I am getting a lot of questions about lab results lately, so I thought I would post a few remarks.
CD57: Burrascano and Sticker have published that is a good measure of Lyme disease activity. My experience has not been consistent with this finding. Many variables affect this measure. Some very sick Lyme patients have high levels. Others who are in clinical remission have consistently low levels. I obtain the test because it may be a clue, albeit a weak on.
C3a and C4a: These are sensitive indicators of complement activation. The complement system is activated when the immune system is responding to a perceived pathogen. Elevation of these levels may also be seen in autoimmune disease such as lupus.
C6 peptide antibody: This is difficult one to call. In my opinion and experience, index levels between 0.1 and 0.3 may be associated with a diagnosis of Lyme. I am fairly confident that levels of 0.4 and greater are highly significant. These levels correlate poorly with Western Blot results. So both tests are ordered.
Lyme ELISA: I am against the grain here. If the results are positive with a negative Western Blot, I can generally demonstrate exposure to Borrelia. Remember: The Western Blot assay associated with the two tier test is based on CDC surveillance criteria and was never validated as a diagnostic test. A positive serology for Lyme will come from: C6 peptide aby, IgeneX WB, or seroconversion after antibiotic therapy. I think that false positives are extremely rare and false negatives extremely common.
Lyme Western Blot: I am lucky (actually the patient) if I get a positive result with the 13 band test provided by most labs. The IgeneX test is more reliable. IgeneX still misses about 30% of cases by their own admission. Indeterminate bands should be give consideration if the clinical picture suggest Lyme.
Ehrlichia and Anaplasmosis: positive serology is very suggestive of concomitant Lyme.
Babesia: Labcorp will only test for B. microti. Specimens sent to IgeneX show a high rate of positivity for B. duncati. There is no test for most strains of Babesia. The IgeneX test costs an extra $135.00. Worth it. Babesia seems to be of increasing frequency and should be strongly considered if clinical signs are present.
Bartonella: Rarely positive. Probably very significant. There is no good test. Its significance is controversial. Some doctors believe that Lyme complex is a triad: Borrelia, Babesia and Bartonella.
B12 and Folic acid: Frequently low. Part of the syndrome. Supplementation recommended.
Vitamin D: Low levels of vit D OH 25 and high levels of vit D 1,25 suggest L-form disease. This is controversial, but it is frequently seen in Lyme patients.
Chamydia pneumonia, Mycoplasma, HHV6 and others. These are tests for other chronic infections which may contribute to chronic Lyme symptoms. LLMDS vary greatly on the significance and approach to positive results here.
Sed rate and CRP: These are markers of inflammation. There are frequently very high. If someone is diagnosed with "fibromyalgia" look out. One criteria for this diagnosis is that lab tests, including these two, are normal. These levels improve as patients improve. Sometimes levels stay high. These patients seem to have co-infections are are difficult to treat.
ANA and RA: Traditional markers of lupus and rheumatoid arthritis. These levels are frequently elevated in Lyme disease. They are associated with autoimmune reactivity. The levels usually return to normal when Lyme patients are successfully treated.
CBC: Many Lyme patients have low WBC counts. (white blood cells). They also frequently have a "right shift." This means there is an excess of cells called lymphocytes and monocytes and a deficit of cells called neutrophils. This abnormality is common. I have not seen it reported in Lyme literature. It usually corrects with treatment. Lyme patients have anemia more frequently than would be expected in the general population as well.
RBC (red blood cell) magnesium. Frequently low. Associated with leg cramps. supplementation may be helpful. Blood levels are not accurate.
C3d: A test only available from Quest. I shows circulating immune complexes which are commonly seen in Lyme disease. Not used much at this time.
Brain MRI: Shows lesions in the white matter of the brain. Correlates with significant neuroborreliosis. (brain involvement)
SPECT scan: Looks for Gray matter abnormalities in neuroborreliosis. Decreased blood flow to the cerebral cortex is frequently seen. This test may show improvement after treatment.
Western Blots, Western Blots: This tests frequently needs to be repeated several times before a positive is obtained.
EMG/NCV: these are electrodiagnostic test which can performed by a neurologist which may help confirm and quantify the presence of peripheral neuropathy seen in Lyme patients.
Most Lyme patients will show something abnormal if all of these tests are done. This is very different from what the average, non LLMD orders: A Lyme ELISA with a reflex WB of only 13 values. This test is almost worthless. Especially in chronic cases.
If you know all of this stuff it will expedite your visit with your LLMD. Lyme disease can still only be diagnosed when the history, physical exam and lab/imaging data are combined in a mosaic to confirm a clinical suspicion. Nonetheless, I have never seen a case of Lyme associated with lab tests which were 100% normal. You have to know what to order and how to interpret the results. The text book for such things has not yet been written.