"Lyme-specific" Western Blot Bands

[Valentijn]

One argument against the CDC two-tier testing method is that their requirements for a positive Western Blot are unnecessarily stringent. While some bands are widely known to cross-react with other infections, it is also said that some bands are Lyme-specific, and do not react to anything else.

Thus the conclusion is that being positive for a purportedly Lyme-specific band should be taken as proof of past or present Lyme infection.

Related to this is the claim that stringent CDC requirements were actually intended for official reporting of the disease, not for diagnosis.

But is there verification of that there are 1) Lyme-specific bands and 2) that the CDC initially did intend the stringent requirements to apply to clinical diagnosis? Research is preferred, though in this case CDC documents are also likely to be relevant in showing their past stance, and/or if that stance has evolved over time. Posts from Lyme forums are not directly helpful, though they might include useful citations.

 

[duncan]

When researchers met in Dearborn, Michigan, over 20 years ago to consider what algorithm to adopt, they looked at two bands and three bands, etc. Supposedly they opted for a minimum of five bands IgG, in part, because the risk of false positives was reduced with this solution. It's a peculiar mindset: I would have thought they'd err on the side of caution for too many false negatives.

Of course, now we know some clinician/researchers have no problem rejecting 2T positives regardless.

Somewhere I have a list of Bb-specific bands. If I find it, I will source it. 18 and 23 come to mind, but let me double check that.

Edited to add: Ok, it's easy to find lists of Bb-specific bands, not so easy to find anything that appears unimpeachable. I found a German diagnostic company Autoimmune Diagnostica, that states band 18 isn't necessarily specific, but that bands 23 (OspC) and 34 (OspB) and 39 and 93 are.

Also, there are studies - by IDSA peeps - that demonstrate some Bands are more correlated with Late Stage than others. Same with early stage. So plenty of research out there that looks at the relationship between specific Bb proteins, and the pathology of the disease.

 

[Valentijn]

@duncan - Do you have sources regarding the Dearborn discussion?

 

[duncan]

@Valentijn , I'm sure I do...somewhere. I have rooms that have post-its and studies pinned to the wall.

My mantra is "Sloppy and absented-minded is good."

Only, my mantra is a lie.

Let me look.

 

[Helen]

Also, there are studies - by IDSA peeps - that demonstrate some Bands are more correlated with Late Stage than others.

Interesting! Maybe you have a study or a post-it about that on one of your walls too ;-)?

 

[duncan]

Looks like they (dressler et al, 1993) were drilling down on five IgG or more bands just before the Dearborn convention. I found a history of Lyme that makes reference to the discussion as early as 1991 whether to embrace two bands or three etc - the 2001 Lyme Disease Association "Conflict of Interest in Lyme Disease."

I know there are studies or retrospectives that explore that debate. It wasn't as if scientists just knew that five bands was the preferred number. There was a discussion. Will keep looking.

@Helen - those references may be in one of the stacks on the mound that used to pass as my kitchen table. I think.

 

[duncan]

@Helen - check out Wormser et al, May 2011, Clin Vaccine Imm, for specific proteins associated with PLDS. For detailed and lengthy discussions on proteins associated with early or acute Lyme infection - and some modest discussion about proteins in late stage - check out Wormser et al, July 2005, Clin Microbiol Rev.

There are all kinds of studies that claim to find correlations between proteins and Lyme stages, but also between Lyme manifestations, like neuroborreliosis and Lyme arthritis etc.

They are out there. Not sure whose to trust, but they are out there.

 

[duncan]

Interest stuff out there. Dangerous, too, as these studies will suck you into a never ending vortex of data and conjecture because it's all still relevant.

Anyway, check out some of the earlier researchers like Blaauw et al in 1992, and Blaauw even later, in 1999, well after Dearborn and Dressler. Not only did they look at different numbers of bands to include, they also considered the absence of certain bands as indicative of positive/negative diagnoses.

 

[maryb]

Am I right in thinking that specific bands relate to different tick famiies (for want of the correct word) I was positive for band 58kda which I understand to be the Scottish tick.

 

[duncan]

Hmmm.. @maryb , I don't know about that. I would think it's more contingent on the Borrelia species, irrespective of tick species.

Not sure, though.

 

[Valentijn]

Am I right in thinking that specific bands relate to different tick famiies (for want of the correct word) I was positive for band 58kda which I understand to be the Scottish tick.

I think they directly indicate certain Borrelia proteins are present. And the proteins are determined based on what is known of Borrelia. Some ticks are more likely to have certain types of Borrelia (just based on geography I think). And it's possible that some bands react differently to different types of Borrelia - but I think that's one of the things we need more data about.

 

[maryb]

I found this extract but anyone know how I can access the full text?

J Med Microbiol. 2005 Dec;54(Pt 12):1139-41.
Audit of the laboratory diagnosis of Lyme disease in Scotland.
Evans R1, Mavin S, Ho-Yen DO.

 

[duncan]

@maryb , you may wish to a look at the abstract for "Isolation of Borrelia Burgdorferi from Ticks in the Highlands of Scotland," J. Med Microbiol, Jan, 1999, Evans R et al.

It seems to suggest Scotland may have strains unique to it.

If you cannot access Pubmed for full articles, see about emailing one of the authors?

 

[maryb]

Thanks for that @duncan - I'll have a look tomorrow.

 

[Valentijn]

I found this extract but anyone know how I can access the full text?

J Med Microbiol. 2005 Dec;54(Pt 12):1139-41.
Audit of the laboratory diagnosis of Lyme disease in Scotland.
Evans R1, Mavin S, Ho-Yen DO.

From pubmed there's often a link to the original journal as a little icon on the right side. In this case it's at http://jmm.sgmjournals.org/content/journal/jmm/10.1099/jmm.0.46003-0#tab2

 

[maryb]

Thank you soooo much @Valentijn