Lyme Medical Workup

Harold Smith <>

Summary: the medical workup (labs, etc.) to rule out Lyme disease (and its relatives).

Lumbar puncture

More often absent are the clinical signs of thus misdirecting the unsuspecting physician.

More often it is just

As borrelia there is Brorson's work demonstrates that spinal fluid induces motile Bb spirochetes to transform into these bleb or larger cyst forms without identifying walls.

This may explain Andrew Pachner's observation ( JAMA symposium on LD in 1995) that he often finds POSITIVE PCR DNA spinal fluid in neuroborreliosis patients who are NEGATIVE by ELISA and Western Blot in serum and spinal fluid ( at least negative for reporting criteria- maybe they are positive by specific bands such as 23 (OspC), 31 (OspA), 34 (OspB)).

Thus the doctors could do

There are other tests that could detect CNS dysfunction besides the spinal fluid analysis. All in all, neuroborreliosis, being predominantly - all this results in little yield from csf studies in later neuroborreliosis.

A more reasonable approach all said is perhaps doing

Regarding the differential diagnosis- Dr. Bransfield listed a source by Dr. ?Weiss of the other infections that can cause a similar chronic subacute encephalopathy with other disseminated organ features. I haven't found it yet. come to mind, but I'm still in the barnyard about what organisms to search for. One word in parting,

IgM should be done as well as IgG since IgM is constantly stimulated by new antigen expressions from the same and new generations of Bb.

Urine antigen (LUAT) at IGENEX often inversely parallels the Western Blot results

Since antigen and antibody are complexed during this disease it is only when one or the other is in excess and free from complexes that their presence in the free form can be detected. ELISA tests are a waste of time and money if one considers that a positive alone is taken as of no value alone, and a negative test makes little scientific, practical, or ethical sense when used to exclude patients.

Not many have done acridine orange stains on buffy coat samples of white blood cell concentrates but it looks easy and rewarding from Lida Mattman's work in Cell Wall Deficient Forms- Stealth Pathogens Third edition CRC Press 2000.

PCR testing of tissue samples is more rewarding in sensitivity that fluid samples such as blood.  I think the likelihood of a positive blood PCR is probably about 15-20% on first testing of a patient with Bb. This might indicate a need for serial PCR DNA out to 6 or 7 samples before offering the patient much in the way of confidence that Bb was unlikely to be present.

If you find the site discussing a full work up of the cns microbes please share it.


Diagnostic Labs in Germany (von J. Gr uber):

Of related interest (added by J. Gruber):

Date: 10.4.2001
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