The 41 band is non-specific. It is meaningless by itself. Haven't we all heard this? The 41 band cross reacts with other spirochetes. Maybe not. Early studies, with Allen Steere as a co-author, showed that the 41 band was the band that was most prevalent and showed up earliest in the course of Lyme infection. The CDC considers it specific. It is one of only 3 IgM bands tested in their surveillance test. IgeneX considers it specific, it is marked with a double asterisk. Peer reviewed literature regarding the topic is scant. It is generally, and incorrectly assumed that the CDC standard can be relied upon for laboratory diagnosis of Lyme. There may be cross reactivity with syphilis we are told. Maybe. How many syphilis patients have I seen in my suburban practice in the last 20 years? One. The patient tested positive for syphilis and the Lyme 41 band was non-reactive. Syphilis is easy to rule out and extremely unlikely to be confused with Lyme -- unless a patient has both. And other spriochetal diseases? Literature suggests the 41 band may cross react with leptospirosis, rat bite fever and relapsing fever. These diseases are very rare, may cause life threatening illness and look nothing like Lyme disease. It is reported that the 41band cross may reacts with dental spirochetes. The primary dental spirochete is Treponema denticola. Oral spirochetes are part of our normal flora and typically are not antigenic (our immune systems recognize these spirochetes as non-pathogens and an antibody response does not occur). The DNA structure of the dental spirochete is very different from that of Lyme. The 41 band corresponds to antibody reaction to a 41 kd Lyme flagellar protein. Equivalent flagellar proteins from T. denticola are of 38,53 and 72 kd weights. If the Lyme Western Blot is properly performed the proteins should not cross react. The non-supported claim that the 41 kd band is only spirochete specific, not Lyme specific is repeated over and over again without supporting source material.
Lyme Western Blots should be performed by a reference laboratory. The test is labor intensive and not automated. There is ample opportunity for human error. The 41 band may appear more often because of laboratory error.
Please know that Lyme disease is not a laboratory diagnosis. The laboratory supports our diagnostic impression and is adjunctive.
There are numerous new and emerging species and strains of Lyme for which the Lyme Western Blot will reliably produce a false negative.
Genetic factors limit the ability of many sick patients to mount an antibody response to Lyme.
A 41 band cannot easily be dismissed. Since the test was ordered I assume the diagnosis was clinically suspected to start with.
In Maryland and Virginia statutes require that doctors inform patients that Lyme tests are inaccurate when the test is ordered.
The CDC criteria is for surveillance, not diagnosis.
To date, lab tests for Lyme all have flaws.
In the right clinical setting, an isolated 41 band should not be ignored. Lyme patients may have no bands. Alternatively, a 41 band may indicate exposure in a patient who is asymptomatic and therefore does not have Lyme disease.
Lyme disease may cause disability or worse, the epidemic is out of control and more cases are reported every year.
If a doctor says you don't have Lyme because you only have a 41 band don't believe it. Late diagnosis can have disastrous consequences. Consider another opinion.