Interpretation of results medical, Lyme disease?

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
Userr0
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Joined: Mon 26 Jan 2015 13:00

Interpretation of results medical, Lyme disease?

Post by Userr0 » Mon 26 Jan 2015 13:07

Hello.

I would like to ask for help in the diagnosis of my health.
I am 26 years old. For several years, I feel bad.
My symptoms:
- Continuous fatigue
- Lack of concentration
- Out of memory
- Terrible sleepiness
- Continuous feeling cold
- Rapid fatigue
- Lack of power
- Muscle pain
- Lack of energy
- Shaking hands
- Sometimes headaches
- Dizziness
- Pain in the joints, muscles, bones
I did research, tests for Lyme .:

Test ELISA: http://images68.fotosik.pl/526/244ab7526d76ae79.jpg

My result: ELISA IgG: 9,30 AU/ml
Norm:
Result negative: <10 AU/ml
Result doubtful: 10-15 AU/ml
Resul positive:> 15 AU/ml

My result: ELISA IgM: 6,50 AU/ml
Norm:
Result negative: <18 AU/ml
Result doubtful: 18-22 AU/ml
Resul positive:> 22 AU/ml

Test Western-Blot:
IgM: http://images68.fotosik.pl/526/a60962f252de7dc4.jpg
IgG: http://images70.fotosik.pl/525/944e060134b8c280.jpg

Test Western-Blot IgM: result negative
VIsE: 0
p83: 0
p39 BmpA : 0
p31 OspA: 0
p30: 0
p25 OspC: 0
p21: 0
p19: 0
p17: 0
Strap position (Anl): 0

Test Western-Blot IgG: result positive
VIsE: 20
p83: 0
p39 BmpA : 0
p31 OspA: 0
p30: 0
p25 OspC: 0
p21: 0
p19: 59
p17: 0
Strap position (Anl): 0

Others medical research:
- Blood count - ok
- erythrocyte sedimentation rate, ESR : 2 (norm: 0-10)
- urine test - ok
- glutamic pyruvic transferase: 18 (norm: 0-41)
- glutamic oxoloacetic transaminase: 17 (norm: 0-38)
- C Reactive Protein : <1 (norm: 0-5)
- Thyroid-stimulating hormone: 3,52 (norm: 0,27-4,20)
- rheumatoid factor, RF: <10 (norm: 0-14)
- bilirubin: 0,82 (norm: 0-1,10)
- anti-cyclic citrullinated peptide antibodies: <7 (norm: 0,0-17)
- total cholesterol: 208,60 (norm: 115-190)
- cholesterol LDL: 136,70
- cholesterol HDL: 49,20
- FE: 147 (norm: 59-158)
- ferritin: 192 (norm: 30-400)
- transferrin: 296 (norm: 200-360)
- TIBC –Total Iron Binding Capacity: 192 (norm: 228-428)
- UIBC -Unsaturated Iron Binding Capacity: 228 (norm: 112-346)
- Na: 141 (norm: 135-145)
- K: 4,98 (norm: 3,50-5,50)
- vitamin B12: 352 (norm: 191-663)
- abdominal ultrasonography : OK

Please, the next response.

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LHCTom
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Re: Interpretation of results medical, Lyme disease?

Post by LHCTom » Tue 27 Jan 2015 2:49

Your Euroimmune is a strong positive for IgG for Vlse and BB_N36

There is also a weak response at 17 DbpA, 30 and 25 OspC which is not meaningless

plus close weak at 83 and 31 OspA.

Vlse is among the most important indicators.

I would say your odds of Lyme are very high

Everyone's Immune system responds differently to Borrelia surface antigens and the ELISA is looking for an aggregate response. But with only 2 IgG positives, that could explain why your ELISA was negative.

How long have your symptoms existed?
Where do you live?
Do you recall a tick bite?
Have you been treated with antibiotics. How long and what kind?

http://www.euroimmun.ch/fileadmin/user_ ... UK_A02.pdf
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

Userr0
Posts: 4
Joined: Mon 26 Jan 2015 13:00

Re: Interpretation of results medical, Lyme disease?

Post by Userr0 » Tue 27 Jan 2015 12:27

LHCTom, thank you for your reply.

Symptoms have been unwell for several years, in recent times it all strongly intensified.
I live in Poland.
In the last five years, I had a lot of ticks, there were occasions that I had four ticks on the body.

I have so that there is a period of time that I feel good, and for some time very badly.
Generally, all the time have a problem with low body temperature which is in the range of 35C to 36C * *.
Often throat hurts and is bleeding from the nose, easily grab all the infections and I have constant problems with the memory and a constant feeling of cold.

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ChronicLyme19
Posts: 564
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Location: NY, USA

Re: Interpretation of results medical, Lyme disease?

Post by ChronicLyme19 » Tue 27 Jan 2015 17:59

Hey, just a thought, you might want to have your IgG, IgM and IgA levels checked, since it sounds like you have potential exposure to ticks, are only showing a few bands but not full positive, but also because you said "easily grab all the infections". Many folks here who have issues getting rid of Lyme also have underlying immune problems. Your overall globulin level can be normal, but some of your subdivisions like IgG, IgA, and IgM may be low or deficient. Your doctor should check out your immune system functioning. Lyme can also suppress your immune system, or you could have immune problems from other causes. And since you feel cold all the time, they might want to check your thyroid function.

The symptoms you describe certain could be from Lyme or other tick borne infections, but they also mimic many other diseases. You certainly have had exposure to ticks, so Lyme is a strong possibility. You should find a doctor who is knowledgeable about Lyme (one who knows you still may have it if you have a "negative" test), but at the same time, they should help you rule out other causes for your chronic symptoms. You can have one problems, or multiple tick borne diseases at once, or have other underlying conditions or genetic factors as well together. A good doctor will keep looking and ruling things out until they find all the ways to get you better. If one is not helpful, go to another.

I would recommend keeping a detailed journal of the symptoms you experience, and anything that makes them better or worse. This will help your doctor narrow down what is causing your symptoms, and it will help you see if things are gradually getting worse or better, or if there is a pattern to it. It will also help you remember what to tell the doctor when you go in.
Half of what you are taught is incorrect, but which half? What if there's another half missing?

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LHCTom
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Re: Interpretation of results medical, Lyme disease?

Post by LHCTom » Tue 27 Jan 2015 21:23

Symptoms have been unwell for several years, in recent times it all strongly intensified.
I live in Poland.
In the last five years, I had a lot of ticks, there were occasions that I had four ticks on the body.
This strong confirmation and Lyme is endemic in Poland

If you want to read the best information, I would suggest going to http://www.ncbi.nlm.nih.gov/pubmed

and entering in "Borrelia Poland" and look through the study abstracts. You can then add terms like the other tests I mention below.

Lyme is endemic in Poland. Based on your Western Blot IgG positive, Lyme is a VERY strong possibility. Here is a study in Poland where the ELISA was problematic but confirmation was done using the same test you received.

http://www.ncbi.nlm.nih.gov/pubmed/25292120

There are two species of Lyme common in Poland. These are B. garinii and B afzelii as described in this Poland study of ticks.

http://www.ncbi.nlm.nih.gov/pubmed/24959768

Each of these 2 species have different strains and the ELISA and Western Blot are based on antigens from certain species/strains. If you are infected with a species/strain with differences in the outer surface protein amino acid sequence, you may not get a response from that ELISA antigen or WB antigen. That can explain why you only show 2 bands on the Western Blot. But the Vlse positive is a very strong indicator for an infection longer than a year. Plus everyone's immune system doesn't produce a strong reaction to all the antigens. If you look at your blot at the top of the test, you will see bumps at or near many important antigens. The curve at the top represents the quantity of antibodies in your blood reactive to that antigen. The curve is analyzed by an optical scanner and a positive indicates the "bump" or quantity of antibodies is above a threshold based on the control from the far left. A human can look at this line Blot and make a judgement that the automatic threshold detection cannot.

So if you look at your results, not only are you positive for the 2, you have some "bumps" at other key antigens. Based on the aggregate of your line blot, Lyme is very likely but it would be wise to rule out other possibilities. You might check your CK which is a blood test for muscle enzymes. Sometimes this is one of the other normal blood tests that is elevated if the spirochetes have disseminated to muscle tissue. This can also sometimes cause elevated Kidney creatinine which at your age should be low.

Since you have a positive Vlse, the C6 peptide would also be a good confirmation test since its a simple ELISA that looks for a specific set of 25 amino acids on the Vlse protein. The C6 tends to vary temporally ( over time) but since you have a positive Vlse, you are someone that is likely to have a good C6 reliability. There is a C6 in Europe based on B garinii which is slightly different from the US version which looks for a B burgdorferi infection. The C6 peptide amino acid sequence is different between the Eurpean garinii and US B burgdorferi. If you have a positive C6, you have Lyme. If its negative, you are still equivocal. The original C6 is still quite good but there is a small difference in B garinii in Europe that could cause a problem.

http://www.immunetics.com/lyme.html

If its possible to get the more advanced Euroimmun Westen Blot, (Anti-Borrelia EUROLINE-RN-AT – new specific markers for comprehensive antibody diagnostics ) it could be helpful confirmation sine its a little better.

http://www.euroimmun.ch/fileadmin/user_ ... UK_A02.pdf


You could also arrange for the Borrelia Elispot-LTT (LymphocyteTransformationsTest) as another confirmation. Contrary to the medical community, I believe you are most likely to get a false negative than a false positive on these tests. The reason is the wide variability of the human immune response, strain/species effect and the temporal variability of the immune response.

http://www.infectolab.de/index.php?id=51&L=1

The reason for getting confirmation tests is to increase the probability of it being Lyme because if you fail the normal 30 day treatment, you want be be very sure if you go on to more extensive antibiotic treatment because its not risk free. If you were to get another positive on the new Euroimmun, the C6 or Borrelia Elispot-LTT or a positive on all 3, the doubt is very low. Two positives is strong confirmation.

You could also get the Advanced Laboratory culture in the US as a confirmation. Its a bit controversial but I feel a positive on it in addition to your Euroimmun Wesern Blot would also be strong evidence.

http://www.advanced-lab.com/spirochete.php

Lyme diagnosis is a mess but your Euroimmun Western Blot is quite convincing and worthy of a 30 day treatment with antibiotics. Before moving to a more aggressive treatment, I would suggest a broader differential diagnosis and a couple confirmation tests looking for 2 or more positives on one of these tests. I would start with the C6 since its the least expensive and simplest and with your positive Vlse, likely to be positive since its a peptide on the Vlse protein.


The problem with symptoms is Lyme symptoms are highly variable depending on the species, strain and where they have disseminated. The problem with many "Lyme literate" doctors are some can be a bit too quick to declare Lyme. On the other hand, many ID doctors are inclined to make snap judgements of NO based on their political beliefs and indoctrination. You need someone in the middle with an open mind without a political bias and with an imagination. Another possibility is Babesia or other TBD. Its another emerging tick borne disease causing a wide symptom variability. Getting tested can be a problem. Here is a study of Forest Workers in Poland and it lists the TBDs found in them.

http://www.ncbi.nlm.nih.gov/pubmed/25528917
I have so that there is a period of time that I feel good, and for some time very badly.
Generally, all the time have a problem with low body temperature which is in the range of 35C to 36C * *.
Often throat hurts and is bleeding from the nose, easily grab all the infections and I have constant problems with the memory and a constant feeling of cold.
These are not common Lyme symptoms so looking at the other possible Tick borne infections symptoms for a match would be wise such as Babesia, B. miyamotoi, Bartonella spp., Coxiella burnetii, and Rickettsia spp., Anaplasma, Erlichia etc...

You can look at studies in Poland to see what other tick borne infections are common. Then look them up and compare your symptoms since you have had significant tick exposure.

Good luck. Hope that's helpful and not too confusing. I'm not a doctor but Have been through the same issues here in the US. You need to be proactive in driving a good diagnosis based on thorough analysis and testing and not the typical snap 15 minute judgements of many doctors with patients lining up in the waiting room. You need to study and do your homework and make sure the doctor you work with makes sense relative to your understanding. Its a terrible mess.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

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ChronicLyme19
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Location: NY, USA

Re: Interpretation of results medical, Lyme disease?

Post by ChronicLyme19 » Tue 27 Jan 2015 23:11

Just a clarification on LHCTom's comment:

"memory and a constant feeling of cold."

Memory problems are a very strong sign of late lyme, the rest however are not as strong indicators.

I wish you luck in your journey to figure out what is causing your symptoms. As LHCTom said, it can be hard to figure out if you have lyme because many of the tests are not good and they depend only on your immune system's response, not for the bacteria directly.
Half of what you are taught is incorrect, but which half? What if there's another half missing?

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LHCTom
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Re: Interpretation of results medical, Lyme disease?

Post by LHCTom » Wed 28 Jan 2015 0:24

The Euroimmun manner of showing the antibodies at protein positions is nice.

Unfortunately each design of a Western Blot doesn't show all relevant proteins which can help read more deeply into your blot.

The good news is the band intensity curve at the top shows where antibodies are present but its not a linear scale. Looking at it roughly, it appears you have bands at positions not counted by Euroimmun but are VERY important.

Since its not a linear scale, I did a rough approximation and it looks like you have antibody/bands at or close to

20 OspC
28 OspD
34 OspB
41 Flag
45
47 BBK32
58 and
66

If Euroimmun would give a marker and value for all important proteins rather than just the ones they chose, it would be much better since its hard to get the scale perfect given its not linear and kDa's near the left are closer than on the right side. But you have more than 2 important proteins and maybe as many as 8. That would upgrade my reading of the blot to very very likely.

And yes memory problems are very common.

Its really a shame nobody simply creates a blot with the curve like Euroimmun and marks values for each protein band found. You can see there are 5-6 "bumps" in the curve between p39 and p83 and those are located very close to 41, 45, 47, 58 and 66 which are all important proteins. You could probably build a very close non-linear scale on the blots and see if these line up as close as my estimation. But I bet half of them would. That would mean that instead of 2 bands which are positive, you would have something closer to 5 or 6 bands.

I wish somebody in the US would provide a printout like this with a scale built in and report all bands. They are too afraid to give doctors all the data and make a better judgement. Its down right stupid. YES STUPID! :bonk:

I think you need treatment to see what happens.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

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LHCTom
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Re: Interpretation of results medical, Lyme disease?

Post by LHCTom » Wed 28 Jan 2015 9:19

Userr0

Could you tell me of a lab in Poland or elsewhere that I might beable to get the Euroimmun test for the US if I write them? Its possible to use Fedex to get 2 day delivery from the US and the blood can be packed in ice.

Since I'm C6 positive, I would very much like to see if I have the same Vlse protein you have. I'd also like to use the blot curve at the top to compare against past blots from US labs.

If you can get me a lead to a lab or two, I would appreciate it.

http://www.euroimmun.ch/fileadmin/user_ ... UK_A02.pdf

I would very much like to get the
Anti-Borrelia EUROLINE-RN-AT (IgG)
http://www.euroimmun.ch/uploads/media/D ... A04_01.pdf

thanks



http://www.euroimmun.ch/uploads/media/E ... UK_A03.pdf
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

Lorima
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Re: Interpretation of results medical, Lyme disease?

Post by Lorima » Wed 28 Jan 2015 13:42

User0,
In addition to the justified suspicion for Bb infection, the low body temperature and other symptoms suggest possible hypothyroidism.
Your TSH is a little high. I would have it rechecked to see if it is increasing, and have your other thyroid numbers checked ("Free T4" and "Free T3") . Hypothyroidism can cause those symptoms and is usually easy to treat.
Also, take your temperature every morning just after you wake up and before you get out of bed. Write it down every day and see if it is consistently, significantly below normal. That's not completely specific for hypothyroidism, but it's a good indicator that something is slowing your metabolism. My family patient checks morning temperatures periodically, as a check on whether his levothyroxine dose is about right.

You could still have LD; one of my family LD patients had both hypothyroidism and late stage LD. If so, treat both.
Last edited by Lorima on Wed 28 Jan 2015 16:09, edited 1 time in total.
"I have to understand the world, you see."
Richard Feynman

Lorima
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Re: Interpretation of results medical, Lyme disease?

Post by Lorima » Wed 28 Jan 2015 15:58

PS: Here is a ref that discusses in detail the problem of setting upper levels for normal TSH:
https://www.aace.com/files/final-file-h ... elines.pdf
This is from the US, but as far as I know it should be the same, in Europe.

There is a lot of individual variation in how high a TSH (and how low T4 and T3) level can get, before the person has clinical symptoms recognizable as hypothyroidism. My bias is that when someone has a set of symptoms consistent with hypothyroidism, as you do, further investigation should be done, especially if their TSH is within the disputed range (between 2.5 or 3.0, and 4.2), as yours is. Hypothyroidism causes a multitude of systemic effects, and because it is so cheap, safe, and easy to treat, it's better to err on the side of treating it early, than to wait for the magic number (the reference range) to be exceeded.

My family patient should have begun treatment 3 years earlier, in retrospect. The clinical signs were there, but the upper limit of normal, at the time, had been set at 5.5. It was later reduced to 4.2, and some evidence suggests that it should be lower. In looking at old lab tests, you can see the TSH creeping up year by year.

Oh, and you could also get anti-thyroid antibodies measured. My patient didn't have that done, but maybe it would have helped flag the diagnosis earlier if he had.

Regarding LD, I would pursue the thyroid possibility first and start treating, if further tests suggest hypothyroidism. But if you don't see improvement in a month, then I would consider treating for borreliosis. The problem is, late-stage borreliosis is slow to respond to therapy, and you'll have to find an unconventional doctor to help you choose the antibiotics, and monitor you for problems while you are on them. If borrelia is causing some or all of your symptoms, then there's no choice but to arrange to treat it; but it is difficult. I hope, for your sake, that it is something a lot easier and less controversial to treat; like hypothyroidism.
"I have to understand the world, you see."
Richard Feynman

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