The fact that a patient suffering from the chronic symptoms of Lyme disease tests positive for IgM in a serological test is explained as a cross-reaction.
No, in fact, modern tests are based on recombinant antigens and a ‘false positive’ result is virtually impossible. As they call it.
In fact
- A false positive is a statistical category and does not indicate a flaw in the test’s design, but merely that there are always some individuals in the negative arm of a clinical trial who will test positive. This is normal. This is what statisticians call a false positive.
- The fact that certain patients test positive for IgM months after the bite, when in theory they shouldn’t, is due to the specific course of the immune response. The key point is that there is indeed a fresh immune response, because the pathogen is constantly changing; after 3–4 weeks, not only the gene expression but also the genome of the new generation changes! So not only the proteins, but the genome itself will be completely different.
- They try to attribute all this to the fact that the p41 bacterial flagellin protein also appears in other bacteria. Of course, there is a 41 kDa flagellin protein in flagellated bacteria. But this is not exactly the same as that of Borrelia. A good designer would never create a test reactive to a general protein, but would instead produce it recombinantly from the Borrelia genome.
- Nevertheless, flagellin is one of the least useful markers. There is a modified serological test that does not include it at all.
- But this does not mean that we completely discard a Western blot result because of a possible or doubtful cross-reaction with flagellin. In an ELISA, it is indeed possible that p41 produces such a strong reaction that it makes the test positive, but in a Western blot, this is just a single spot, and at least one more protein—5–6 spots—is needed for it to be positive. This means that certain scientists are discarding even the completely specific OspC or VlsE reactions because of p41. This is a mistake.
Conspiracy theories have become common practice these days. That is why I dare to write about how, at the Dearborn conference, the tests were altered in such a way as to mean lower treatment costs for insurers. Although the ‘scientists’ in Dearborn were aware of the existence and causes of serological problems (e.g. the existence of seronegative Lyme borreliosis), they deliberately defined the interpretation of the tests in such a way that, whilst maintaining 100% specificity, they could safely disregard a large proportion of patients—a group amounting to several tens of percentage points. This still influences the operation of many tests today. Dr Béla Pál Bózsik, head of the OKI Lyme serology laboratory, demonstrated precisely this with the development of the Bózsik Western blot test: that serology can be further optimised. Significantly.
So I don’t want to hear any more of this ‘false positive’ nonsense. Let’s be truly positive that this disease is recognisable and treatable.
(C) Lyme Borreliosis Foundation
