Help w/ IGenex Results..?

Hello,
I just received my copy of my Igenex results 2 days ago. Can anyone please interpet what all of this means?  

Are my tests results "clear-cut" for a lyme disease diagnosis or is it "border-line/suggestive" of lyme?  

What does it mean when I have a negative IgM but positive IgG- does having a negative IgM cast any doubt of lyme?





IGENEX IGM RESULT NEGATIVE

CDC/NYS RESULT NEGATIVE



**39 kDa. IND

**41 kDa. IND



=====================================

IGENEX-IGG-RESULT POSITIVE

CDC/NYS-RESULT NEGATIVE



**31 kDa ++

**41 kDa +

[JackieCalifornia]

Welcome to MedHelp Lyme --

First, there is virtually nothing clear cut about Lyme ... sad but true.  Eventually it won't seem like such an odd thing.  It's just that modern medicine prides itself on bright-line tests, totally binary (yes/no) with no ambiguity allowed.  Lyme doesn't play by those rules.  

But back to your test results:

The IgM and IgG tests measure your immune system's response to a Lyme infection.  IgM antibodies appear shortly after infection and then trail off and the IgG antibodies then appear.  However, there are no hard and fast time cutoffs, and everyone's immune system is different.

That your doc even sent your test to IGeneX is a very good sign, because only a good Lyme doc is likely to use IGeneX -- so I'd see the doc and discuss his/her thoughts on what to do now.  

You are positive on the test as measured by IGeneX.  That doesn't happen by accident.

Get copies of all the tests for your own files, because you may well need them later, and getting complete copies down the road is often difficult.  A later doc might read the tests differently, so having ALL the tests is important.

Let us know what you hear from the doc as to diagnosis and treatment plan, and we can suggest to you what we would do then.

[JackieCalifornia]

Welcome to MedHelp Lyme --

First, there is virtually nothing clear cut about Lyme ... sad but true.  Eventually it won't seem like such an odd thing.  It's just that modern medicine prides itself on bright-line tests, totally binary (yes/no) with no ambiguity allowed.  Lyme doesn't play by those rules.  

But back to your test results:

The IgM and IgG tests measure your immune system's response to a Lyme infection.  IgM antibodies appear shortly after infection and then trail off and the IgG antibodies then appear.  However, there are no hard and fast time cutoffs, and everyone's immune system is different.

That your doc even sent your test to IGeneX is a very good sign, because only a good Lyme doc is likely to use IGeneX -- so I'd see the doc and discuss his/her thoughts on what to do now.  

You are positive on the test as measured by IGeneX.  That doesn't happen by accident.

Get copies of all the tests for your own files, because you may well need them later, and getting complete copies down the road is often difficult.  A later doc might read the tests differently, so having ALL the tests is important.

Let us know what you hear from the doc as to diagnosis and treatment plan, and we can suggest to you what we would do then.

[Ricobord]

I will throw in my two cents.  First, Jackie's answer is excellent (as usual).  :)

Second, you show an important Borrelia specific band on your IgG, band 31.  The other band, 41, is very common in Lyme patients, but could also be caused by other spirochetes.  IGeneX is saying you are positive because you have Borrelia specific antibodies.

Some LLMDs consider an INDeterminate response as a positive. It means that the lab technician saw something on that band, but not enough to call it positive. If your two IND bands on the IgM had been fully positive, your IgM would be CDC positive and IGeneX positive.  One of those bands (39) is also Borrelia specific.

I remember the day I got my IGeneX results!  I had been looking for answers for 16 months at that point.  I was so grateful for an answer. Keep us posted!

[JackieCalifornia]

Thanks, Rico, for the commentary.  I'm so brain-fried today from work that I could manage only a half-witted response.  Your comments are spot-on, and you're sounding quite chipper today yourself!  That's definitely a good thing.  :)

[mojogal]

Some people don't have a positive result for years, a friend of mine is one and she has Lyme. As Jackie says, it plays by it's own rules and if your symptoms are there a good LLMD will treat you based on symptoms until a positive result comes. Yours seems good, (the doc) using the IGENEX lab so you showing positive is in a way a blessing. Let us know what the doc says.

[Moonfly]

Noticed a small bullseye type rash on my hip this summer (Aug 2012) that never went away but did change appearance slightly.  Having slight joint pain in one, and now the other shoulder, a little fatigued, too.  Haven't seen a doctor yet, but went to a private blood test facility and took the IGeneX Western Block Lyme test.

Very confused about the results, but am reaching out for knowledgeable opinions on if it appears I may have Lyme, and if yes, what to do next:
IFA, B Burgdorferi G/M/A 40

IGM result Negative/CDC/NYS Negative - all bands negative except: 18 kDa. +, **34 kDa. IND, **41 +

IGENeX-IGG Positive - all bands negative except: 18kDa ++, **31 kDa +, **34 kDa IND, **39 kDa IND, **41 kDa ++, **83-93 kDa +

Any input is greatly appreciated!  Thank you.

[JackieCalifornia]

Good for you for taking charge!

IgM antibodies appear soon after infection; that response by your immune system fades after a fairly short time, and your immune system begins to produce IgG antibodies.  Both are valid markers, but both are tested for because testing only for one could miss a positive result due simply to timing.  So docs look at both.

I have a list of the meanings of each band that I copied a while back from a website called truthaboutlymedisease, so you might look there if you are interested in the description of each band.  

Here are the meanings of the bands on which you tested positive (the numbers are the same within IgG and IgM markers), acc. to the truthaboutlymedisease notes:

18 -- highly specific to Lyme, meaning no other bacteria will cause a positive on this band

**31 -- outer surface protein A (OspA) -- highly specific to Lyme

**34 -- outer surface protein B (OspB) -- highly specific to Lyme

** 39 -- a major protein of the Lyme bacterium flagella, or little tail on the bacteria

**41 -- common to all spiral-shaped bacteria, which includes Lyme, so it be Lyme or could be something else

** 83-93 -- specific antigen for Lyme bacterium, probably a cytoplasmic membrane

Sounds pretty Lyme-ish to me, but I'm not medically trained, but I would take these results to a Lyme specialist without delay so you can also be worked up for other infections the Lyme ticks often carry (but need separate testing and treatment from Lyme).

Given these results and your history of a bullseye rash and current symptoms ... well, go buy a lottery ticket -- evidence doesn't get much better than this.

And in case you haven't heard the rant here:  if you go to a doc who doesn't consider possible co-infections and doesn't plan to treat you with anything more than a couple weeks of doxycycline, ***find another doc***.

You are early in your infection (assuming that's what it is -- I'm not a doc), but still, 2 weeks standard treatment may not be sufficient, and you really don't want to find out it was not enough.  The longer Lyme is around, the harder it gets to exterminate.  Move quickly and hit it hard.

If you need help finding a Lyme doc, let us know, and/or email to

                        contact [at] ILADS [dot] org

and tell them your location.  ILADS is the main voluntary organization for Lyme specialists.

Let us know how you do -- and good for you for jumping on this.

[Ricobord]

Yes, it looks like you have Lyme. Many people convert from making IgM antibodies to IgG within about a month of the onset. The researchers who define the guidelines believe everyone does this without fail, but actually, some of us do not.

You need to get on antibiotics as soon as you can. The longer you wait, the more likely that the standard treatment will fail. Be sure to get a bare minimum of 4 weeks of abx, preferably more.

The bulls eye rash is considered definitive for Lyme and must always be treated right away, even without a positive blood test. It is a good thing you go tested!  You do not want late stage Lyme!

[Moonfly]

Thank you Jackie & Ricobord!  What a wonderful resource this board is, and people like the two of you make it happen!

I like to visit doctors only when there is a valid reason (not a fishing expedition), and this certainly meets that requirement ... will contact an LLMD this Monday, and will post a progress report once there is something to report.  

[Moonfly]

Took the last 100 mg doxycycline tablet last night following 30 days worth of one every 12 hours.  Have a slight amount of discomfort remaining in the left shoulder when I stretch it funny, but that was probably there when I was bit.

Still have a very slight discoloration from the original target rash remaining on the hip.  I'm feeling good!

Any tips for retesting at any point in the future to make sure I've beat this?  Thanks!

[JackieCalifornia]

It's good to hear you have made such excellent progress.  Did the doc test you for any other infections the Lyme ticks sometimes bring?  A good doc will take a careful history from you to try to tease out symptoms that may overlap with Lyme.  Just wondering.  Very glad you are feeling better --

[Moonfly]

No, this Doctor did not ask for any additional testing.  I plan on continuing to order up my own blood tests at the local private lab.  What types of blood tests should I be requesting at the next visit?

[JackieCalifornia]

[part 1 of 2]

Do-it-yourself test selection and ordering is problematic.  The local lab may or may not honor your requests for additional requests, because (just guessing here) labs are licensed by the state government, and there may prohibitions on honoring test orders from anyone but an MD.  Others here may be able to comment with specific knowledge.

A bigger problem from my point of view is that there are a number of different infections that often come from the Lyme ticks, with symptoms that overlap with Lyme.  Each of those diseases needs a separate test to have a full picture of what needs to be treated, and each disease usually needs different medication, given in a different order to knock out one disease before progressing to the next.  

And in any event, you would not be able to obtain most of the meds needed even online from some far away country.  Lyme treatment is not by cookbook -- it is complex and needs an experienced doc who knows and respects these infections as fearsome competitors.  Over time during treatment, sometimes additional infections that were masked by known infections come to light -- someone posted here about that very thing.

[continued in next message]

[JackieCalifornia]

[part 2 of 2]

Bottom line:  Lyme diagnosis and treatment is not a do-it-yourself venture.  

I wish it were, but it is not.  You need a knowledgeable doc who thinks progressive thoughts about Lyme.  There is so much still unknown about tickborne disease that even the best docs are baffled at times, let alone the patients.

If you do not have confidence in your doc (which I can fully understand; I went through 20+ docs before I even got a Lyme diagnosis, much less treatment -- had to find another doc for that), then:

-- Post here a new query 'Need LLMD in Minneapolis area' or whatever.

-- Also try your local or state Lyme disease association, if there is one.

-- And email to

                           contact [at] ILADS [dot] org

and tell them where you are and how far you can travel.  ILADS is the main voluntary organization for Lyme specialists.

Sorry not to be of more help.

[end]

[Ricobord]

Glad you got a month of doxy. It sounds like you got the minimum of what LLMDs use, so hopefully it's all gone.  However, If your symptoms are ongoing, you'll want to get to a LLMD.  Sometimes when there is a hidden coinfection, it interferes with the Lyme treatment.

[Moonfly]

One month ago I tried to get an appointment with the only ILADS recommended doctor within a few hours driving distance.  He has a 3 month waiting list.

I have confidence in my doctor, and he has treated many people for lyme ...I'll  ask him about testing for additional infections.

We've fortunate around here to have private blood labs that will conduct whatever type of test you are willing to pay to receive.  Not sure how long that will last with the upcoming nationalized health care game changes.

Thanks for your clarity and guidance, it is greatly appreciated!