posted
I have read and heard that the band 41 can cross react with both syphillis and dental infections. Thus if you have symptoms and all you are pulling up is band 41 on your tests that you should rule out those two things. I know there is a test for syphillis called the VDRL, so presumably if you are positive on band 41 and negative on the VDRL you can rule out cross reaction from syphillis. But what about the dental infections? Most of us probably don't appear to have gum disease (gums don't bleed, not swollen, etc...), but is there a second confirmatory test that is more specific for the dental spirochetes?
thanks
asus
Posts: 116 | From Ann Arbor, MI | Registered: Nov 2007
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posted
Actually Band 41 can cross react with more than what you mentioned. I have read that EBV can cause a positive band 41 as well as some mycoplasma infections.
Posts: 649 | From United States | Registered: Dec 2003
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posted
Is there more detailed information regarding this? ie What mycoplasma, or what EBV antibodies cross react? (IGM? EBNA IGG? EA IGG? etc..)
thanks!
asus
Posts: 116 | From Ann Arbor, MI | Registered: Nov 2007
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disturbedme
Frequent Contributor (1K+ posts)
Member # 12346
posted
I am so tired of all the things that people say can cross-react with band 41. It's rather annoying, especially for those of us who really do believe we have lyme.
Don't get me wrong, it's good to rule out other things, but at one time it was just syphilis and dental problems causing 41 cross-reactions and now it's just about EVERYTHING.
We really need some more research done on this.
I'm one of the unlucky ones who only had 41++ IgG on my WB and I've really come to hate it.
-------------------- One can never consent to creep when one feels an impulse to soar. ~ Helen Keller
My Lyme Story Posts: 2965 | From Land of Confusion (bitten in KS, moved to PA, now living in MD) | Registered: Jun 2007
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posted
"Don't get me wrong, it's good to rule out other things, but at one time it was just syphilis and dental problems causing 41 cross-reactions and now it's just about EVERYTHING."
Makes you wonder whether anyone really knows what they're talking about, in terms of interpreting these tests results. I guess that's why despite treating just to be safe, I have my natural skepticism.
-------------------- Craig Posts: 207 | From Tallahassee, Florida | Registered: Nov 2007
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kelmo
Frequent Contributor (1K+ posts)
Member # 8797
posted
Me, too, Disturb. However, I did insist on a virus test and was positive for HHV-6.
But, when I had my blood smear done with Fry lab, it was clean for everything. Did six months of zith, took ONE rifampin pill. Had a huge reaction.
Got another blood smear done...BANG...bartonella.
He said that the abx broke up the biofilm, releasing the bacteria back into the blood stream.
My LLMD believe 41 is bart because it's a flagella of some kind. If not syphillis, or H-pylori...can we just agree it's bartonella?
Posts: 2903 | From AZ | Registered: Feb 2006
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posted
I posted on this subject a while a go myself, as I had band 41 IgM come up positive.
During the same batch of blood work, I had abnormally high EBV titers as well. (IgG, not IgM, very high titers, the kind associated with serious medical concerns)
The consensus from my post was to talk to my doctor, but also that EBV reactivation could very well cause that cross reaction in a lyme western blot.
I'm suprised Timaca hasn't posted on this yet, but if you check her post on viral testing, you can get the idea of her take/experiences on the role of viruses ect.
Reactivated EBV has symptoms very similar to lyme, but can also have some serious health implications.
I don't know if that helps answer your question, but that's my 2 cents.
take care. kp
Posts: 394 | From tinton falls nj | Registered: Jul 2007
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tickled1
Frequent Contributor (1K+ posts)
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posted
I only had band 41 as well both Igg and Igm. I also have Mycoplasma and EBV over 2000.
From what I understand, the symptoms of Myco can be identical to Lyme, even the neuro symptoms. With Myco you can also herx on many abx so who knows if it's a Lyme herx or a Myco herx.
So I don't know if I have Lyme and Myco or just Myco (w/EBV of course and who knows what else). I just insist on being treated w/abx that cover both Lyme and Myco now as I know for sure that I have Myco.
I definitely did have a tick bite in 2000 though so I don't know what the chances would be that it only spread Myco w/out Lyme. Or maybe I got the Myco somewhere else. God only knows!
Posts: 2541 | From Northeast | Registered: Jan 2008
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posted
Well the reason I ask is that I have been on anti-viral for a while and my symptoms have not changed. I have been tested for lyme 3 times (mainly by labcorp and quest, but once by Stonybrook) and I have consistently shown IGG and IGM 41. I also was given Zithromax for an unrelated infection of a cut on my hand and some of my cognitive symptoms seemed to get better. So I am wondering if I am not feeling better on the antiviral after my 6 months if I should re-visit lyme.
What do you mean by high EBV titer? You were actually EA positive (meaning re-activation) or just your EBNA and VCA titers were high? Which once cross reacts with lyme, reference?
Posts: 116 | From Ann Arbor, MI | Registered: Nov 2007
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METALLlC BLUE
Frequent Contributor (1K+ posts)
Member # 6628
posted
Most Lyme patients only show up with 41kd. I had 41kd alone on two of my tests, and 45kd show up along with 45kd. I've had Lyme for 21 years. My immune system was crushed.
Most Lyme literate physicians will tell you the vast majority of patients only see kd41 as it's the largest protein of the spirochette. Another thing to consider is that you ought to test at different labs, stonybrook, MDL, Igenex, Bown, Quest, Labcorb -- whatever you can afford in a reasonable context, and see if the numbers from one lab correspond with others in a pattern.
I've found that can be helpful for a lot of patients. It's unfortunate that it comes with a price though.
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
The high EBV titers that I was referring to are as follows:
EBV Early antigen Ab, IgG 158 positive>120
EBV Ab VCA IgG 2131 positive>120
EBV Nuclear Antigen Ab, IGG 567 positive>120
The doctor who ordered the labs indicated that I was having an Epstein Barr episode of epic proportions, ordered a ct scan to check for cancer, as such titers are associated with cancer. (CT was negative).
I just had the bloodwork done again yesterday to see if has improved. I suspect that it hasn't though, as my hands are starting to feel swollen again, I'm very tired no matter what, and some of my joints are starting to bother me. This eased up over the winter, but seems to be coming back with the warmer weather.
I hope that answers your questions.
Take care, kp
Posts: 394 | From tinton falls nj | Registered: Jul 2007
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What I find strange is that soooo many people here tested positive for just the 41-band and were probably told it wasn't lyme's because the 41-band is not specific to borrelia.
Obviously, the 41-band is the band specific to the flagella. What is a doctor's response then when the 41-band is positive??? "Oh that's not specific to borrelia". What the heck is it specific for then??? How then does one get exposed to a 41-band???
Who cares if it's not specific to borrelia, it's positive for flagella movement. What are all the possibilities in the biological/animal kingdom that has a flagella? Hmmmm, so I come up with these; sperm, bacteria, and possibly viruses. Since it's doubtful sperm is swimming around in the bloodstream, I'm going to go with either bacteria or a virus.
LisaS
Frequent Contributor (1K+ posts)
Member # 10581
posted
I dont know if any of it matters (to Drs anyways!) I have a 41+ & 58+ on IGG and 23+ on IGM and the Drs dismiss these three as well. And I beleive if Im interpretting this correctly on my ELISA I have a 1.19H. Which is positive. That doesnt sway them either!
Vermont_Lymie
Frequent Contributor (1K+ posts)
Member # 9780
posted
My understanding from this article below, is that because immune system response to borrelia b. often first shows up strongly in Band 41, corresponding to the Bb flagellum, that this band has been proposed by these researchers as the reference band to use for serodiagnosis of lyme disease.
The abstract:
JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 1988, p338-346 Vol. 26, No. 2 1988, American Society for Microbiology
Measurement of Antibodies to the Borrelia burgdorferi Flagellum Improves Serodiagnosis in Lyme Disease
KLAUS HANSEN,* PETER HINDERSSON, AND NILS STRANDBERG PEDERSEN
Borrelia Laboratory, Department of Treponematoses, Statens Seruminstitut, Amager Boulevard 80, DK-2300 Copenhagen S, Denmark Received 8 September 1987/Accepted 3 November 1987
The isolation of Borrelia burgdorferi flagella and an enzyme-linked immunosorbent assay [ELISA] for detection of immunoglobulin G [IgG] and IgM to the B. burgdorferi flagellum are described.
The diagnostic performance of the flagellum ELISA for serodiagnosis of Lyme disease was compared with the performance of a traditional whole cell B. burgdorferi sonic extract ELISA. We examined sera and cerebrospinal fluid [CSF] from 56 patients with lymphocytic meningoradiculitis [Bannwarth's syndrome], the most frequent secondarystage manifestation of Lyme disease in Europe.
Two hundred healthy individuals and patients with aseptic meningitis, encephalitis, Guillain-Barr� syndrome, and syphilis served as controls.
The flagellum ELISA was significantly more sensitive than the sonic extract ELISA. The diagnostic sensitivities were increased from 41.1 to 76.8% P < 0.01, for IgG and from 35.7 to 67.9% P < 0.05, for IgM detection in serum.
The increase in sensitivity was most pronounced in patients with a short duration of disease, less than 20 days after onset.
The diagnostic specificity increased for IgG detection but was almost unaltered for IgM. The flagellum ELISA did not improve the diagnostic sensitivity of measuring antibodies to borreliae in CSF, most likely owing to the low level of unspecific antibodies in CSF compared with serum. The cross-reactivity of sera and CSF from patients with syphilis decreased significantly.
**The flagellum antigen of B. burgdorferi shows no strain variation, is easy to purify in sufficient quantity, and is therefore a suitable reference antigen for routine serodiagnosis of Lyme disease.**
**
Note: although the abstract does not mention Band 41 by its number, just as the "flagellum antigen," the rest of the article makes it clear that the flagellum antigen is Band 41, e.g., further in the article:
The aim of this study was to develop a more sensitive serological assay using a single, Borrelia-specific, immunodominant antigen.
Three observations made us believe that the B. burgdorferi flagellum might be a suitable candidate:
1. Western [immuno]-blotting [WB] studies with B. burgdorferi showed an early and strong immune response against the 41-kilodalton [kDa] band corresponding to the flagellum;
2. a highly sensitive ELISA has been developed for diagnosis of syphilis which made use of the flagella of Treponema phagedenis as test antigen [22]; and
3. even high-titered sera from patients with Lyme disease reacted only occasionally and weakly in the T. phagedenis flagellum ELISA.
Posts: 2557 | From home | Registered: Aug 2006
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The conclusion I draw from this is that essentially in early cases of Lyme disease, band 41 is reliably reactive. What we don't know is how reliably reactive band 41 is with other diseases. Band 41 is just a weight associated with the Bb flagella but could also be the weight of another part of another organism (or no organism at all).
Problem is, we have NO IDEA how often this band cross-reacts with other things, including non-infectious agents. We just know that it does.
Oh, how I hope detection methods improve so we don't have to play these guessing games any longer.
Posts: 561 | From mass | Registered: Jul 2007
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Vermont_Lymie
Frequent Contributor (1K+ posts)
Member # 9780
posted
Hi KS,
The literature says that the 41 Band also cross reacts with syphilis; other borrelia species; and possibly oral spirochetes.
Although the 41 band cross-reacts (though weaker) with syphilis, the two diseases -- lyme and syphilis -- are otherwise easy to distinguish with testing, so this is not too much of a problem.
41 also cross reacts with other borrelia species; the authors note that since relapsing fever is not prevalent in the NE USA or Europe where lyme is prevalent, that is not so much of a problem either.
Further discussion from the 1998 article:
The early and strong immune response to the spirochetal flagellum shows that the search for a valuable test antigen should not be limited to surface proteins. In the case of B. burgdorferi infections, the human antibody response to the flagellum is much stronger than it is to the 31- to 34-kDa major surface proteins (7, 13, 27).
WB studies have shown that the 41-kDa flagellin band is not completely specific. Sera from healthy controls may react slightly with the B. burgdorferi flagellum, as seen in Fig. 2, 5, and 6. The specificities of these cross-reacting antibodies are unknown. Exposure to oral spirochetes could be an explanation.
Flagella from different Borrelia species are antigenically related [8]. The flagellum ELISA is therefore not expected to improve serological discrimination between patients with relapsing fever and patients with Lyme disease.
However, this is of minor practical importance because relapsing fever does not occur in Europe and the northeastern United States, where Lyme disease is most prevalent.
The main limitation of the diagnostic specificity of the 41-kDa band is the reactivity with sera from patients with syphilis.
Despite this observation, we found that the flagellum ELISA significantly diminished the cross-reactivity of serum and CSF specimens from syphilis patients.
This is most likely a consequence of the elimination of other crossreacting spirochetal antigens. The exposure of different epitopes of the morphologically intact flagella and the fiagellum protein flagellin may explain the stronger reactivity of syphilis sera with the 41-kDa band in WB compared with the flagellum ELISA.
In any event, the cross-reactivity between Treponema pallidum and B. burgdorferi does not constitute a major problem because patients with syphilis and Lyme disease are easily differentiated clinically and serologically by the nontreponemal syphilis serological tests (24).
The limited number of sera from patients with leptospirosis investigated does not permit any conclusions as to whether the flagellum ELISA is more specific than the sonic extract ELISA in terms of serological discrimination between Lyme disease and leptospirosis.
***
On a personal note -- after several known tick bites in endemic areas, several bulls eye rashes, all the symptoms, a positive spinal tap AND a great response to abx, I have only ever had band 41 show up positive on blood tests.
All the llmds that I have spoken with have told me that they see many patients with only Band 41 positive. This article helps to explain why. Patients can also be checked, and should be, for syphilis if their blood tests show this flagellum antibody response.
If you have any literature or studies showing the band 41 cross-reacting with 'non-infectious things' please share it here! This is the best of lymenet -- learning about tickborne diseases and how to treat them.
Otherwise, my conclusion from the literature is that flagellum antibodies, in conjunction with history and clinical presentation, is a good indicator.
Posts: 2557 | From home | Registered: Aug 2006
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Love a good data exchange! Please know that by no means do I question that many people with only a band 41 have Lyme. My only point is that the band alone does not mean someone has Lyme. I've done a great deal of research regarding diagnostic testing and am all too aware of the issues with available tests (have been victim myself). Anyway, back to band 41, here is a reference:
Diagnosis of Lyme Borreliosis Maria E. Aguero-Rosenfeld,1,4* Guiqing Wang,2 Ira Schwartz,2 and Gary P. Wormser3,4
"B. burgdorferi sensu lato antigens of importance in immunodiagnosis. It is important to understand the antigenic composition of B. burgdorferi sensu lato, as it pertains to immunodiagnosis. Numerous early studies recognized the importance of the flagellar protein flagellin (41 kDa), or FlaB, as an immunodominant antigen (63, 70). Strong IgG and IgM responses to this protein are developed within a few days after infection with B. burgdorferi sensu lato (8, 84, 111).
Thus, some immunoassays consist of purified flagella alone (114, 115, 138, 148), whereas in others, flagellin is added to enrich the antigenic mixture (174). Unfortunately, although highly immunogenic, this antigen is highly cross-reactive with antigens in other bacteria, particularly when denatured, as in immunoblots (35, 91, 179).
Certain flagellin epitopes are also cross-reactive with antigens found in mammalian tissues such as neural tissues, synovium, and myocardial muscle (1, 179). The internal portion of the flagellin molecule, containing the variable, genus-specific immunodominant domain, is less cross-reactive with antigens of other bacteria than the whole protein (101, 179, 274)."
Again, I believe the available diagnostic testing to be very flawed, particularly people with neurological involvement.
Kristin
Posts: 561 | From mass | Registered: Jul 2007
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disturbedme
Frequent Contributor (1K+ posts)
Member # 12346
posted
Vermont, thank you so much for posting those articles as well as your experience and that you only had 41 positive after bites and bulls-eye rashes, etc.
I too only had 41++ IgG positive, so it was really good and reassuring to read the articles and to hear your take on what it means, etc.
Thank you!
-------------------- One can never consent to creep when one feels an impulse to soar. ~ Helen Keller
My Lyme Story Posts: 2965 | From Land of Confusion (bitten in KS, moved to PA, now living in MD) | Registered: Jun 2007
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