From coast to coast, frustrations abound among patients and clinicians regarding the diagnosis of chronic Lyme disease.
Misinformed health care providers in Texas and surrounding states consider the infection rare and non-endemic.
They are inclined to rule out Lyme disease based on the negative result of a laboratory test that, unbeknownst to them, is highly insensitive.
In the absence of a reliable laboratory test or adequate experience in the recognition of the varied and complex presentations of the illness, most clinicians are ill-equipped to diagnose chronic Lyme disease.
Many patients suffer needlessly for years, hopelessly lost in the maze of the health care system, looking for answers and enduring the skepticism of practitioners inexperienced with the disease's signs and symptoms.
What is needed is a better Lyme test or some other objective measure to persuade the practitioner to consider the diagnosis of chronic Lyme disease.
Enter the CD57 test! You may have heard the term ``CD57'' tossed around on chat groups, or your Lyme-literate health care provider may have even explained the test to you in one of your moments of brain-fogged stupor.
What is this number that sounds more like a type of Heinz ketchup than a lab test, and what in the world does it have to do with Lyme disease?
Let's start by going back to basic high school biology. You may remember that white blood cells (a.k.a. leukocytes) are the components of blood that help the body fight infections and other diseases.
White blood cells can be categorized as either granulocytes or mononuclear leukocytes.
Mononuclear leukocytes are further sub-grouped into monocytes and lymphocytes.
Lymphocytes, found in the blood, tissues and lymphoid organs, attack antigens (foreign proteins) in different ways.
The main lymphocyte sub-types are B-cells, T-cells and natural killer (NK) cells.
B-cells make antibodies that are stimulated by infection or vaccination.
T-cells and NK cells, on the other hand, are the cellular aggressors in the immune system and are our main focus in the discussion that follows.
Let's pause a moment and introduce something you probably never learned about in high school biology class: CD markers.
CD, which stands for ``cluster designation'', is a glycoprotein molecule on the cell surface that acts as an identifying marker.
Think of comparing cells as comparing people. Humans are made up of innumerable superficial identifying characteristics (such as hair color, eye color, etc.) and so are cells.
Cells probably have thousands of different identifying markers, or CDs, expressed on their surfaces, but 200 or so have been recognized and named so far.
Each different marker (or CD) on a cell is named with a number, which signifies nothing more than the order in which the CD was discovered.
On any given cell there are many different cluster designation markers (CDs), giving each cell its unique appearance and function but also linking certain cells by their similarities (like grouping all people with brown hair or all people with blue eyes).
Cells that have a certain kind of CD present on their surface are denoted as + for that CD type (e.g., a cell with CD57 markers on its surface is CD57+).
NK cells have their own specific surface markers. The predominant marker is CD56.
The percentage of CD56+ NK cells is often measured in patients with chronic diseases as a marker of immune status: the lower the CD56 level, the weaker the immune system.
You may have heard Chronic Fatigue Syndrome patients talk about their CD56 counts.
A smaller population of NK cells are CD57+. A below-normal count has been associated with chronic Lyme disease by the work of Drs. Raphael Stricker and Edward Winger.
No one knows for sure why CD57+ NK cells are low in Lyme disease patients, but it is important to note that many disease states that are often confused with chronic Lyme (MS, systemic lupus, rheumatoid arthritis) are not associated with low CD57+ NK counts.
The good news is that for most Lyme patients the CD57+ NK level increases as treatment progresses and health is regained.
CD57 markers can also be expressed on other kinds of cells, including T-cells, so it is important to distinguish between CD57+ T-cells and CD57+ NK cells.
Clinicians need to be aware that many testing laboratories claiming to perform the CD57 test are actually looking at CD57+ T-cells rather than CD57+ NK cells, which are the cells of interest in chronic Lyme disease.
In order for a testing laboratory to measure the CD57+ NK level, it first measures the percentage of lymphocytes that are CD57+ NK cells.
Then an absolute count is calculated by multiplying that percentage by the patient's total lymphocyte count.
The standard normal range for the absolute CD57 NK count is 60 to 360 cells per microliter of blood.
This wide range was established based upon test results of hundreds of healthy patients. By these laboratory standards, a test result below 60 cells per microliter would be considered below normal and therefore associated with chronic Lyme disease.
However, a recent study of my Austin patients has led me to believe that 100 cells per microliter is a more reliable threshold separating Lyme patients and healthy controls.
When Drs Stricker and Winger discovered that CD57+ NK cells are low in chronic Lyme patients and tend to increase with patients' clinical improvement, an opportunity arose for Lyme-literate practitioners to utilize a handy tool to aid in the diagnosis of chronic Lyme disease, to follow treatment progress, and to determine treatment endpoint.
Just as AIDS patients have always held great store in their CD4 T-cell count, Lyme patients now have a fairly reliable marker of the status of their illness.
It is important to remember that the CD57 result is just a number; far more important is the patient's clinical status.
An old professor of mine used to say, ``treat the patient, not the lab test!''
There is still much we do not know about the CD57 marker and what other factors may lower or raise it.
However, overall, the CD57+ NK count is a useful tool in diagnosing and treating chronic Lyme disease in most patients.
As a measure of immune status, it provides an indirect measure of bacterial load and severity of illness.
Furthermore, in a patient who has a negative or indeterminate Lyme test but is highly suspect for the disease, the clinician may utilize the CD57+ NK count as one more piece in the complex puzzle of a Lyme disease diagnosis.
Postscript: If you would like your health care provider to order the CD57 NK test for you, your blood sample needs to be drawn into an EDTA tube (lavender top) on Monday through Thursday and sent immediately to either LabCorp in Burlington, NC, or Clinical Pathology Laboratories (CPL) in Austin, TX.
LabCorp and CPL are the only two labs that perform this test properly. Quest does NOT. The LabCorp test code is #505026 and is named HNK1 (CD57) Panel.
The CPL test code is #4886, CD57 for Lyme disease. The test is time-sensitive and must be performed within 12 hours of collection, so blood should not be drawn on a Friday or results may be inaccurate.
-
Posts: 6956 | From Lancaster, PA | Registered: Feb 2004
| IP: Logged |
posted
I am new at trying to understand all of the Lyme info. Thanks, Carol in PA, for posting this.
To those who've said that CD57 is not the most current way of tracking progress, is there another test I need to read up on? Thanks!
Posts: 170 | From New Jersey | Registered: Jun 2008
| IP: Logged |
djf2005
Frequent Contributor (1K+ posts)
Member # 11449
posted
pretty much how you feel
welcome to lyme, where there is NO solid ANYTHING
cheers
-------------------- "Experience is not what happens to you; it is what you do with what happens to you."
posted
My LLMD no longer bothers with the CD57 test-it has proven to be an unreliable indication of the degree of sickness for her patients.
IP: Logged |
sparkle7
Frequent Contributor (5K+ posts)
Member # 10397
posted
That seemed pretty confusing to me. Maybe this is easier to understand?
Stricker NK Panel CD-57 Compiled by Melissa Kaplan
Note:
This panel is referred to as the "Stricker Panel" because Dr. Stricker and a couple of other doctors decided to look at this particular collection of data to see if they could see any patterns between the test results and how their patients were feeling and responding (or not) therapeutically.
The panel could just have easily been called the NK CD-57 Panel, or George. It is not a proprietary-to Stricker, or proprietary-to-LabCorp test or set of tests.
For ease in communication, it was just simpler for people to refer to it as "the Stricker Panel" than "that WBC, Lymphocytes, % T cells (CD3+), % NK Subset (CD57+/CD8), % CD8+/CD57+, Total Lymphocytes, Total T cells (CD3), Total CD8+/CD57+, and Total NK subset (CD57+/CD8) panel."
Another test gaining popularity amongst physicians treating Lyme patients is one of the antigen tests, CD-57.
For information on the use of the test Lyme patients, please read Long-Term Decrease in CD-57 Lymphocyte Subset in Patients with Chronic Lyme by Stricker, Burrascano and Winger.
Your physician can order the Stricker NK Panel CD-57 from Labcorp (who recently purchased IDL, the lab that developed this particular test).
If your physician or lab has questions about this test, they can call LabCorp at 510-635-4555. As of this writing, this test was not yet on Labcorp's website.
If you live near a LabCorp collection site, bring a lab slip from your physician.
The physician needs to indicate the diagnosis (ICD-9 for Lyme: 088.81), the test procedure code AND description (Test ID# 32103-5, Stricker NK Panel CD-57).
Not all LabCorp facilities are familiar with this test panel, so the collection site personnel may have to call headquarters to find out the collection and shipping procedure. Check the LabCorp site for a collection site near you.
If your doctor's office draws blood for tests, they will need to complete the LabCorp form as described above (diagnosis, test ID number, test name).
They will need to fill 1 lavender top and 1 yellow top. The blood does not need to be spun, nor refrigerated.
It does need to be shipped so that LabCorp receives it within 24 hours. That means blood draws need to be done on Monday-Thursdays, not on Fridays.
If push comes to shove, LabCorp can send out a test kit for this test, but the kit currently (as of 9/8/2003) does not have the above instructions in it.
Make sure that the date and time the blood was collected is written on the form.
If you want a copy of the test results for your files, you can enter your name and your mailing address, or email address, or fax number, in the shaded field provided on the lab form, just above the fields for the patient's name, address, etc.
This holds true for any lab tests ordered from LabCorp.
This test is not meant to replace the IGeneX Western Blot. This series of tests looks at various other immune factors that Dr. Stricker and others are looking at in conjunction with relapsing and remitting chronic neuroborreliosis.
The tests included in the Stricker NK Panel CD-57 are:
Labcorp Test Code
Test Name
32001 WBC
32017 Lymphocytes
32347 % T cells (CD3+)
32252 % NK Subset (CD57+/CD8)
32261 % CD8+/CD57+
32010 Total Lymphocytes
32279 Total T cells (CD3)
32284 Total CD8+/CD57+
32285 Total NK subset (CD57+/CD8)
Just to ensure that nothing is ever cut-and-dried with Lyme, most patients who are in a Lyme relapse (flare) will have a very low NK cell count, while those who are feeling somewhat better will have normal-high NK counts.
And then there are people like me, who had a zero (that is, 0) NK count in while feeling significantly better (all things being relative) than some friends in severe flare, who had normal-high NK counts.
While many Lyme patients are getting this test, it is not a Lyme--or any sort of TBD--test.
It is a look at some aspects of the immune system's ability to fight off infection, and so a general immune deficiency ICD code is generall used on the test request form, such as 279.3 - Unspecified immunity deficiency.
Posts: 7772 | From Northeast, again... | Registered: Oct 2006
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[Smile]](smile.gif)
Printer-friendly view of this topic