Western Blot results- only IgM band 23...?

[bluebird4500]

Hi guys,

For those interested, I am posting my [b]Western Blot[/b] lab results from [b]LabCorp[/b]:


It is as follows:

[u][b]IgM:[/b][/u]

Bands:
41 Absent
39 Absent
[b]23 PRESENT ABNORMAL[/b]

[u][b]IgG[/b][/u]

[b]Bands:[/b]
93, 66, 58, 45, 41, 39, 30, 28, 23, 18 ---> [b][u]ALL[/u] ABSENT[/b]


[u][b]% CD8-/CD57 Lymphs[/b][/u] is 5.0 (in range 2.0-17.0)
[u][b]Abs. CD8-CD57 +Lymphs[/b][/u]  60 (in range 60-360)



[u][b]My questions/ comments:[/b][/u]

1) Why does the CDC ask for 5 bands total? I understand it was based on early research and at the time those first groups of people with the 'typical' lyme symptoms presented these specific bands.  But why do they want at least a [i]few[i]?[/i]  Could my 23 band be something else??

According to my doctor he canNOT ignore band 23. He says your body just doesn't 'make' antibodies to Lyme without it present.  

2) Now, I've heard some people will have [b]one band [/b]on one Western Blot, and then the next time that band is absent, but another band Present/ abnormal.

How many have had this happen? Furthermore couldn't it mean I DO have more bands possibly present, but because Lyme isn't often in the blood, they may not be showing?  

Perhaps if I did Igenix I'd get a more complete picture?


[b]UPDATE on 2nd lab Doctor is running that I talked about in another post. I was unsure why he asked me to come in for more blood work today after my Western blot a week or so ago
[/b]
I found out he is sending out my blood to another lab that will [b]grow a T cell and then see if it attacks Lyme[/b], to see if my T cell has a memory of it, so to speak.



Thank you, and ANY help is so much appreciated!!!

[JackieCalifornia]

Welcome to MedHelp --

Would you post back with what area your mother lives in, such as 'near Dallas TX' or 'the Florida panhandle' etc.?

[tjap12]

Can you please let me know who the doctors were? My mother has been suffering for many years and now she requires 24 hour care. All of the doctors that we have seen try for a little then give up. If any one can put us in touch with a person/doctor it would be a blessing.

[JackieCalifornia]

It's 'Lyme brain' -- been there, done that!!!  Oh, and a "little" stress from just everyday living for icing on the stress-cake.

No worries -- take care, keep us posted -- !

[bluebird4500]

Can't believe i forgot to thank you all for your comments! Very forgetful these days.

Thanks again for all your help!! :-)

[mojogal]

Right!

[Ricobord]

If our regular doctors knew all this stuff, we wouldn't have to!

[mojogal]

I even have a headache reading all this stuff we have to know. Imagine people going through it for the first time.

[JackieCalifornia]

That makes sense ... tricky little beggars, the Lyme bacteria, eh.  Thanks.

[Ricobord]

I think what you describe of converting from IgM to IgG is what the immune system is expected to do.  It's what the CDC and IDSA insist on.  My LLMD and PA have no such requirement of IgM or IgG.  They have seen way too many variations in immune system responses.  They look at both for Borrelia specific antibodies, regardless of where they show up.

My situation is complicated as I had a week of abx when I first got sick.  That is known to interfere with antibody production. Years later when I finally developed chronic symptoms, I was given some prednisone for my supposed asthma, which further suppressed my immune system. It's no wonder I wasn't showing a strong immune response on antibody tests.

My PA explained that over time, as the spirochetes move out of the blood and into tissues, the concentration of spirochetes in the blood drops, leading the body to reduce antibody production, sometimes too low to be detected.  Lyme can also hide in the body, resulting in decreased antibody production.  

Theoretically, the IgM antibody production drops and IgG antibody production ramps up about 4-6 weeks after initial infection.  Eventually, sometime after the bacteria is gone, IgG antibodies go away. But immune systems are not simple machines that follow a recipe. It can get really complicated.  The spirochetes are known to invade our own cells to hide, and also to turn themselves almost inside out to hide their outer proteins, which is what the antibodies go after.  This is called the cell wall deficient form or L-form version.  Eva Sapi has done some really interesting research with this, as well as in vitro studies on different abx for treatment.

A researcher presented actual pictures at an ILADS conference of a spirochete rotating its way into an immune cell. There was also a video shown of a spirochete going into a human cell, and then coming out wrapped in the human mucus so it would not be recognized as foreign. I suspect this is why some doctors who previously researched and treated AIDS got interested in Lyme.  There are major differences of course...Lyme is bacterial and curable with abx.  But both are immunosuppressive.

Another example of hiding:
I have read two unusual stories of patients who repeatedly relapsed after treatment.  In one, they found a cyst in her lung.  In the other, I think the cyst was next to a lymph node.  In both cases, after they took the cysts out surgically, the cysts tested positive for spirochetes, and then the patients stopped relapsing.  They were cured. It sounds to me like the cysts were protected Lyme factories that the antibiotics and immune system couldn't get to.

As one researcher has said, this is not your run of the mill bacteria.  This thing is a couple rungs up the evolutionary ladder.

[JackieCalifornia]

I had not heard until you posted  here what your PA says about why the basic Lyme tests trail off after a while (that it's bec. the bacteria go intracellular).  

I had read that it was because the human immune system is set up to figure after a relatively short period of time that it has killed everything it was mobilized to go after.  As in:  IgM activates shortly after Lyme infection, and then after a while (a month, a few months) the IgM trails off and the IgG ramps up.  That doesn't seem to fit with the scenario the PA describes ...

Any ideas on that?  Just wondering.  thx

[Ricobord]

My PA explained the question of Lyme in the blood by saying that it prefers to be in the tissues.  Over time, there are more bacteria in the tissues and less in the blood. People who have been sick longer than a year are less likely to show lots of antibodies in part because of this issue.

However, there's always some quantity of bacteria in the blood.  That's why a good culture is more reliable than an antibody test.

Given what I have read (and I am not a doctor, just an analytical person who likes to read), I would be convinced I had Lyme with your results.

[JackieCalifornia]

Good answer.

[JackieCalifornia]

Wow, your doc DOES work fast!  I like this doc.  :)

Okay, so you had WBlot through LabCorp.

Band 23, on which you are positive, will show up ONLY if the test detects Borrelia burgdorferi (Bb), which is the Lyme bacterium.

Nothing else but Lyme, to my understanding, will cause Band 23 to be positive.  I don't know what 'ABNORMAL' means.

That Band 23 was part of the half of the test called IgM (Immunoglobulin M), which means the antibodies that appear relatively soon after infection.

The second half of the test, on which your bands were all 'absent', means the IgG, which appears after you've been infected for a while, would indicate you haven't been infected all that long.

As to the CD-8/CD57 reading, you are at or toward the bottom of the normal range, which some or many LLMDs say indicates a Lyme infection.  CD57 is something of measure of activity of your immune system, and a low level is said to indicate that your body is fighting Lyme.  CD-57 is not a direct measure of Lyme itself, as I understand it.

------------------------------------------------

"1) Why does the CDC ask for 5 bands total?"

-- The CDC requirements were set up as surveillance of the spread of Lyme, NOT to diagnose it.  Therefore the CDC wanted to be darn sure that it was ONLY counting strong, absolute cases of Lyme so that the stats were not in question at all.  It's driven by epidemiology, not by clinical medicine.

"Could my 23 band be something else??"

-- To my understanding, no.  I would agree with your doc:  "According to my doctor he canNOT ignore band 23. He says your body just doesn't 'make' antibodies to Lyme without it present."  

"2) Now, I've heard some people will have [b]one band [/b]on one Western Blot, and then the next time that band is absent, but another band Present/ abnormal.  How many have had this happen?"  

-- Dunno.  The point is that your immune system is not a factory make exactly X widgets each day -- it makes antibodies when, in the mysteries of the immune system, it seems prudent.  Like everything else in nature, your immune system rises and falls.

"Furthermore couldn't it mean I DO have more bands possibly present, but because Lyme isn't often in the blood, they may not be showing?  

-- The test measures your immune system reaction to Lyme, not the numbers of Lyme bacteria in your blood.  I would not agree from what I have read that 'Lyme isn't often in the blood' esp early in infection.

"Perhaps if I did Igenix I'd get a more complete picture?"

-- Maybe.  IGeneX measures different things than the W.blot does, coming at Lyme by looking not for your immune system reaction to Lyme but looking for bits of Lyme DNA.

"I found out he is sending out my blood to another lab that will grow a T cell and then see if it attacks Lyme, to see if my T cell has a memory of it, so to speak."

-- This may be a new test I have heard mentioned, but not sure.

-- If you don't agree with the doc's diagnosis, assuming he says Lyme, then what?  Where do you go from here, and why would you reject the diagnosis?

[Ricobord]

Hi, Bluebird.  From what I have read, your doctor is right.  Band 23 is called Osp(C) and is unique to Borrelia (Lyme bacteria).  You do not produce Borrelia specific antibodies unless you have been exposed to Borrelia.

This is part of the problem with LabCorp and some other major labs.  They only report the bands that are part of the CDC surveillance criteria. There are other IgM Borrelia specific bands that could paint a clearer picture, including 31, 34, 39, 83, and 94!  But you only know if you are positive on those bands if you use a lab that reports them.  

Usually, an IgM response without an IgG response suggests recent infection. However, when I finally had a Western Blot, I'd been infected for 6 years and I responded primarily on the IgM with only 1 positive IgG band. As I've said to some people, my immune system didn't get the memo on how it was supposed to act.

I have also read that you can test with different results over time on a WB.  The bacteria can literally change its shape to hide the proteins that your immune system is attacking, leading to a reduction in that particular antibody. Some tend to show up early, like Band 41.  Others tend to show up later, like Band 31.

When they came up with the surveillance criteria, they used the blood of known Lyme patients who were recently infected and who had rheumatic involvement.  Why they would assume that a late stage neurologic patient would test the same, I don't know.

They left out 31 and 34 on the IgM interpretation, two highly specific antibodies, because there was a vaccine about to come out that used those antibodies.  They wanted to make sure they excluded vaccinated patients from the positive criteria so they wouldn't show a false positive. Unfortunately, now it excludes people who are genuinely infected.

Is it right that you're pregnant?  If so, congratulations!  If you have Lyme, you'll probably want to ask your doctor about preventing transfer to your baby.  My doc keeps pregnant women with Lyme on abx for the remainder of their pregnancy, even if they seem well.