I found the text for the critical publication on "rel-risk.blogspot.com":
Failing the LL Test for Chronic LD
Dessau RB, et al. The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful. Clin Micro Inf, 2014;20:O786–O787.
This letter is a comment on a study using the lymphocyte transformation test (LTT) for the diagnosis of active Lyme borreliosis caused by Borrelia burgdorferi sensu lato*. The study has several major shortcomings. Concerning inclusion criteria, it was not clearly specified how the 94 patients with clinical Lyme borreliosis were defined.
…and it remains unclear how it was determined that the 34 patients with migratory arthromyalgias were suffering from Lyme borreliosis. The 160 controls for the LTT were preselected as being seronegative for Borrelia-specific antibodies, and this could introduce a selection bias, because serology and LTT results tend to correlate.
Concerning the selection criteria for the large group of 1480 patients, it is not clear what is meant by ‘clinical diagnosis of suspected Lyme borreliosis’, among what appears to be a mixture of protean disorders. The clinical spectrum of these patients was not described.
Forty per cent of the 1480 patients suspected of having Lyme borreliosis were LTT-positive, and 63% were serology-positive. This is a high percentage of positive results as compared with a series of consecutive patients suspected of having Lyme borreliosis in Denmark, where 9.2% were found to be IgM-positive and 3.3% IgG-positive.
…owing to the study design, evidence of active infection is lacking. Clinical features, including follow-up and/or detection of the organism by culture or PCR, are absent. Also, the conclusion that the Borrelia LTT may be used for follow-up monitoring of disseminated B. burgdorferi sensu lato infections and provide indications for antibiotic treatment is not supported by the study design, as this would require a prospective trial with a control group.
An ethics statement is missing, and the authors declare no conflict of interest, but are associated with a commercial laboratory recommending this test (
http://www.imd-berlin.de/leistungsschwerpunkte/borreliose/ltt-borrelien.html). This website indicates that a positive LTT result may indicate a persisting infection. However, both neurological and
microbiological European guidelines discourage the use of LTTs, owing to insufficiently rigorous validation and a low reported specificity.
…‘chronic Lyme borreliosis’ is a problematic concept, as discussed elsewhere. As an example, it is stated that ‘over 250 peer-reviewed scientific articles demonstrate the causal association between Lyme/tick-borne disease and mental illness’. This is contradicted by the conclusion based on a substantial review of the literature (Final Report of the Lyme Disease Review Panel of the Infectious Diseases Society of America;
www.idsociety.org). In the Infectious Diseases Society of America review, it was determined that the large number of scientific articles concerning ‘chronic Lyme borreliosis’ were uncontrolled case observations, which do not give convincing evidence of the persistence of viable organisms or the effects of prolonged antibiotic treatment.
*von Baehr V, Doebis C, Volk HD, von Baehr R. The lymphocyte transformation test for borrelia detects active Lyme borreliosis and verifies effective antibiotic treatment. Open Neurol J 2012; 6: 104–112.
