Thursday, June 26, 2008

What are objective markers of chronic Lyme disease?

  • Changes in mental status per physician exam
  • Neurological abnormalities on careful exam: These include: a deviated uvula and or soft palate, decreased sensation on one side of the face, asymmetry of the face, restricted movement of eyes with extreme lateral gaze, hearing loss, deviation of the tongue with protrusion, Hoffman or Babinsky reflexes, decreased sensation to pinprick of the extremities in a "stocking and glove" pattern, a loss of vibration sense in the feet compared with the hands.
  • A low CD57 count
  • Some Western Blot bands which are positive or indeterminate on an IgneX test, in specific double asterisk locations
  • A Lyme C6 peptide antibody index which exceeds 0.1
  • Antibodies for co-infections such as Babesia, Ehrlychia and Bartonella
  • Elevated markers of inflammation, including: sed rate, CRP, C3a and C4a
  • Mild elevation of markers for auto-immune disease including: rheumatoid factor and ANA
  • Low or borderline low vitamin B12 and folic acid
  • A reversal of vitamin D levels with low vitamin D OH 25 and high vitamin D 1,25
  • An abnormal brain MRI showing non-specific white matter disease
  • An abnormal brain SPECT scan show changes in blood flow in the brain

All of my chronic Lyme patients have some combination of the objective markers for the disease as listed above. If one only considers CDC surveillance criteria as objective confirmation, then I believe more than 90% of cases will be missed. The testing is complex, expensive and cumbersome. It is only indicated when there are clear cut symptoms which suggest the diagnosis of chronic Lyme disease.

3 comments:

PALymeFamily said...

Do you have any updates since 2008 to add to your "objective markers of chronic Lyme disease" post?

Charshie said...

Would a band 41 serve as enough evidence for you? (Alongside other indicators: low CD57, low vitamin D?)

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