Topic: Medscape: Alternative Lab Tests May Not Reliably Diagnose Lyme Disease
TX Lyme Mom
Frequent Contributor (1K+ posts)
Member # 3162
posted
Yikes! Ouch!! This one is hot off the press just today on Medscape..
It's important to know what the opposition is up to, which is why I'm posting this -- not because I agree with it.
Notice that the research was done in British Columbia, Canada and that it first appeared in an infectious disease journal (CID) last week on June 16. (It is not a free, open access article though. Only just its abstract is free on-line.)
Then it appeared on Medscape today where it will undoubtedly get lots more coverage in the popular press.
TXLM
Alternative Lab Tests May Not Reliably Diagnose Lyme Disease
Alternative Lab Tests May Not Reliably Diagnose Lyme Dis... Lyme disease diagnosed by alternative laboratory methods is indistinguishable by detailed clinical and laboratory evaluation from chronic fatigue syndrome, a case-c...
Alternative Lab Tests May Not Reliably Diagnose Lyme Disease
Laurie Barclay, MD
June 25, 2015
Detailed clinical and laboratory evaluation cannot distinguish alternatively diagnosed chronic Lyme syndrome (ADCLS) diagnosed by alternative laboratory methods from chronic fatigue syndrome (CFS), according to a case-control study published online June 16 in Clinical Infectious Diseases.
The investigators note that symptoms of ADCLS are often similar to those of CFS, and that the incidence of Lyme disease is low in British Columbia, where the study took place.
"Amongst patients reporting a diagnosis of Lyme disease, we observe four distinct groups, largely differentiated by the method of diagnosis," write David M. Patrick, MD, from the School of Population and Public Health, University of British Columbia, and the British Columbia Centre for Disease Control, both in Vancouver, Canada, and colleagues.
"One of these is the controversial category of [ADCLS], in which diagnoses are made on clinical grounds supported not by testing at a regional reference laboratory, but rather by western blot testing performed at an American non-reference Lyme specialty laboratory (Lab A).
Such tests have been the subject of warnings with respect to their accuracy, offer no benefit in finding Lyme disease when it is present, and may produce false positive results for more than 50% of people without Lyme disease who are tested."
The investigators compared 13 cases with ADCLS, of whom 12 were diagnosed by one alternative US laboratory; 25 cases with CFS; 25 matched healthy controls; and 11 controls with systemic lupus erythematosus.
Measurements included history and physical examination, screening laboratory tests, seven functional scales, reference serology for Lyme disease using CDC criteria, reference serology for other tick-associated pathogens, and cytokine expression studies.
Disability was significant among patients with ADCLS and CFS, including inability to work full-time, sleep disturbance, and profound fatigue, and both these groups had significant differences compared with controls. However, ADCLS cases did not differ significantly from CFS cases on any of the measured parameters.
Reference laboratory testing did not confirm positive Lyme serology in any of the ADCLS cases. Furthermore, the groups did not differ in distribution of positive serology for other tick-transmitted pathogens or in cytokine expression.
"Lyme disease diagnosed by alternative laboratory methods is indistinguishable from [CFS] by detailed clinical and laboratory evaluation," the study authors write. "Discordant tests for Lyme disease likely represent false positive results from an alternative lab in our low prevalence setting [in British Columbia]."
Limitations of this study include small sample size with low power to detect small between-group differences, recall bias inherent in case-control studies, possible selection bias, and low generalizability to higher prevalence areas for Lyme disease.
"Those diagnosed with ADCLS deserve comprehensive work-up and care," the study authors conclude. "Many will meet case definitions for CFS and should be included in studies employing metagenomics, transcriptomics and other approaches in the search for a more plausible etiology."
The British Columbia Centre for Disease Control Foundation for Population and Public Health funded this study. The authors have disclosed no relevant financial relationships.
Clin Infect Dis. Published online June 16, 2016. Abstract
PS -- I substituted the link to its PubMed abstract because PubMed allows you to find other similar related articles easily, whereas the link to the abstract on the publisher's website does not offer this extra advantage.
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Breaking up a couple paragraphs for easier reading for many here -
posted
This is ridiculous and there are many ways to refute it. I'll refer this on...
Posts: 13116 | From San Francisco | Registered: May 2006
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posted
I haven't read the full article yet, but this reminds me of a similar Steere study, where he declared that all the patients who tested negative at his lab but positive at other labs must have false positive results. The key missing element here is that he had no real proof that his negative results weren't false negatives.
Karla
-------------------- KarlaL Posts: 694 | From New Lebanon, NY | Registered: Dec 2010
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posted
I also think that the authors of this study are referring to the recent Brian Fallon study, where he found evidence of false positives in the IGeneX IgM Western blots. At the MA Lyme conference this spring, Robert Guigere of IGeneX told me that Brian misrepresented some of his data and that he had just submitted a correction for publication, but he wouldn't give me any details. Part of the correction might include the need for the IGeneX 31kDa IgM Epitope Test to rule out indeterminate IgM results with a positive 31kDa band. I just noticed that IGeneX has added a 31kDa Epitope Test for IgG antibodies to thier list of tests as well. I wonder if it is for similar reasons?
-------------------- KarlaL Posts: 694 | From New Lebanon, NY | Registered: Dec 2010
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LisaK
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GGGGGrrrrrrrrrrrrrrrrrrr
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-------------------- Be thankful in all things- even difficult times and sickness and trials - because there is something GOOD to be seen Posts: 3558 | From Eastern USA | Registered: Jul 2013
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TX Lyme Mom
Frequent Contributor (1K+ posts)
Member # 3162
posted
There were 11 comments posted to this article on Medscape the last time I checked there, just a few minutes ago. The discussion appears to be heating up over there right now, in case anyone is interested in following the discussion at Medscape: http://www.medscape.com/viewarticle/846997?src=wnl_edit_tpal&uac=49081CK -- (Look for the "comments" link -- small print near top of page, below title of article.)
Be ye forewarned: Anything pertaining to the diagnosis and treatment of Lyme is controversial among mainstream health care providers, who make up the main audience for Medscape articles and discussions.
What's surprising to me though is that there are a few comments posted at Medscape already which are favorable to our common cause of advancing the diagnosis and proper treatment of Lyme disease. Cheers!
TXLM
PS - Thanks to Robin for breaking up my first post for us because I had simply cut and pasted the article from Medscape in its original format. Robin's improved formatting is much better for Lyme eyes. Thanks, Robin.
Posts: 4563 | From TX | Registered: Sep 2002
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