Item 2.) Diagnosis of Lyme disease

One lab that is supposed to be very good at doing accurate tests for Lyme disease and associated coinfections is IGeneX, Inc.

See:  http://igenex.com/Website .

Nick S. Harris, PhD, who was mentioned in the text provided by Martin Atkinson-Barr, PhD, in the “Item 1” page, is president of IGeneX, Inc.

Other laboratories also are reported to provide accurate test results, and careful research should turn up their names. You do need to be very selective about which laboratories you use. Some clinicians who specialize in treating Lyme disease have discovered that many laboratories, including some prominent national laboratories, provide an extremely high percentage of false-negative test results. So, it is very important to do your research when choosing a clinician or when agreeing to have your lab tests done at any particular laboratory. If you didn’t know any better, you could get false-negative test results that incorrectly report that you do not have a treatable infection, when in fact you do, and you could lose the opportunity to get the help that you need.

More information about laboratory testing is mentioned below in this “Item” of this document.

By the way, did you know that less than half of the people with Lyme disease never saw a bull’s eye rash? (The bull’s eye rash is also referred to as erythema migrans [EM]. The statistics about the prevalence of the bull’s eye rash vary with the reference source, so it’s hard to find an exact number to quote.)

Another thing to learn is that some doctors who treat Lyme disease recognize that more than one pathogen could be involved in a patient’s illness. Lyme disease is typically thought of as an infection caused by Borrelia burgdorferi, although other strains of Borrelia also can cause Lyme disease. Some people prefer to call the illness “Borrelia.” However, other pathogens also can be transmitted by ticks. These include, but are not limited to, various strains of: Ehrlichia or Anaplasma (bacteria which are “rickettsial type organisms” according to IGeneX); Rocky Mountain spotted fever and other spotted fever pathogens, typhus, and rickettsia (types of bacteria that are, as a group, referred to as rickettsiae or sometimes Rickettsiaceae); Bartonella (a genus of bacteria); Babesia (“an intraerythrocytic parasite … which is similar in effect to Plasmodium falciparum, the causative agent of malaria”, according to IGeneX); and mycoplasma species, such as Mycoplasma fermentans. (According to Dorland’s Illustrated Medical Dictionary 30th Edition, mycoplasmas are “a bacterium of the class Mollicutes,” and the definition of Mycoplasma is “a genus of bacteria of the family Mycoplasmataceae, made up of round, highly pleomorphic, gram-negative cells that are bounded by a single triple-layered membrane and lack a true cell wall. Cholesterol or another sterol is required for growth. […]”)

Many clinicians refer to those pathogens as Lyme disease “coinfections,” in recognition of the fact that a single tick bite can transmit Borrelia and one or more of the other pathogens simultaneously. Other clinicians believe the term “coinfection” is inaccurate, because, as they point out, a person can have the symptoms of “Lyme disease” but be infected only with one or more of the other tick-borne infections, and not be infected with Borrelia at all.

Other clinicians and researchers have pointed out – and this can be found published in the medical literature – that some of the infections that are typically thought of as being transmitted by ticks also can be transmitted by biting flies, lice, fleas, gnats, chiggers, mites, sandflies, and possibly even mosquitoes. Insects that can transmit infections are referred to as “vectors of transmission.” So, when researchers or clinicians want to refer to these various infections in general they refer to “vector-borne illnesses.” There is disagreement over what has been proved versus what is suspected as far as vectors of transmission go, and the availability of proof varies in the medical literature with each individual pathogen. So, to determine what may be relevant in your unique medical case, you will need to go back in your medical history and identify where you went, geographically speaking, before and at the time that you first realized that you had developed symptoms. Then, learn what types of vector-borne infections are known to exist in those geographic areas. Then learn more about the individual infections, how they are transmitted, and their typical and atypical symptoms. This will give you an idea of what you need to ask your clinician to test you for. And, it will also give you an idea of whether any particular lab is equipped to test you for the infections that are most likely to be relevant to your case.

I have attempted to make the information above correct to the best of my ability, but please seek official sources of information whenever absolute accuracy is needed.

 

A book called The Lyme-Autism Connection (ISBN-10: 0-9763797-5-9; ISBN-13: 978-0-9763797-5-1; copyright 2008), by Bryan Rosner with Tami Duncan, has a very good list of laboratories that test for Lyme disease pathogens as well as the coinfection pathogens. The list includes contact information for each laboratory, and concise details about the types of lab tests that each lab offers. Even though this book focuses on the connection between Lyme disease and autism, it contains much information that is useful to adults who don’t have autism but who do have Lyme disease, and generally has good health advice for everyone.

This web page has links to many documents that discuss both diagnosis and treatment of Lyme disease (plus many other topics): www.lymeinfo.net/lymediseasetreatment.html 

These web pages offer some very useful links to information about laboratory testing for Lyme disease and coinfections. See: http://betterhealthguy.com/joomla/blog/215-emerging-tests-for-tbis and http://betterhealthguy.com/joomla/lyme-disease/testing and http://betterhealthguy.com/joomla/blog/210-spiro-stat-technologies-a-new-option-for-testing

Here is a link to a blog (see: http://stevensponaugle.wordpress.com/2010/07/12/enula-helping-with-babesia/) by a doctor named Dr. Phuli who has Lyme disease, and he discusses how his illness is being treated. He also discusses coinfections. Note that Dr. Phuli also makes this statement about the lab IGeneX, Inc.: “Most people with Lyme also have other infections, called coinfections. […] The only laboratory that found my Babesiosis was Igenex Labs (listed in my book). Some say that ‘everyone tests positive at Igenex.’ This is not so. I have tested many chronic fatigue patients over the years for Lyme with Igenex and many test negative.” At the end of Dr. Phuli’s webpage is a comment by a reader who is passing along information about a lab other than IGeneX, Inc., that she read has “the best test” for diagnosing Bartonella infections.  

The lab that diagnoses Bartonella which is mentioned in the comment within the previous link is called GALAXYdiagnostics. (See: www.galaxydx.com/web/.) The GALAXYdiagnostics lab is a fairly new business (see: www.techjournalsouth.com/2009/05/galaxy-diagnostics-plans-to-fight-bug-borne-bacteria/), but it is an offshoot of the North Carolina State University College of Veterinary Medicine Vector Borne Disease Diagnostic Laboratory (see: www.cvm.ncsu.edu/vth/ticklab.html) that “has been testing animals for vector borne infections, including Bartonella[,] since 1984.” (See: www.galaxydx.com/web/our-team.) I have not yet seen any comments about this lab by doctors treating patients for Lyme disease and Bartonella infections, so I don’t know yet what the clinicians think about using this lab. However, a Google search on the word “bartonella” and the phrase “Galaxy Diagnostics” turns up a lot of good information.

Here are some links to articles relevant to the possible connection between Bartonella infections and neurological disorders. They do not discuss ALS, but they do show that infections with Bartonella can be associated with neurological symptoms including incoordination, stumbling, muscle weakness, tremors, “leg myoclonus,” and paresis (incomplete paralysis). Consider that in most of the cases discussed, the people knew approximately when they had become infected and had been infected for five years or less. See:

“Bartonella henselae and Borrelia burgdorferi Infections of the Central Nervous System” by Podsiadly et al., Annals of the New York Academy of Sciences, June 2003, Volume 990, pages 404-406:  http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2003.tb07400.x/abstract

“Bartonella sp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction” by Breitschwerdt et al., Journal of Clinical Microbiology, September 2008, Volume 46, Number 9, pages 2856-2861:  www.ncbi.nlm.nih.gov/pmc/articles/PMC2546763/?report=abstract

Note that this Breitschwerdt Journal of Clinical Microbiology article mentions that Bartonella henselae is known to be transmitted via cat scratches and cat bites, but that in addition “dogs can be involved in the transmission of B. vinsonii subsp. berkhoffii and B. henselae to people […].” It also says: “Most recently, our research group has amplified and sequenced DNA of four Bartonella species from saliva samples obtained from healthy or sick dogs (17). Although the finding of Bartonella DNA does not confirm the presence of viable Bartonella organisms in an animal’s mouth, it does indicate that bites or contact with saliva from cats or dogs may be an incompletely defined risk factor for the transmission of these organisms to people (17). […] As cats and dogs serve as reservoir hosts for B. henselae and B. vinsonii subsp. berkhoffii, respectively, pet contact may represent an incompletely defined risk for disease transmission to people, particularly individuals such as veterinarians, animal handlers, and farmers with extensive animal contact […].” It also says: “Although vector competence has not been established for tick transmission of Bartonella species, there is both case-based and seroepidemiological evidence supporting transmission by Rhipicephalus sanguineus and Ixodes scapularis (4, 8, 9). Several recent studies have found Bartonella DNA in questing ticks, ticks attached to animals, or ticks attached to human beings (1, 23, 35). In addition, there are previously described case studies in which tick attachment preceded the onset of illness and the documentation of B. henselae infection in children or adults. […] More recently, investigators from the United States and Poland have documented concurrent infection of the central nervous system with Borrelia burgdorferi and B. henselae, supporting the possibility of the cotransmission of these pathogens by Ixodes spp. (20, 33). […] Evolving evidence appears to support the potential for the transmission of B. henselae to people following tick attachment.” This article also lists, in a table, the “potential risk factors” of “exposure” to fleas and biting flies in addition to exposure to cats and ticks.

“Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease” by Breitschwerdt et al., Parasites and Vectors, April 2010, Volume 3, pages 1-9 (electronic version of article):  www.parasitesandvectors.com/content/3/1/29

Some statements of interest within this Breitschwerdt Parasites and Vectors article include: “Prior to 1990, only two pathogenic Bartonella species, B. bacilliformis and B. quintana, were known to exist. Since 1990, greater than 22 Bartonella species have been described, of which at least half have been implicated or confirmed as human pathogens […].” And: “An increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflies and ticks have been confirmed or are suspected as the primary mode of transmission of Bartonella species among animal populations and may also pose a risk to human beings.”

Here are links to more articles that discuss Bartonella and the possibility that it can be transmitted to humans via animal contact:

“Bartonella Spp. In Pets and Effect on Human Health” by Chomel et al., Emerging Infectious Diseases, March 2006, Volume 12, Number 3, pages 389-394:  www.cdc.gov/ncidod/eid/vol12no03/05-0931.htm

Bartonella DNA in Dog Saliva” by Duncan et al., Emerging Infectious Diseases, December 2007, Volume 13, Number 12, pages 1948-1950:  www.cdc.gov/eid/content/13/12/pdfs/1948.pdf

“Bartonella Species in Blood of Immunocompetent Persons with Animal and Arthropod Contact” by Breitschwerdt et al., Emerging Infectious Diseases, June 2007, Volume 13, Number 6, pages 938-941:  www.ncbi.nlm.nih.gov/pmc/articles/PMC2792845/

“Frontal and stealth attack strategies in microbial pathogenesis” by Merrell and Falkow, Nature, July 2004, Volume 430, pages 250-256:  www.umanitoba.ca/faculties/medicine/medical_microbiology/Courses/MicroPath97.705/PDF/BartonellaNature2004.pdf

This Merrell and Falkow Nature article discusses many pathogens, including Bartonella. Of interest: “Bartonella infections are disseminated from their natural reservoir (cats, rats, humans, deer and other mammals) by arthropods such as fleas and ticks. Carrier rates in the reservoir population are quite high: as many as 41% of domestic cats have been shown to be infected with B. henselae (39). Bartonellae are fairly unique among bacterial pathogens in terms of their ability to sustain prolonged periods of parasitism within red blood cells. They have been shown to invade, multiply within and persist for the lifetime of the infected host cell (40), and to reach titres of 10 [to the 4th power] per ml of blood in infected humans (41). How this many Gram-negative organisms can persist within the bloodstream without inducing a classic septic shock response remains to be determined, but the finding suggests that, as with H. pylori, the LPS [lipopolysaccharide] of Bartonella may have reduced immunostimulatory properties. Also, as for Salmonella, the ability to survive intracellularly helps Bartonella to escape the host immune response. […] It has also been suggested that intracellular Bartonella may affect the development of an adaptive immune response in a manner similar to that seen with malaria-infected red blood cells (43). Malaria prevents the maturation of dendritic cells, which are essential for the development of a normal adaptive immune response (44).”

Some good sources of information about Lyme disease and other vector-borne infections include the following:

www.cdc.gov/ncidod/dvbid/lyme/index.htm  (The CDC Division of Vector-Borne Infectious Diseases)

www.ilads.org  and  www.ilads.org/guidelines.html

www.publichealthalert.org

www.canlyme.com

www.canlyme.com/phys.html  (Toward the bottom of that web page is a section of links with the subhead “Other Diseases and Lyme… Relationship” and directly under that subhead are links to documents about “ALS and Lyme.”)

www.canlyme.com/sympchar.html  (On this page, click on the link that says, in large type, “For this document Click Here”. This will take you to a PDF document called “Lyme Disease Symptoms & Characteristics: A compilation of peer-reviewed literature reports.” Go to page 26 of that PDF document and see the Symptoms section with the subhead: “Motor neuron disease or amyotrophic lateral sclerosis-like presentation” to see three relevant citations listed there.)

www.canlyme.com/flawedtest.html  (An article titled: “Will There Ever Be An Accurate Test for Lyme Disease?” by Tom Grier, MS)

www.canlyme.com/tom.html  (This article, called “The Complexities of Lyme Disease: A Microbiology Tutorial” by Thomas M. Grier, M.Sc., explains in detail the way Borrelia bacteria behave within the human body and why it is so difficult to diagnose and to treat Lyme disease.)

www.lymetimes.org

www.LymePa.org

www.LymeInfo.net

www.LymeDiseaseAssociation.org

www.lymedisease.org

www.lyme.org

www.lymenet.org

www.NatCapLyme.org

www.columbia-lyme.org

www.townsendletter.com  (See issue #324 from July 2010 of the print journal called Townsend Letter: The Examiner of Alternative Medicine, which is mostly about Lyme disease. This particular issue is very helpful!)

www.tickencounter.org

Information about mycoplasmas and other vector-borne pathogens and their relationship to Lyme disease can be found here:

www.medicalnewstoday.com/articles/73982.php or www.medicalnewstoday.com/printerfriendlynews.php?newsid=73982

www.newhaven.edu/unhtoday/archive/UNH_09172007/pages/faculty_profile.html

www.neicenter.com/downloads/ChallengesOfLymeDisease.pdf

www.deeralliance.com/index.php?pageID=5&articleID=118

www.newhaven.edu/unh/lyme/Webinfo.pdf

www.immed.org/illness/clinical_testing.html

 

Information about infections in general can be found here:

www.medscape.com  (Register to use the site, then search for the pathogen or illness you want to learn more about.)

www.ncbi.nlm.nih.gov/pubmed  (Search for the pathogen or illness you want to learn more about.)

www.cdc.gov/eid  (Emerging Infectious Diseases is a free online medical journal. Search within EID for articles about specific pathogens or illnesses.)

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