April 14, 2009
The Problem with Testing for Lyme disease (part 1)
Lyme disease is caused by an infection with the bacteria Borrelia Burgdorferi. While many other bacterial diseases can sometimes be eliminated by our intact immune systems, there are many bacterial diseases which require the intervention of antibiotic therapy. Lyme disease is one of the latter diseases which require antibiotic therapy. What is interesting is that Lyme disease does not depress the immune system. It evades the immune system.
This evasion is due to a number of known mechanisms, and for sure other mechanisms which we are as yet ignorant of. One reason is that while a person can be terribly ill from Lyme disease, the number of actual organisms in that person's body is very few. In science this is referred to as the Bacterial Load. This is in contrast to the HIV virus. When a person acquires infection with the HIV virus, they may not begin to develop symptoms of AIDS until the Viral Load is greater than hundreds of thousands to millions of viruses per cubic centimeter of blood (20 drops of blood which contains about five million red blood cells)! While Lyme disease does not live in the blood but in tissue, the bacterial load usually is as low as hundreds to just thousands of Lyme disease bacteria per cubic centimeter of tissue ( containing maybe ten million tissue cells)!
Bang to the buck, the Lyme disease bacteria is infinitely more virulent than the HIV virus, yet the HIV virus, just by sheer numbers can overwhelm the person's immune system leading to death.
One impediment to the development of a clinically measurable and confirmatory immune response for many patients with Lyme disease is that there are just too few organisms to really rally even a normal immune system to create antibodies against it.
In many patients who do not develop big swollen joint from Lyme disease, there will not be a measurable nor confirmatory immune response, yet they are infected and ill. In these patients, one finds negative ELISA and Western Blots for Lyme disease, yet they have Lyme disease. Unfortunately Physicians have overly relied on these tests, and have told patients that in fact they do not have Lyme disease. The Lyme disease bacteria when it enters the body at first strives to target tissue derived embryonically from mesoderm for infection (this is tissue is destined to become our connective tissue, joints, muscle, blood, and even the meninges around the brain). In some patients this is very dramatic and aggressive, leading to the famous Lyme arthritis, and meningitis seen in early disease. These are the patient who develop classic Lyme disease and usually develop positive Lyme ELISA and Western Blot test results.
In other patients who have also develop Lyme disease, there symptoms are much different. Their disease may be more Neurotropic (targeting the central nervous system, the Brain). Many of these patients do not develop a clinically measurable nor confirmatory ELISA or Western Blot. These patients generally do not get diagnosed nor treated promptly and are left in limbo by the majority of health care providers.
Peer reviewed studies of the development of the serological (antibody) response to infection with Lyme disease have not supported the blanket conclusion that if a Lyme ELISA and/or Western Blot is negative, that a patient does not have Lyme disease. In my next few blogs I will review in detail the medical literature and what reasonable conclusions can be drawn from the results.
