early antibiotics and test result

[wsch]

I have seen that some say if a patient has received antibiotics in the early stage of the disease, antibody levels may be too low to be detected or nonexistent.
I just want to ask if this is the case, how can such patients get diagnosed? Or such patients can not be diagnosed because of negative test results though  he or she is actually infected.

[JackieCalifornia]

It is interesting how fixated scientists are by insisting that various species and sub-species are located Only In One Limited Area Of The World.  It is natural for scientists to try to sort out species and sub-species, but they go wrong by making those geographical areas into permanent domains.

Mother Nature just doesn't work that way.

[grdner]

Sorry, didn't mean to highjack your thread with a detour through biology!  It seems like there's a possibility that a U.S. test might work for a European infection, but it also might not, depending on which specific bacteria is involved.  Unfortunately it seems like there's never anything simple with Lyme!

[grdner]

I think you will appreciate this - following is a medical research article summary from a PubMed archive on an NIH site, a lot to wade through but I find it interesting.  As far as we knew in 2011, 7 of the Borrelia species cause Lyme disease in humans, and your analogy of flu is a good one because there are different strains of flu virus and we call the resulting disease flu regardless of which bug caused it.  Same with Lyme, at the moment anyway.  We know there are hundreds of symptoms associated with Lyme borreliosis (hmmmm does the naming itself tell us the disease is caused by members of the genus and not just a particular species?). It seems like everyone experiences it a little differently, though certain symptoms tend to be commonly experienced.  I remember when I first saw the comment that Lyme can mimic over 300 other diseases... I was shocked. Drs who use process of elimination are going to continue to take years to get to Lyme if it's the last thing they consider!
Anyway, yes, I think you are right and the different species probably do react differently to the tests, further complicating identification and diagnosis.

Here we go:
Borrelia burgdorferi sensu lato (s.l.) complex is a diverse group of worldwide distributed bacteria that includes 18 named spirochete species and a still not named group proposed as genomospecies 2. Descriptions of new species and variants continue to be recognized, so the current number of described species is probably not final. Most of known spirochete species are considered to have a limited distribution. Eleven species from the B. burgdorferi s.l. complex were identified in and strictly associated with Eurasia (B. afzelii, B. bavariensis, B. garinii, B. japonica, B. lusitaniae, B. sinica, B. spielmanii, B. tanukii, B. turdi, B. valaisiana, and B. yangtze), while another 5 (B. americana, B. andersonii, B. californiensis, B. carolinensis, and B. kurtenbachii) were previously believed to be restricted to the USA only. B. burgdorferi sensu stricto (s.s.), B. bissettii, and B. carolinensis share the distinction of being present in both the Old and the New World. Out of the 18 genospecies, 3 commonly and 4 occasionally infect humans, causing Lyme borreliosis (LB) - a multisystem disease that is often referred to as the 'great imitator' due to diversity of its clinical manifestations. Among the genospecies that commonly infect people, i.e. B. burgdorferi s.s., B. afzelii, and B. garinii, only B. burgdorferi s.s. causes LB both in the USA and in Europe, with a wide spectrum of clinical conditions ranging from minor cutaneous erythema migrans (EM) to severe arthritis or neurological manifestations. (Copyright © 2011 Elsevier GmbH)

[JackieCalifornia]

"Lyme bacteria differ around the world, as do the tick varieties that carry them, although the resulting disease is sadly the same."

I think that's accurate when speaking *generally* of various strains of Lyme disease, but each species of Lyme (and the diseases that each of those species propagate) are not all the same.  

For example, a quote from the Canadian Lyme Disease Foundation ('CanLyme') states that borreliosis (the scientific name for 'Lyme disease') is "caused by many genotypes within the genus borrelia, just like the flu is caused by many strains each of which is not referred to as flu-like."

I read that to mean that there are many strains of Lyme bacteria, and the resulting infections of those various strains *may* have similar symptoms, but there are actually a variety of symptoms depending on which strain of Lyme a patient has.

It's a picky point I'm making, but important to note imo because MDs who think there is only one kind of Lyme infection are often too quick to reject a diagnosis of Lyme because the symptoms do not line up exactly with those of traditional, basic 'Lyme.'

In addition, various 'Lyme' strains may react differently in tests, again causing rejection of a Lyme diagnosis.

[grdner]

To add to what Jackie said, patients can also be clinically diagnosed from a combination of symptoms plus the probability of having encountered ticks, or from a known tick bite at some point.

I have read that the Lyme bacteria differ around the world, as do the tick varieties that carry them, although the resulting disease is sadly the same.  If you get that far, it's definitely worth asking IgeneX if the PCR can reliably be used internationally.

[JackieCalifornia]

You are quite welcome.  

If the test approach outlined above does not match your experience, please consider posting here for others to read.

Best wishes --

[wsch]

Thank you for the detailed reply!

[JackieCalifornia]

Good question!

If the patient continues to have symptoms of Lyme after a negative Lyme test, a wise physician will test for Lyme again, because it may be that the Lyme bacteria moved from the bloodstream into protected areas in the body called 'biofilms', where the immune system cannot enter and the usual Lyme tests may be negative as a result.

Repeating the same test again likely will give the same negative result, so a Lyme specialist would likely then test with an entirely different test, called 'PCR', which is short for 'polymerase chain reaction'.  The PCR test does not rely on the immune system's reaction, but instead looks in the patient's blood for bits and pieces of the Lyme bacteria's genetic material ('DNA').

If the Lyme DNA is found, that is evidence of a Lyme infection.  The DNA test is patented and is made by only one company, IGeneX Laboratories in California.  They have a website with information about the test.

Not all MDs use the IGeneX test, but a wise Lyme MD will know when and how to order it.  I understand that IGeneX can ship a small collection kit to your local MD or laboratory to take a blood sample from you, and then the kit is shipped back to IGeneX for analysis.  The MD will receive the test results directly and discuss them with you.

Whether there are any restrictions on the transfer of the blood sample from Germany to the US, I do not know, but IGeneX probably can tell you.

Also consider that there may be different strains of Lyme in Europe than in the US, and I would ask IGeneX if that makes a difference in their test kit.

Viele Gluckwunsche!  (Sorry, no umlauts here  :)