WESTERN BLOT IN LYME * Reflects antibody response to specific Bb antigens- they are reported as numbers called ``bands'' * Some bands are seen in many different bacteria- ``nonspecific bands'' * Some bands are specific to spirochetes * Some bands are specific to Bb
WESTERN BLOT IN LYME * Positive blot contains bands specific for Lyme * Specific: 18, 21-24, 31, 34, 37, 39, 83 & 93 * Spirochetes in general: 41 * Nonspecific: All others! * The more specific bands that are present, the more sure the diagnosis
PITFALLS OF THE WESTERN BLOT * Very difficult to produce and interpret a western blot * Bands do not easily line up * Appearance affected by subtle changes in temperature and chemistry of the test system * The specific strain of Bb used to produce the antigens may not match the strain the patient has!
HOW DO YOU MAKE THE DIAGNOSIS? * Lyme is a clinical diagnosis * Even the best Lyme tests are only an adjunct * Use the ILADS point system
POINT SYSTEM * Tick exposure in an endemic region 1 * History consistent with Lyme 2 * Systemic signs & symptoms consistent with Bb infection (other potential diagnoses excluded): * Single system, e.g., monoarthritis 1 * Two or more systems 2 * Erythema migrans, physician confirmed 7 * ACA, biopsy confirmed 7 * Seropositivity 3 * Seroconversion on paired sera 4 * Tissue microscopy, silver stain 3 * Tissue microscopy, monoclonal IFA 4 * Culture positivity 4 * B. burgdorferi antigen recovery 4 * B. burgdorferi DNA/RNA recovery 4
POINT SYSTEM DIAGNOSIS * Lyme Borreliosis Highly Likely - 7 or above * Lyme Borreliosis Possible - 5-6 * Lyme Borreliosis Unlikely - 4 or below
Bartonella * More ticks in NE contain Bartonella than contain Lyme * Clinically, seems to be a different species than ``cat scratch disease'' * Gastritis and rashes, CNS, seizures, tender skin nodules and sore soles * Tests are insensitive! (serologies and PCR) * Levofloxacin (Levaquin) is drug of choiceconsider adding proton pump inhibitor
PIROPLASMS (Babesia species) * Many different species found in ticks (13+) * Not able to test for all varieties * WA-1 more difficult to treat than B. microti * Diagnostic tests insensitive * Chronic persistent infection documented * Infection is immunosuppressive
Ehrlichia * Can cause acute and chronic presentations * Acute- sudden high fever, severe headaches, very painful muscles, low WBC counts, elevated liver enzymes * Chronic- same, but not as severe * Test with serology, PCR or smear * Treat with doxycycline or rifampin
Mycoplasma * ``Chronic fatigue'' germ * Not clear its origin or source * More often seen in the immunosuppressed * Test with PCR * Treat with doxycycline and add fluoroquinolone * Erythromycins & rifampin, with added hydroxychloroquine OK but less effective
Other Co-infections * Especially in the immunosuppressed * Chlamydiae * Viruses - HHV-6, CMV, other herpes * Yeasts * Others
DANGEROUS MIX! * Co-infections missed in Lyme patients * Co-infected patients more ill * Babesiosis and Ehrlichiosis can be fatal! * Lyme treatments do not treat Babesia or Bartonella * One reason for ``treatment-resistant'' Lyme * ``Silent infections'' may be transmitted by transfusions
ASSOCIATED CONDITIONS Neurally Mediated Hypotension * Dehydration, autonomic neuropathy, pituitary insufficiency * Paradoxical response to adrenaline - profound fatigue - adrenaline rushes and palpitations - unavoidable need to lie down * Diagnose with tilt table test performed by a cardiologist, and pituitary function tests
ASSOCIATED CONDITIONS Hormonal Dysfunction * Significant disturbance of the hypothalamic-pituitary axis * Extremely difficult to diagnose * When corrected, are tremendous benefits! * A major key to the debility in chronic Lyme
ASSOCIATED CONDITIONS Hormonal Dysfunction * Chronic lack of stamina * Loss of libido * Intolerance of stress including Herxheimers! * Unexplained weight gain * Hypersensitivity to the environment * Persistent encephalopathy despite Lyme treatment
ASSOCIATED CONDITIONS Borrelia Neurotoxin * Effects - Neurologic dysfunction - Cytokine activation - Hormone receptor blockade * Testing for neurotoxin: - Visual contrast sensitivity test - Measure cytokine levels - Test for insulin resistance * Treat with bile acid sequestrants
ASSOCIATED CONDITIONS Cerebral Vasculitis * Contributes to encephalopathy * Vascular headaches * Seen on SPECT brain scans
SPECT BRAIN SCANS * Reflects blood flow and health of the nerve cells * Pre and post-Diamox scans * Proves the symptoms are real! * Useful in differentiating Lyme Disease from a psychogenic illness * Can be done serially to reflect clinical changes
SUPPORTIVE THERAPY * NUTRITIONAL SUPPORT - Blend of multivitamins, B-complex, CoEnzyme Q-10, and magnesium - Essential fatty acids - Low glycemic index, high fiber diet - Absolutely no alcohol * MANAGE YEAST OVERGROWTH - Oral hygiene, acidophilus/yogurt - Low carbohydrate diet J
SUPPORTIVE THERAPY METHYLCOBALAMIN * Prescription drug derived from vitamin B12 - Aids in healing the central and peripheral nervous system - Documented benefit in strength, energy and cognition - Helps restore normal day-night cycle - Improves T-cell immune responsiveness * Must be injected daily for 3 to 6 months * Available only as a ``compounded drug'' * Excellent safety profile
SUPPORTIVE THERAPY * ENFORCED REST; NO CAFFEINE - Must try to prevent afternoon energy sags - Proper sleep is essential * REHAB AND EXERCISE PROGRAM - Required for a full recovery - Intermittent program one to three days per week - Toning, stretching, posture, balance - Aerobics are not allowed until nearly fully recovered
ALTERNATIVE THERAPIES POSSIBLY HELPFUL * Immune modulation - Reishi spore extract, transfer factor - IVIG only if deficient * Vitamin C * Acupuncture ALTERNATIVE THERAPIES NO PROVEN BENEFIT * Colloidal silver * Heat therapy - Sauna, infrared, hot tubs * Rife machines
YOUR DUTY AS A LYME PATIENT * Political awareness and activity - Join support groups and be pro-active - Be willing to participate in events - Support the major Lyme organizations- ILADS, LDA, LDF * Fundraising!!! * Aggressively spread the truth especially to the media * Never give up, and never go away until our goals are met
Posted by treepatrol (Member # 4117) on :
cave i put it here so i could link to it in newbie links under western blot section.
Posted by WildCondor (Member # 434) on :
Why is this forum not moderated or organized? hello?
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