That's a *really* good question. There are others here who can respond from their own experience or reading. Below I've pasted the abstract of a 2011 article published in a medical journal about the scientific varieties of Lyme.
How that fits with current testing approaches, I don't know -- I think Ricobord who posts here (Rico? are you there?) got infected in Australia, but I don't recall if there were special tests needed here to identify those strains, or if there's a generic test that will pick up most or all of the Lyme strains.
Please let us know what you learn. Best wishes to you --
The expanding Lyme Borrelia complex--clinical significance of genomic species?
Stanek G, Reiter M.
Institute for Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria. gerold.***@****
Ten years after the discovery of spirochaetes as agents of Lyme disease in 1982 in the USA, three genomic species had diverged from the phenotypically heterogeneous strains of Borrelia burgdorferi isolated in North America and Europe: Borrelia afzelii, B. burgdorferi sensu stricto (further B. burgdorferi), and Borrelia garinii.
Whereas B. burgdorferi remained the only human pathogen in North America, all three species are aetiological agents of Lyme borreliosis in Europe.
Another seven genospecies were described in the 1990s, including species from Asia (Borrelia japonica, Borrelia turdi, and B. tanukii), North America (Borrelia andersonii), Europe (Borrelia lusitaniae and Borrelia valaisiana), and from Europe and Asia (Borrelia bissettii).
Another eight species were delineated in the years up to 2010: Borrelia sinica (Asia), Borrelia spielmanii (Europe), Borrelia yangtze (Asia), Borrelia californiensis, Borrelia americana, Borrelia carolinensis (North America), Borrelia bavariensis (Europe), and Borrelia kurtenbachii (North America).
Of these 18 genomic species B. afzelii, B. burgdorferi and B. garinii are the confirmed agents of localized, disseminated and chronic manifestations of Lyme borreliosis, whereas B. spielmanii has been detected in early skin disease, and B. bissettii and B. valaisiana have been detected in specimens from single cases of Lyme borreliosis. The clinical role of B. lusitaniae remains to be substantiated.
Another good question! And there are probably other strains we just haven't parsed out of the tall grass yet. Mother Nature: a tricky gal, eh?
I don't know how specific the tests are as to strain ... as in: if there are 20 strains of Lyme, do the current tests identify them all, or only some? I think this was discussed a while back, but I wasn't focussed on it. All the more reason for a good doc to look at history and symptoms and not just at the test results. Doctoring, the old fashioned way.
I believe they pick up b.burgdorferi, b.afzelii, b.garinii, b.spielmanii, and b.bavariensis.
I have not contacted them, so I don't know exactly what their testing entails, but you might contact them with your questions.
I suspect that I have b.garinii from Australia. My symptoms are consistent with European neuroborreliosis, but my disease presentation is more like Australian, as described by Dr. Peter Mayne. I tested Igenex positive, but CDC negative. My experienced LLMD says the treatment is no different, in the sense that they work from the same list of meds and tailor the treatment to the individual.
There is a belief among many Lyme treating doctors that genetic variation of Borrelia will result in differing antibodies appearing on the Western Blot. Some in the southern US believe that a higher percentage of people with Lyme there test CDC negative (as compared to the Northeast, where the test criteria was developed) because of genetic variation. That is probably also true with the West Coast, where we have significant genetic variation (I seem to remember it's about 300 at last count.)
I think part of why I tested negative on the screening test (an IFA) and CDC negative on the Western Blot is because I have a different species, I'd been given steroids recently, and I took insufficient antibiotics early in my disease, which can interfere with antibody production.
So far, only b.burgdorferi is endemic to North America. Where you have travelled or had a known tick bite would narrow the list of possible Borrelia species.
At some point, I would think that stirring the infection pot through migration (for whatever duration) of people and pets from continent to continent will cause all strains to be more widely distributed. NonLLMDs can be so wedded to a static view of epidemiology. Curious.
Infectolab in germany looks for all strains.
If I understand it right, they do the test for the usual bands - you get a different combo of bands come up positive depending which strain.
For example, there are 3 common strains in Europe and my doc mentioned that one of my bands is very typical for one of them.
Therefore, if you are told your western blot is negative in America, it could be, the bands you get are actually positive for an Aussie strain, for example.
I haven't seen it written down so I cannot swear to it, but this is how I understood it.
I know the IGENEX lab tests for antibodies specific to a protein found in flagella, which all the strains would have, but unfortunately other microbes too. So I guess that's one of the non-specific bands that I was positive on.
Hi all, thanks for your answers. Let me tell you that I contacted Igenex and they told me that they only test for B. Burgdorferi at their lab. I asked them to refer me somewhere to get tested for other strains, but they weren't able to do so.
I believe I might have contracted Lyme in Norway, where I've been a lot to the woods. I could also have had exposures in Serbia or Italy, but the worst exposures were in Norway. As I've been researching, B. garinii has been detected there.
I just wonder, if the medical community doesn't find another answers for our problems than Lyme, why can't they just make a clinical diagnosis of Lyme ? Why are the blood tests so important to them?
Ultimately, the diagnosis is clinical, supported (to the extent available) by test results.
NonLLMDs (that is, so-called mainstream medicine) rely heavily on tests; LLMDs (those who take the broader view) are more broadminded because they understand how inaccurate the tests are. Thus the importance of finding an LLMD.
LLMDs will also run tests, tho, and which tests depends on your symptoms, in order to test for any co-infections, which usually need separate treatment from Lyme. It is prudent for LLMDs to test and not just wing it, but LLMDs are more broadminded and so will sometimes give a course of antibiotics (abx) and then re-test, because your immune system may be re-activated by the abx, thus showing a positive (or more positive) test result than previously.
MDs can be accused of malpractice by treating without reasonable cause to do so, and it's just bad medicine to not do tests, because some other infection could be missed. Prudent docs will test, whether LLMD or not, but LLMDs are more likely to prescribe on less test evidence because the tests are flawed.
Ricobord (who posts here) may be able to give you more data on where nonUS strains of Lyme can be tested.
You pose an excellent question that deserves to be answered... "Why are the blood tests so important to them?" I would also like an answer to that.
I personally think it is because of fear of negative repercussions from the IDSA, which has taken on the mantle of protecting us all from superbugs by reducing the usage of antibiotics. I think this is the biggest priority for lobbying our political representatives to make the CDC change the surveillance, testing, and diagnostic dogma on Lyme Disease. (Treatment is a whole other ball of yarn.)
Somewhere along the line, the powers that be in the CDC and IDSA and NIH were concerned that people were panicking about Lyme and that suddenly it was all over New England. They put out all sorts of communications trying to reassure people that the disease isn't that bad, and that it is not that common. It seems this was based on a very narrow understanding of the disease as a bulls eye rash, sore joints, and eventually arthritis. It was probably also a result of public officials being terrified of a terrible disease that they didn't understand, and wanting to avoid "unnecessary"panic rather than wanting to get to the bottom of the REALITY of the disease.
These same scientists were quite surprised in the early 80's to find out this wasn't really a new disease, but an old one documented in Europe for about a hundred years. There are also colonial era descriptions of it in the New England area. And so they became focused on "Lyme Borreliosis," a variation of the diseases described in Europe.
While most other countries have unfortunately followed the CDC two tier testing protocol and interpretation, I saw an IDSA doctor in an interview acknowledge that it applied to b.burgdorferi throughout the U.S. (This qualification to me says they know they haven't tested anything with other species.) I am not sure how he can even claim this much, as the testing criteria was developed in New England where there is little genetic variability. I have been unable to find anything whatsoever showing similar testing in the south or west to see if their assumptions were correct.
Sorry...I am venting again. I just get so annoyed when I read about the Lyme deniers insisting they have science and "evidence based medicine" on their sides, and that ILADS is "anti-science. In reality, most of the orthodoxy of Lyme, including the use of antibody tests, is based on OPINION or narrowly defined, self reinforcing "studies", not on actual fact or on any study design that might disprove their opinions.
I would encourage everyone who reads this to go to the CDC's website and complain about the Lyme testing protocol. Eventually, they will get so many complaints, they can't ignore it anymoret. Or, someone in the Federal Gov't will finally pay attention and order them to change it. Until then, status quo reigns.
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