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Chronic Lyme Disease
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Chronic Lyme Disease

The term "chronic lyme disease" has been applied to a number of different conditions. As well as referring to patients who have not been treated, or who have been inadequately treated, it is also used to refer to patients who are seronegative (i.e. the standard antibody tests are negative) but who have typical symptoms such as pain, fatigue and neurocognitive complaints.

There are many labs which use unvalidated tests to diagnose patients with lyme disease. Research shows that many of these unvalidated tests produce large numbers of false positive results — up to 50% in some cases. Some lyme advocates claim that the standard CDC test does not pick up some cases of lyme, and that these tests are more accurate. However there is no evidence that the standard 2-tier CDC test is inaccurate — extensive peer-reviewed literature shows that it's specificity is 99% (i.e. 1% false positives), and its sensitivity is 97-100% after the initial acute phase of the illness (i.e. 0-3% false negatives).

CFS — the real cause of seronegative chronic lyme?

These patients clearly have a illness, so it is important to find out what is causing their disability. Studies show that the majority of patients who go for treatment at lyme laboraties are seronegative for borrelia, and fit the criteria of CFS rather than for lyme disease.

Interestingly, if you look at the igenex lyme results posted on the internet by some people, you'll see that many of them are positive in bands 31, 41 and 83/93 in the IgM western blot. However the igenex test itself says "Positive result for 83/93kDa, 31kDa and 41kDa may be present in persons infected with HSV,EBV,HCV and/or syphilis and may give false positive result". (CDC critera requires other bands for a positive result). HSV and EBV are herpesvirus infections, which reactivate in the body when under any stress. Active herpesvirus infections are also very common in CFS, likely also due to reactivation. In both CFS, and when under stress, the immune system shifts away from the anti-viral Th1 branch, resulting in increased susceptibility to viral infection and reactivation of latent viruses such as herpesviruses. 90% of the population is infected with HSV, so a positive igenex test in bands 31/41/83/93 (negative by CDC standards) is just saying that you are under stress or have CFS.

References

Lyme Disease: Other Types of Laboratory Testing

Dessau, Ram B., et al. "The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful." Clinical Microbiology and Infection 20.10 (2014): O785-O786.

Feder Jr, Henry M., et al. "A critical appraisal of "chronic Lyme disease." New England Journal of Medicine 357.14 (2007): 1422-1430.

Patrick, David M., et al. "Lyme disease diagnosed by alternative methods: a phenotype similar to that of chronic fatigue syndrome." Clinical Infectious Diseases (2015): civ470.

Cottle, L. E., et al. "Lyme disease in a British referral clinic." QJM 105.6 (2012): 537-543.

Johnson, B. "Laboratory Diagnostic Testing for Borrelia burgdorferi Infection".



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