| JWissmille 2004-08-26, 10:08 pm |
| " In our experience, the finding of even a single suspicious band (A
suspicious Western Blot is defined by this office as the presence of any
“CDC” specific band that is present in either the IgM or the IgG band
lines, or the presence of 31 (OSP A), or 34 (OSP B) kilodalton bands in
either the IgM or the IgG band lines.), and particularly one or more bands
23, 31, 34, 39, or 93 is FREQUENTLY THE HARBINGER OF AN EXPANSION OF
SIGNIFICANT BANDS OVER TIME and may serve as an EARLY CLUE to the presence of
Lyme disease.
SIMULTANEOUS ELISA AND WESTERN BLOT TESTING
IN EVALUATION OF PATIENTS FOR SUSPECTED LYME DISEASE
Janice M. Kochevar, FNP-C, Kenneth B. Liegner, M.D.
Abstract; LDF 10th Annual International Scientific Conference
on Lyme Borreliosis & Other Tick-borne Disorders: April 28-30, 1997
OBJECTIVE: To report findings on simultaneous Elisa and Western Blot
testing in a practice specializing in the diagnosis and treatment of Lyme
disease.
METHOD: Elisa and Western Blot results on all 62 new patients to the
practice, during the last quarter of 1996, were retrospectively reviewed.
A positive Western Blot is defined by the “CDC” criteria as the presence
of
at least two specific IgM bands, or the presence of at least 5 specific
IgG
bands. A suspicious Western Blot is defined by this office as the presence
of any “CDC” specific band ** that is present in either the IgM or the IgG
band lines, or the presence of 31 (OSP A), or 34 (OSP B) kilodalton bands
in
either the IgM or the IgG band lines. A borderline Elisa is defined as
reactivity within 2 to 3 standard deviations from the control. Blood work
from the 62 new patients were sent to two independent laboratories:
Immunopathology Laboratory at SUNY, Stony Brook, and BBI- North American
Laboratories.
RESULTS:
16% (10 patients) tested for Lyme disease resulted in a positive Elisa
and
a positive Western Blot.
10% (6 patients) tested for Lyme disease resulted in a positive Elisa and
a
suspicious Western Blot.
3% (2 patients) tested for Lyme disease resulted in a borderline Elisa
and
a positive Western Blot.
5% (3 patients) tested for Lyme disease resulted in a borderline Elisa
and
a suspicious Western Blot.
21% (13 patients) tested for Lyme disease resulted in a negative Elisa
and
a positive Western Blot.
45% (28 patients) tested for Lyme disease resulted in a negative Elisa
and
a suspicious Western Blot.
0% (0 patients) tested for Lyme disease resulted in a negative Elisa and
a
negative Western Blot.
DISCUSSION:
In a population of patients with clinical suspicion of Lyme disease,
Western
Blotting showed a high yield of bands having relevance to Lyme disease.
As
high as 21% of patients with totally negative Elisas demonstrated fully
diagnostic Western Blots satisfying the stringent “CDC criteria” intended
to define a “case” for epidemioliogic surveillance purposes. Many other
patients showed suspicious bands that would not be expected to be found in
persons not having been exposed to B. burgdorferi. In our experience, the
finding of even a single suspicious band (as defined above), and
particularly one or more bands 23, 31, 34, 39, or 93 is frequently the
harbinger of an expansion of significant bands over time and may serve as
an
early clue to the presence of Lyme Disease.
CONCLUSION: A two-tiered approach to testing, although standard for HIV,
may be inappropriate in Lyme disease since Lyme Western Blotting is more
specific than Elisa testing and my be more sensitive. Omission of Western
Blotting in patients clinically suspected of having Lyme disease when Lyme
Elisas are negative would have missed conclusive proof of Lyme disease in
21% of patients, and important clues to possible diagnosis in 63% or more.
These findings suggest that in patients clinically suspected of having
Lyme
disease, simultaneous Lyme Elisa and Western Blotting should replace the
presently recommended two-tier schema of testing.
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The CDC's recommended criteria for a positive WB are as follows:
For IgM, two of the following three bands: OspC (21-25), 39 and 41
For IgG, five of the following 10 bands: 18, OspC (21-25), 28, 30, 39,
41,
45, 58, 66 and 93.
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