Discussion about Armin labs (Split Thread).

[bertiedog]

You may be right. I was asking because I think several people on the forum have mentioned that their LTT testing turned from negative to positive after taking an antibiotic. So there are at least the following possibilities for this (in addition to the notation included with your first test results about the low lymphocytes):

I tested positive on the LTT two years ago with a +5, +4 and +3 to the various antigens but I hadn't taken any antibiotics before the test. I also tested positive to bank 57 on a Western Blot. CD57 cells were 67 which was considered low.

In view of all the uncertainties of testing I still feel confused over it butI do have a history of visiting the New Forest which is considered an endemic area for Lyme disease, for well over 30 years on and off with my dogs who did used to get ticks on them and I also remember having an inflammatory illness like nothing I have had before or since and it turns out I had been on holiday in the New Forest only about 2-3 weeks before this. Since that happened in 1996 everything has changed for me. I did suffer with migraine and vertigo attacks before this event but I had no problems with energy and no muscle problems.

Within 3 years I could no longer walk for longer than 20 minutes, I could no longer work and the vertigo had taken over my life and my immune system was rubbish and since then I have low wbc count, low lymphocytes and pick up many viruses and infections.

Because of the test result and my weak immune system I decided to use a herbal protocol and have done a modified Cowden protocol from which I have had a lot of benefit especially in my energy level. I did stop it last November after about 16 months but my immune system has taken a nose dive and I have needed 2 separate courses of antibiotics since then because of throat infections. Also I have had 2 bouts of cystitis, something I used to suffer with but haven't had for years.

So all in all I don't really know what I am suffering from but it definitely affects my immune system and energy! Also Cumanda, Banderol, Mora and Houttunia plus Burbur and Pinella all help these two things so I feel so much better on them and restarted a week ago with good improvements in my energy and sense of well-being this past week. It is very noticeable and is reflected in the number if steps I do daily.

Pam

 

[Hip]

I wouldn´t ask those questions if I were you, unless that is you want to sound ignorant about Lyme testing.

I don't mind sounding ignorant about Lyme testing, because that reflects the reality. I really don't know that much about it.

Re: your first point, whether Armin has adjusted the cut off or not isn´t as important as how he and other physicians interpret it.

One of the questions I wanted to ask Dr Armin Schwarzbach is how he uses his various Lyme tests in combination to come to a probabilistic conclusion about whether the patient is Lyme positive or negative.

The way cutoff points, sensitivity, specificity, false negatives and false positives all relate to each other mathematically is known as the receiver operating characteristic (ROC), a field I just recently came across.

the LTT-ELISPOT has been openly documented, since they have published a study showing it´s sensitivity and specificity.

Armin Schwarzbach says in his webpage for the LTT EliSpot test that "the sensitivity of EliSpot is estimated at 84%, and the specificity is 94%."

Presumably they estimated it because they did not use a gold standard.

Re: your second point, as I have pointed out several times in this thread, there is no gold standard in Lyme. That means no one uses culture as the standard. This is because so far it has been very difficult to culture Lyme.

So how can Advanced Laboratory Services offer a commercial Borrelia culture test if it is so difficult?



As an aside, I wonder how ArminLabs coxsackievirus antibody tests rate against the Arup Lab tests? Dr Chia found that out of the US labs, only ARUP Lab was sensitive enough to detect the low levels of antibodies present in ME/CFS patients.

However, I am not sure how European labs compare to ARUP, because I don't think Dr Chia trailed those.

 

[halcyon]

As an aside, I wonder how ArminLabs coxsackievirus antibody tests rate against the Arup Lab tests? Dr Chia found that out of the US labs, only ARUP Lab was sensitive enough to detect the low levels of antibodies present in ME/CFS patients.

However, I am not sure how European labs compare to ARUP, because I don't think Dr Chia trailed those.

A couple of patients have posted their results from this test and it's a little perplexing. They don't break down which serotypes the patient is positive for so I don't see how you can make much sense out of that.

 

[halcyon]

only ARUP Lab was sensitive enough to detect the low levels of antibodies present in ME/CFS patients.

To clarify, we don't have low levels we actually have very high levels of antibodies to these viruses. It's just that the other commonly available test methods used besides what ARUP uses require large amounts of virus in the blood which we don't have.

 

[msf]

I don't mind sounding ignorant about Lyme testing, because that reflects the reality. I really don't know that much about it.





One of the questions I wanted to ask Dr Armin Schwarzbach is how he uses his various Lyme tests in combination to come to a probabilistic conclusion about whether the patient is Lyme positive or negative.

The way cutoff points, sensitivity, specificity, false negatives and false positives all relate to each other mathematically is known as the receiver operating characteristic (ROC), a field I just recently came across.





Armin Schwarzbach says in his webpage for the LTT EliSpot test that "the sensitivity of EliSpot is estimated at 84%, and the specificity is 94%."

Presumably they estimated it because they did not use a gold standard.





So how can Advanced Laboratory Services offer a commercial Borrelia culture test if it is so difficult?



As an aside, I wonder how ArminLabs coxsackievirus antibody tests rate against the Arup Lab tests? Dr Chia found that out of the US labs, only ARUP Lab was sensitive enough to detect the low levels of antibodies present in ME/CFS patients.

However, I am not sure how European labs compare to ARUP, because I don't think Dr Chia trailed those.

Once more, there is no gold standard, if there was we wouldn´t be having this discussion as there would be no Lyme testing controversy. So the sensitivity and specificity of every Lyme test is ´estimated.´

How can they offer a test? It´s not hard to come up with a Borrelia culture test, it´s hard (so far impossible) to come up with that has a high enough sensitivity for it to be used as the gold standard.

 

[Hip]

How can they offer a test? It´s not hard to come up with a Borrelia culture test, it´s hard (so far impossible) to come up with that has a high enough sensitivity for it to be used as the gold standard.

Even if the culture test lacks sensitivity, if you culture live Borrelia bacteria from a given patient's blood, there is no question that this patient has Lyme; it is 100% certain. Thus with a series of patients like that who have Lyme with 100% certainty, couldn't you then use them check the specificity of other Lyme tests, such as the LTT EliSpot test?

Or might that introduce error because the patients with culturable Borrelia in their blood might have higher levels of Borrelia than patients also having Borrelia, but at too low a level for the culture to pick up?

Still, it could be a useful validity check on tests like the LTT EliSpot.

To clarify, we don't have low levels we actually have very high levels of antibodies to these viruses.

I have replied to your above post in another thread, to avoid taking this thread of track.

 

[Mel9]

It is so interesting to hear the different opinions regarding the (Western) Immunoblot Lyme tests because I was positive for Borrelia afzelii by this method (BTW – as I do have an ACA rash I am fairly sure it is
probably right).


From my reading, the method separates antigen proteins by molecular size. The important proteins seem to be outer surface protein C (OspC, found at 18 kDa and 25 kDa) and the flagella protein (also called FlaB, or P41, found at 41 kDa). So - can I trust my results? To try to answer this I read the attached a paper by Panelius et al., 2002 on OspC. They wrote:

"Cross-reactive antibodies to rOspC were observed in serum samples from patients with rheumatoid factor positivity and with syphilis or Epstein–Barr virus (EBV) infection"

So - yes, these diseases will cause 'false positives'. However, it appears that there were no, or negligible, 'false positives' for normal healthy patients not suffering from the above diseases (see Figure 2). Similar findings have been repeated in more recent papers. I could not find a study that showed cross reaction other than in the presence of these, or similar, diseases.

To me, this indicates that a positive OspC band is probably always a bad thing, whether Borrelia is present or not? So the ‘false positive’ argument against taking this sort of test does not seem valid. I guess that if medical practitioners are worried about the existence of 'false positives' for OspC on pathology reports, they should probably do further testing for syphilis, rheumatoid arthritis and Epstein Barr Virus before finally diagnosing a Borrelia infection. It seems to me that OspC cannot just 'appear' in the results without an accompanying disease.

Further, logically, if you did have Lyme disease symptoms (e.g. an EM rash or ACA rash etc) plus a positive OspC result, and you were negative for syphilis, EBV and Rheumatoid arthritis, that, alone, is probably evidence that you do really have a Borrelia infection?

But I am certainly not an expert in this area. Does my argument make sense?

 

[Dufresne]

Once again I want to make it clear that I believe Lyme exists and it can be a devastating condition. The tests have inaccuracies which means a clinical decision which involves weighing many complex factors is often needed. It's rarely an either or diagnosis. It's in the best interests of patients to get an accurate diagnosis and treated appropriately which is the bottom line!

As it's redundant to acknowledge Lyme disease as real and serious, should I infer that you're indicating you believe chronic Lyme (persistence) exists?

 

[barbc56]

As it's redundant to acknowledge Lyme disease as real and serious, should I infer that you're indicating you believe chronic Lyme (persistence) exists?

Why do you think acknowledging that Lyme is real and serious means you must believe in the existence of chronic lyme? I fail to see the connection.

Barb

 

[duncan]

@barbc56 , are you suggesting chronic Lyme does not exist?

Perhaps there is some confusion over what constitutes chronic Lyme; certainly a few individuals who belong to some mainstream Lyme organizations have helped to muddy those waters.

What does chronic Lyme mean to you, @barbc56 ?

 

[justy]

@barbc56 , are you suggesting chronic Lyme does not exist?

Perhaps there is some confusion over what constitutes chronic Lyme; certainly a few individuals who belong to some mainstream Lyme organizations have helped to muddy those waters.

What does chronic Lyme mean to you, @barbc56 ?

I tell you what it doesn't mean to me - PTLD - post treatment Lyme disease. Most people with chornic or late stage Lyme have NEVER been treated, as they have been left for years and years with no diagnosis or testing to languish in ill health until they develop M.E or some other horrible illness. For those that have been treated it is clear that the treatment may not have been adequate. There is a hwole wealth of info and studies now available on the inadequacy of short duration monotherapy - especially if we imagine two weeks of Doxy could just force the Borrelia into cyst forms.

 

[Dufresne]

Why do you think acknowledging that Lyme is real and serious means you must believe in the existence of chronic lyme? I fail to see the connection.

Barb

I thought it was pretty clear. Indicating Lyme is real and serious is like acknowledging chickenpox is real and causes scabbing. I don't know why you would actually have to state this: it goes without saying. So when you make the point of clarifying such a thing, I'm just wondering if you actually meant chronic Lyme is real.

I'm kind of sorry I brought it up seeing as this is how almost every one of these Lyme threads ends up going for a bit, and that is redundant. So sorry to everyone. But I really did get the impression you might be changing your position on chronic Lyme. Assuming this is not the case, we can skip the debate.

 

[Valentijn]

Thus with a series of patients like that who have Lyme with 100% certainty, couldn't you then use them check the specificity of other Lyme tests, such as the LTT EliSpot test?

Theoretically it could (and probably should) happen. But in the real world, cultured samples are not even used to validate the mainstream two-tier testing method. The best I've seen was something like 20 cultured samples out of the 200 samples used for calibrating other results, and with no breakdown of results based on the type of sample being used.

I'm not sure why it isn't happening. It's expensive, and time-consuming, but surely it would be worthwhile if it meant that the accuracy of other testing methods could be determined, and better methods selected. I'm not a fan of conspiracy theories, but it's hard to imagine why CDC is so seriously dropping the ball on this issue.

 

[Hip]

Theoretically it could (and probably should) happen. But in the real world, cultured samples are not even used to validate the mainstream two-tier testing method.

The only argument I could think of against using culture-positive patients for Lyme test validation is that possibly a culture test itself may be selective: due to its own sensitivity issues, culture positive may select for Lyme patients with higher levels of Borrelia in the blood, and miss Lyme patients with lower blood levels of Borrelia (those with lower blood levels may test culture negative).

But I am just guessing here, as I really don't know much about Lyme testing.


Presumably another way of validating Lyme tests might be to use patients that are known to: (1) have had a tick bite; (2) have manifested the classic Lyme bullseye rash; (3) and to have developed classic Lyme symptoms soon after the bite.

 

[justy]

The only argument I could think of against using culture-positive patients for Lyme test validation is that possibly a culture test itself may be selective: due to its own sensitivity issues, culture positive may select for Lyme patients with higher levels of Borrelia in the blood, and miss Lyme patients with lower blood levels of Borrelia (those with lower blood levels may test culture negative).

But I am just guessing here, as I really don't know much about Lyme testing.


Presumably another way of validating Lyme tests might be to use patients that are known to: (1) have had a tick bite; (2) have manifested the classic Lyme bullseye rash; (3) and to have developed classic Lyme symptoms soon after the bite.

I think the other main problem with Lyme testing is not the reliability of the tests themselves, but the fact that Lyme can evade the immune system and go into cyst form, where it can lay undetected. That is why a clinical dx is so important. My Armin LTT Ellispot was negative (yes it does happen!), but I have a clinical dx based on other immune markers, presence of tick born co infections and symptoms.

 

[Hip]

I think the other main problem with Lyme testing is not the reliability of the tests themselves, but the fact that Lyme can evade the immune system and go into cyst form, where it can lay undetected.

There may be three different forms that Borrelia can exist in and change between: spirochetes, cysts, and L-forms. The L-form is the morphology that allows bacteria to invade human cells and live inside cells as an intracellular infection.

Although I have read that some researchers think that Borrelia cysts and Borrelia L-forms may be one and the same.



If Borrelia L-forms do turn out to exist, then one could make some analogies between Borrelia infection and enterovirus infection. Enterovirus is now known to live both outside cells like a normal virus, but enteroviruses can also form chronic intracellular infections within cells (called enterovirus non-cytolytic infections), and researchers such as Dr Chia think the intracellular enterovirus infections could be playing a major role in ME/CFS.

 

[justy]

There may be three different forms that Borrelia can exist in and change between: spirochetes, cysts, and L-forms. The L-form is the morphology that allows bacteria to invade human cells and live inside cells as an intracellular infection.

Although I have read that some researchers think that Borrelia cysts and Borrelia L-forms may be one and the same.



If Borrelia L-forms do turn out to exist, then one could make some analogies between Borrelia infection and enterovirus infection. Enterovirus is now known to live both outside cells like a normal virus, but enteroviruses can also form chronic intracellular infections within cells (called enterovirus non-cytolytic infections), and researchers such as Dr Chia think the intracellular enterovirus infections could be playing a major role in ME/CFS.

Well put - and this creates problems for testing. So again the Gold standard is clinical diagnosis. Mnay co infections are also difficult to test for - Bartonella has a huge false negative rate, as does Babesia. Chlamydia Pneumonia which many Lyme sufferers have (including me), also becomes an intracellular infection. All difficult stuff to detect and to treat - but the effort should be put n to track these infections, and others down in people with M.E, because treating them (if possible) can increase functioning and quality of life.

 

[duncan]

Borrelia also has been found to form biofilms.

Persister cells I think retain normal spirochete shape, but perhaps not. According to three independent research teams, they do possess a quality that enables a small but meaningful portion of them to withstand abx, and perhaps the body's own immune defenses - this is decidedly different than antibiotic resistant.

And then there is their reported ability to shift their outer surface proteins, to confound immune systems into thinking there is no threat, or there is a perpetual new threat (hence so many testing IgM positive for protracted periods).

 

[roller]

they have the blood where the parasite is in and they cant tell for sure that its in?

and after antibacterial treatment for that parasite/bacteria, its possible that you are tested positive?

 

[johnfirb]

Hi all,
I have this week recieved blood test results from Arminlabs being unwell for the last 3 years. Seraspot shows negative for Borelia burgdoferi antibodies but the Elispot shows a +16 for the same. Being that the positive number is high, does this mean that the chances of it being a lyme infection is greatly increased? My CD 57+ NK-cells was 70 absolute value which is claimed to be low. Any comments appreciated.

John.