Does increasing IGG borrelia levels indicate active infection?<

nerd

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Not an active infection, but it can show a chronic subacute infection. Like many viruses, borrelia have the tendency to nest themselves in deep tissues in small quantities. That means small enough that they can not cause major infection symptoms or immunological responses. But even small quantities can trigger increasing antibody counts, e.g. in times of stress when the immune system is suppressed, or when creating a symbiotic pathology with another pathogen.

In any way, normal ELISA and Western Blot Borrelia tests are very unreliable. Their sensitivity and specificity are subpar. Other tests can be used to verify the diagnosis, e.g. LTT, CD57+ to NK cell count ratio, and CXCL13 in the CSF (for neuroborreliosis).
 

duncan

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Not an active infection, but it can show a chronic subacute infection.
My understanding is that a chronic subacute infection is an active infection.

Like many viruses, borrelia have the tendency to nest themselves in deep tissues in small quantities. That means small enough that they can not cause major infection symptoms or immunological responses.
Not many in Lyme world that would agree with this opinion. :)
 

nerd

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My understanding is that a chronic subacute infection is an active infection.
Diseases aren't defined pathologically first. This means that a symptomatic manifestation is required for a normal diagnosis of an active infection. Active, so one understanding, means active replication. Borrelia, however, can survive many months without replication. So how do you call latent or lytic infections that still cause pathology in the residing tissue? If latent infections were recognized as real and active infections, every human on earth is infected. This makes it difficult for medicine to accept such a definition because they would have to recognize all the viral pandemics nobody bothers about. Science has systematic issues accepting new paradigms.
 

duncan

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Diseases aren't defined pathologically first. This means that a symptomatic manifestation is required for a normal diagnosis of an active infection..
Perhaps you are conflating subacute with subclinical? Lyme, for example, usually presents with fever in early disease, but not so much in late stage. How Borrelia presents in late stage is generally subacute, but frequently not subclinical (although it certainly can be subclinical as well).
 
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nerd

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Perhaps you are conflating subacute with subclinical? Lyme, for example, usually presents with fever in early disease, but not so much in late stage. How Borrelia presents in late stage is generally subacute, but frequently not subclinical (although it certainly can be subclinical as well).
Good point. Subclinical is a more fitting classification of what I meant. Yet, acuteness still plays a role during the initial phase. You can develop chronic Lyme without an initial acute infection. And whatever happens many years later will not meet the clinical criteria for acute Lyme either. This makes the diagnosis of the disease more difficult.
 

duncan

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You can develop chronic Lyme without an initial acute infection.
Yes. You mean without initial acute symptoms, I think. Agreed. Willy Burgdorfer - something like 40 years ago -wrote that Lyme can begin and last how ever long asymptomatically, if I recall correctly.

And whatever happens many years later will not meet the clinical criteria for acute Lyme either.
Well, it does happen. Antigenic variation and all that. Fooling the body into thinking it's a new infection, when it's anything but. Can even come with a positive IgM. It's not the norm in late stage circles, however.

This makes the diagnosis of the disease more difficult.
Agreed. That doesn't even address other tick-borne diseases that are equally difficult to diagnose, and treat, like babesiosis. Distressing when you factor in the fact that in many parts of the world, Lyme is increasingly a package deal, i.e., if you get Lyme, there's a good chance you may also be infected by one or more additional tbd's. Alternatively, if you get bitten by the right kind of tick, and you escape without Lyme, you may still have to deal with one or more other pathogens,
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