
  36. Marcus LC, Steere AC, Durray PH, Anderson AE, Mahoney EB. Fatal Pancarditis in a Patient with Coexistent Lyme Disease and Babesiosis. Annals of Internal Med 1985:103:374-376
  37. Marsch WC, et al. Cutaneous fibrosis induced by Borrelia burgdorferi. Br J Dermatol 1993;128(6):674-8
  38. Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme Disease: Meningitis, cranial neuritis, and radiculoneuritis. Neurology 1985;35:47-53
  39. Pfister HW, Preach-Mursic V, Wilske, Rieder G, et al. Catatonic syndrome in acute severe encephalitis due to Borrelia burgdorferi infection.  Neurology, 1993;43(2):433-5
  40. Preach-Mursic V, Pfister HW, Spiegel H, et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophthalmology 1993;13:155-161
  41. Reik L, Smith L, Kahn A, Nelson W. Demyelinating Encephalopathy in Lyme disease. Neurology 1985;35:267-269
  42. Reik L, Steere AC, Bartenhagen NH, et al. Neurological abnormalities in Lyme Disease Medicine 1979;58:281-294
  43. Schmutzhard E, Pohl P, Stanek G. Borrelia burgdorferi antibodies in patients with relapsing/remitting form and chronic progressive form of multiple sclerosis. J Neurol Neurosurg Psych 1988;51:1215-1218
  44. Sigal LH. Cross-reactivity between Borrelia burgdorferi flagellin and a human axonal 64,00 molecular weight protein. J Infect Dis 1993;167:1372-8
  45. Sigal LH, Stein S, Williams S, et al. Monoclonal antibody to B. burgdorferi (BB) flagellin (fig)Hp724: probe in studies of the immunopathogenisis of Lyme neurologic disease. Arthritis Rheum 1991;34:5164
  46. Sigal LH, Tatu AH. Lyme Disease patient’s serum contains LgM antibodies to Borrelia burgdorferi that cross react with neuronal antigens.  Neurology 1988;38:1439-1442
  47. Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia burgdorferi from the myocardium of a patient with long-standing cardiomyopathy.  Med Intelligence 1990, January 25, 322(4):249-254
  48. Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, Wolfson S. Lyme carditis: Cardiac abnormalities of Lyme disease. Ann Intern Med 1980;93:8-16
  49. Steere AC, Durray PH, Danny JH et al. Unilateral Blindness Caused by Infection with the Lyme Disease Spirochete Borrelia burgdorferi. Annals of Internal Med, 1986;103:382-384
  50. Stiernstedt GT, Skoldenberg B, Vandvik B, et al. Chronic Meningitis and Lyme Disease in Sweden.  Yale J Biol Med 1984;57:491-497
  51. Uldry PA, Regli F, Bogousslavsky J. Cerebral angiopathy and recurrent strokes following B. burgdorferi infection. J Neurol Neurosurg Psych. 1987;50:1703-1704
  52. VanDerLinde MR, Crijns HJGM, DeKoning J, et al. Range of atrioventicular conduction disturbances in Lyme borreliosis: A report of four cases and review of other published reports. British Heart Journal 1990:63:162-168
  53. VanDerLinde MR. Lyme Carditis: Clinical characteristics of 105 cases. Scan J Infect Dis Supplement 1991;77:81-84*
  54. Vallat JM, Hugon J, Lubeau M, et al. Tick bite meningoradiculoneuritis: clinical, electrophysiologic, and histologic findings in 10 cases. Neurology 1987;37:749-753
  55. Waniek C, Prohovnik I, Kaufman MA. Rapid progressive frontal type dementia and subcortical degeneration associated with Lyme disease. A case report/abstract/poster presentation. LDF State of the art conference with emphasis on neurological Lyme. April 1994, Stamford, CT* 
  56. Webber B, Wiedersheim P, Matter L, et al. Chronic progressive neurological involvement in Borrelia burgdorferi infection. J Neurol 1987;234:40-43
  57. Weigelt W., et al. Sequence homology between spirochete flagellin and human myelin basic protein. [Letter] Immunology Today, July 1992;13(7):279-80

 

Annonser

Kommentera

Fyll i dina uppgifter nedan eller klicka på en ikon för att logga in:

WordPress.com Logo

Du kommenterar med ditt WordPress.com-konto. Logga ut / Ändra )

Twitter-bild

Du kommenterar med ditt Twitter-konto. Logga ut / Ändra )

Facebook-foto

Du kommenterar med ditt Facebook-konto. Logga ut / Ändra )

Google+ photo

Du kommenterar med ditt Google+-konto. Logga ut / Ändra )

Ansluter till %s