Topic: Babesia ducani "reactive at 1:512"..what does this mean? Neg or pos?
Hoosiers51
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Doesn't this mean I am positive for babesia ducani?
I was positive for b. microti a few years ago.
I dated a lymie for awhile who had b. ducani....could I have gotten it from him?
Or could both of these species have been found in the same tick that bit me? (either in Eastern PA, in Florida, or in Indiana)
I was at my sickest before meeting this boyfriend, so I'm thinking it is likely I had both forms of babesia before meeting him? I dunno....
I just stopped my mepron a couple weeks ago...i am so confused...should i go back on? help!
[ 06. November 2008, 06:05 PM: Message edited by: Hoosiers51 ]
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lymielauren28
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Hey Hoos,
Hmm...I really have no idea. I would think it's very possible for a tick to carry multiple strains of babesia - I know that they can carry multiple strains of borrelia, so why not babs too?
Lauren
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Hoosiers51
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Thank you so much for responding!
Does "reactive at 1:512" mean "positive" though?
My doctor didn't call me, just mailed me this test. So I don't even know if this means positive!!!!
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Hoosiers51
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EDIT: I shouldn't say "I was positive for b. microti a few years ago"....I should say, I had a positive Igenex FISH.
But back then, didn't the FISH not catch b. ducani? Or did it? So I assumed my positive FISH back in 2005 meant I had b. microti....
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not sure about the positiveness of the test, but i would lean towards thinking you have had this prior to relations, thats just imo tho. brian
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Hoosiers51
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So maybe 1:512 means negative?
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disturbedme
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Not sure if that means it's positive or not, but if you are positive for that too, I'd say it's not a huge surprise to have more than one Babesia. We know these ticks carry many, many bugs and I wouldn't doubt it could have had more than one Babs and gave you both of them too.
I'd be betting you got it from the bite of the tick before getting it through your boyfriend. I'm not saying it's NOT sexually transmitted, but ticks carry tons of bugs and probably some we don't even know yet.
First, though, you need to find out if that is a positive or negative.
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AliG
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512 is the dilution at which it is still detected.
that's pretty diluted, it means you have quite a high level of AB to it in your blood.
You should be on Babs Tx, if you're not, call and ask your LLMD about this.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Hoosiers51
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Thanks Ash
I should mention this test was done at Sonoma County Public Health Laboratory. For anyone curious....or in case that means anything.
Reading that it made it sound like 1:512 is positive....because it's "greater than 1:256" but I dunno. This is what it said:
"Positive Babesiosis titers are generally 1:160 or higher. Early in disease the titers may rise 4-fold to 1:1280. Later in disease the titer falls"
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Hoosiers51
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Oh really AliG? YIKES!
I was on Mepron and Zithromax at the time the blood was drawn, and I was pulsing Artemisinin.
Honestly, I feel like it was pulsing the Artemisinin that was bringing this parasite "out in the open."
I feel like the Mepron wasn't touching it.
I wonder if that means I should just treat this b. ducani with Artemisinin and not waste my time with Mepron?
OR, do these high antibody titers mean that my body was responding well to the Mepron treatment? (this blood was drawn at 4 1/2 months into Mepron/Zithromax)
What should I take for this? Does this mean I should abandon Mepron or keep going with it?
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AliG
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Assays for Babesia are usually performed using IFA against cells containing the organism. For the IFA, patient serum is titered using doubling dilutions. These dilutions start at 1:8 or 1:10.
Thus, an assay starting at 1:8 would have values at 1:16, 1:32, 1:64, 1:128, 1:256, 1:512, 1:1024, etc., and an assay starting at 10 would have values at 1:20, 1:40, 1:80, 1:160, 1:320, 1:640; 1:1280, etc.
Cut-off ranges between a laboratory negative and a laboratory positive sample are comparable for most clinical laboratories. The laboratory positive must be statistically different (mean +/- 2SD) from the negative sample. This does not imply that a titer of 1:40 or 1:80 is clinically significant. In fact, a positive antibody test by itself implies nothing. However, a positive antibody test, with appropriate clinical symptoms (determined by a physician), can lead to a diagnosis.
Positive Babesiosis titers are generally 1:160 or higher. Early in disease the titers may rise 4-fold to 1:1280. Later in disease the titer falls. For this reason, the testing of paired samples 4 to 6 weeks apart improves the diagnostic efficiency.
Diagnosis based on antibody response requires the seroconversion of infected individuals toward production of anti-Babesia antibodies. Unfortunately, this approach does not always work because:
* At the height of Babesiosis (within weeks of the initial bite) a patient with fever may fail to have evidence of antibody. * Antibodies often persist long after the symptoms have disappeared. * Polyclonal antibody-based tests lack specificity.
******************************************
They were still able to find it after 6 dilutions. That's pretty high. If you're still symptomatic, you're still infected.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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I think B.duncani is harder to kick than B.microti.
I had been Txing B.microti and my Tx progress was followed by declining titers. I recently had another flare & this time microti was negative but duncani was positive.
I am planning to hit it with IV Clindamycin, IV Zith, Mepron, Artemesiae and Bactrim DS. One of us is going down and I sure hope it won't be me.
There is a lag in the titers dropping I think it was about a month or so. You may feel symptoms go before the titers come down but I'm not sure if that really means you're in the clear.
If you're still symptomatic, I wouldn't stop the Mepron. I was just reading that there seems to be a consensus among LLMDs that Artemesinin alone won't get rid of it. It's helpful as an adjunct.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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posted
My copy of the Sonoma lab test report on this species of babesia said:
Babesia WA-1 serology IFA reactive at 1:640 Serum positive for Babesia WA 1
But that was several years ago and I have heard that they changed the cutoff point, so that for reporting purposes it is much higher. Tried to find this on the lab website and on the state health dept website but it didn't jump out at me. They don't make it easy to find this info.
Another one of those deals where the number of reported cases does not accurately reflect the real number of cases, and probably done for the same reason as the lyme cases.
I think for treatment purposes, it depends on who is interpreting these results.
Have you ever been on the west coast? The claim is made that this babesia is only on the west coast. It would be interesting to find cases all over the country instead. I have been hearing of other WA-1 (Babesia duncani) cases in the east.
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Hoosiers51
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Thanks.
What does "higher" mean in this sense? Would something like 1:5120 be "higher" and 1:256 would be "lower"?
That is what I am thinking.
On the test it says, "A titer of 1:256 with Babesia Duncani (formerly Babesia WA-1) may only indicate exposure to the parasite and may not indicate clinical disease. Results should be closely correlated with clinical symptoms. Babesia WA1 parasites have not been detected in people with titers less than 1:5120."
So that is confusing......on the one point it seems that those with even 1:256 have been exposed.........but what does the last part mean?
Is that saying you need to be "higher" than 1:5120 to have it? Huh?
I am so confused.
I have never spent much time in California or Washington state.....though I have been to San Diego very briefly and spent time in Montana and Wyoming. I have also had a sexual relationship with a boyfriend from California who had babesia....but all my life I have either lived in Florida or Indiana. I have had positive IgG's and IgM's for Lyme (this was before the boyfriend).
I also know that when I was bit by a tick in Florida is had extremely high fevers immediately following the tick's attachment.....so I assume I contracted some form of babesia in Florida. Whether that was microti or duncani or both obviously remains to be unseen........
......because of my positive Igenex FISH from years ago when people claimed it only came back positive for the b. microti people, I am wondering if I even have both.
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AliG
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quote:Originally posted by Hoosiers51:
On the test it says, "A titer of 1:256 with Babesia Duncani (formerly Babesia WA-1) may only indicate exposure to the parasite and may not indicate clinical disease. Results should be closely correlated with clinical symptoms. Babesia WA1 parasites have not been detected in people with titers less than 1:5120."
So that is confusing......on the one point it seems that those with even 1:256 have been exposed.........but what does the last part mean?
Is that saying you need to be "higher" than 1:5120 to have it? Huh?
Is that 5120 or 512? I think 1:512 sounds more reasonable than 1:5120.
I think they are saying that at the lower titers, strong consideration should be given to symptoms.
In my experience, I believe that Babesia will go through cycles of latency & then recrudesce.
I would imagine that untreated Babesia would lead to an up & down antibody pattern according to those cycles.
I also think it's best to test for Babesia at times when those symptoms are at their strongest. That would likely be the time when the ABs would be highest.
The smears, looking for the actual protozoa, should be drawn every 6 hours for 36 consecutive hours to be of any diagnostic usefulness, due to the shed cycle of the organism.
I'm sure it would be possible to "get lucky" and catch it just right, but if only one smear is done & it shows negative, it's meaningless. It doesn't count as a rule-out.
Perhaps at 1:512 or greater, the higher level of active parasitemia would lead to a greater chance of detecting it in a smear.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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Quest had been positive, turned to negative and they only test for microti.
Last flare Quest was negative, then through Igenex, I tested positive for duncani, negative for microti.
I'm thinking that means I have both & may have taken out microti, but not duncani, which I'm told is a much tougher nut to crack.
I just had the feeling that I may be repeating myself. (Sorry, if I am please disregard. )
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Hoosiers51
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Everything you said made sense...thanks.
Mine was definitely 1:512....and I quoted the test right when I said it says that the parasite hasn't been detected in people lower than 1:5120.
I am not sure though if "lower" would be like.... 1:6100, etc........since they are fractions of sorts...... in the same way that 1/8 is less than 1/4...
...so i'm confused in that regard. I called my LLMD today, and i HOPE he calls me back sometime today so I don't have to wonder about this all weekend.
Thank you so much for your input AliG...and SkyLord! Posts: 4590 | From Midwest | Registered: Jun 2008
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Yes, I had heard that they had changed the cutoff point, and that 5000 figure is what I had heard.
Meanwhile, at !:640, my blood smear showed babesia.
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Hoosiers51
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Yes, I did speak with my LLMD. He seemed to consider this result, 1:512, a positive.
He said that they haven't found the actual parasite itself in people lower than 1:5120 (so I am lower than that)......but he still seemed to believe 1:512 is evidence enough of b. duncani for him. And he is, in my opinion, conservative in his diagnosises.
I had a positive FISH from Igenex when it only apparently detected b. microti. I asked him if he thought I had both, and he said while it's possible they cross-react, he thinks it is more likely that I have both.
However, I had already been on Mepron for 4 1/2 months when I came back as having the 1:512 titer. I hadn't made any improvement with my major symptoms, so even when he drew the blood, (before the results were back), he told me to stop the Mepron because he didn't think it was helping me at this juncture. I was curious as to why he even bothered running a babesia test while I was on Mepron, but I guess I'm glad he did.
That decision to stop Mepron I think was fueled also by another test he uses (C1Q Immune Complexes) to gauge my level of infection, and this marker didn't go down at all on Mepron for me. So moreso than symptoms, I think that test let him know we were failing so far with the Mepron.
So he said he would rather move on to my other tick diseases and treat the babesia later.
It is my personal belief that the b. duncani came back positive because i was pulsing artemisinin (4 days on, 3 off) at the time of the bloodwork. I am just going to continue the artemisinin while I take my minocycline and rifampin he switched me to.
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AliG
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What ABX were you on with the Mepron, Azithromycin?
The higher the number following the 1:, the greater the number of ABs present. (They are still detectable at a greater dilution.)
The greater the number of ABs present, the higher the level of parasitemia.
Lou, sounds like you got lucky. It's still there in the blood at the lesser dilution numbers, it's just at lower levels and therefore the odds of catching it in a smear are much, much lower.
When the ABs are still detectable when it's diluted by 5120, you've got a lot of protozoa in there & a much greater chance of catching it on a smear.
Am I making sense yet?
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Ali, I could be wrong about this, but my interpretation of what is going is this:
By having the cutoff at 5000+, you are only going to catch the cases that are acute, high level parasitemia. Chronic cases may have lower levels. So, you will not have many cases reported at these levels. And since most people do not get blood smears done, their ability to get treatment will depend on the positive antibody test. A lot of them will not get it, with this high cutoff, especially as the surveillance criteria are not good for clinical purposes. Just like lyme.
By the time this testing was done, it was three years post bite. Chronic babesia + chronic lyme.
Do you see anything wrong with this reasoning?
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AliG
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I'm not interpreting that as a cut-off for being positive. I believe they are saying that you wouldn't likely find it in a smear at the lower numbers.
The "interpretation that I have is:
<1:20 IGM - suggests no evidence of infection <1:40 IGG - suggests no evidence of infection
1:20 IGM - 1:160 or 1:40 IGG - 1:160 May suggest evidence of infection. If sample within last 6 months had titer of 1:640 or >, patient may be recovering.
>1:160 - 1:640 Suggests infection of unknown duration.
>1:640 - Suggests active infection
It also states that: Babesia specific AB titers generally rise to > or = 1:1024 during acute illness and then decline gradually over 6 months to titers of 1:16 - 1:256.
There's nothing in there pertaining to numbers that high for an AB test to be considered positive. I think it just means that if less than 1:5120, you'd probably be wasting your time & $ trying to catch it on a smear.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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It's also not the cut-off for reporting.
Any positive gets reported & you get banned from ever donating blood.
I do think they may require a positive smear for definite confirmation, but none-the-less they'll ban you for positive AB.
Stupid for determining "endemicity"? ABSOLUTELY!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Well, not sure where you got the info about the cutoff for reporting. I could not find it. The state of CA has very few babs cases accepted for reporting purposes, because of that high cutoff number. Lymies in the state believe the cutoff was changed to produce a lower number of cases, and they have had no luck in getting more cases reported.
I am paying attention to this because I was bitten in CA and got babesia duncani and lyme.
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Hoosiers51
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AliG,
You asked what antibiotics I was taking with Mepron/Zith. I was taking 1 tsp Mepron twice daily, 500mg Zithromax daily, and during much of the Mepron treatment, high doses of Amoxicillin. However, at the time of the blood draw, I had been off the Amox for awhile and had been pulsing Artemisinin (had been doing so for about a month) along with the Mepron/Zith.
Everything you all are saying about the "levels" makes sense. Seems like my load of b. duncani was in the low-positive range at the time. Maybe that is why my LLMD didn't seem too eager to treat it right away when we finally got the results back. (he had taken me off Mepron and Zithromax the day of the blood draw and put me on Minocycline and Rifampin....I was on the previous combo to treat my b. microti)
I'm thinking we will address the b. duncani later on though....what meds have you had the best success with for your b. duncani? I am thinking for me maybe higher doses or Malarone since Mepron didn't work out well for me. I am not ruling out quinine, Riamet (not available in U.S.), etc.
For now I will continue pulsing my artemisinin.
PS--are any of you female? Any concerns about mother-to-child transmission later in life? (I am 25 and haven't had children yet)
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