Die Problematik des Borreliennachweises und was Sie vielleicht noch nicht wissen

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Borrelia infections are usually associated with tick bites. Unfortunately, there are also a few other ways of transmission, for example through certain mosquitoes or lice.  A certain Borrelia, Borrelia Theileri, is not transmitted through insects, but probably through food. There are over 60 types of Borrelia and not all of them can be tested in the laboratory. It is quite possible that several types of Borrelia infect the organism at the same time. Borrelia infections belong to the zoonoses. Zoonoses are infectious diseases that can be transmitted from animals to humans or from humans to animals. However, this general assignment can be refined. Borrelia belong to the spirochetes. There are many types of spirochetes, including those that cause syphilis and those that cause diarrheal diseases. Borrelia live intracellularly, ie in the cells of humans or animals. This makes diagnosis and therapy difficult. They don't leave the cells unless they have to. It was proven that Borrelia can also move in nerves and that the journey through the sciatic nerve, which is often more than 1 meter long, only takes an incredible 2 minutes.

Borrelia can also take on cystic forms, which means they encapsulate themselves in the cell and are resistant to antibiotics. Laboratory diagnostics includes the determination of IgG and IGM antibodies. The detection of IgG antibodies speaks for older past infections. However, “expired” does not mean eliminated. The pathogens can sit in the cells as "sleepers" and wake up again years later and lead to an invasion. The IGM antibodies speak more for an acute infection. However, it takes about 8 weeks for the antibodies to form during an infection. So no treatment can be given during the first eight weeks of the infection if you want to make it dependent on a positive laboratory result. Since Borrelia infections do not always follow a typical course, you can never be sure during the 8 weeks whether it really is Borrelia. And even after waiting six weeks, some patients do not develop any antibodies, even though they are infected with Borrelia. One of the reasons for this is that there are too many different types of Borrelia and the test kits cannot react positively to all types.

Routine screening found 20% of the population in certain areas with positive antibodies, although most of them had no recollection of an infection. The immune system was apparently able to keep the pathogens in check here so that infections did not occur. However, the apparent certainty can be deceptive because the Borrelia may have formed cysts in the cells that are not active. However, this can result in active Borrelia infections at any time. I remember patients who were symptom-free for up to seven years and then suffered again from a Borrelia infection. With some symptoms such as headaches, tiredness and exhaustion, Lyme disease is occasionally wrongly diagnosed with positive antibodies.

The symptoms of Lyme disease depend primarily on the affected organs. In erythema migrans, for example, the skin can become red and inflamed (often ring-shaped as erythema). When the nervous system is affected, patients suffer from chronic fatigue, headaches, sensory disturbances, paralysis and dizziness. The involvement of the joints is accompanied by joint pain and swelling. Borrelia can also cause heart muscle inflammation. With all Borrelia infections there are usually always sleep disturbances. If the antibodies are negative despite all these symptoms, this often leads to serious misdiagnoses.

To improve laboratory diagnostics, some laboratories offer the lymphocyte transformation test for Borrelia (LTT Borrelia). In this test, the white blood cells "T-lymphocytes" are examined for Borrelia-specific proteins. If the result is positive, it is assumed that the T-lymphocytes are in a defensive fight with the Borrelia. If a successful treatment has been carried out, the LTT will be negative about 4-6 weeks later. The sensitivity of the test is given as approx. 90%. i.e. 90% of those infected are detected by this method. However, 10% are “accidentally” assessed as healthy. To make matters worse, about 8% of positive results were not infected. They would then receive therapy even though they are healthy. Reputable laboratories clearly point out that some infected people fall through the diagnostic mesh and that the negative result does not rule out an infection. They explain that it is therefore always important to assess the clinical picture (symptoms). This raises the question of the value of such a laboratory test.  The waiting time of around six weeks after the end of the therapy to assess the success of the therapy seems far too long to me. If the therapy was not successful, a new therapy must be found, the questionable success of which can only be checked again in six weeks. This is very cumbersome, time-consuming and expensive. Also, other spirochete infections are not found by this test. I still presented the LTT quite positively, based on the information from a laboratory.

The test was also reported in the Deutsches Ärzteblatt:

Contradictory results

However, the LTT is also not standardized between the various laboratories, and the Berlin immunologist is aware of the uncertain data available on the question of whether the LTT actually has advantages in routine diagnostics. "The LTT can be helpful, but a positive result does not prove the Borrelia infection." Borrelia can be detected directly via a PCR or the pathogen culture, although culturing in the laboratory is difficult.

The researchers at the National Reference Center for Borrelia in Munich, on the other hand, do not consider the LTT to be suitable for Borrelia diagnostics. "The LTT is less sensitive and, above all, less specific than the serology," criticize Fingerle and Wilske (6). The Swiss Society for Infectious Diseases takes a similar view: the results of the LTT are very contradictory and not specific, since there are also reactions in healthy, seronegative controls and in newborns with seronegative mothers (1).

Values between 45 and 95 percent were given for sensitivity and specificity. False-positive results are caused by immunological cross-reactions with other pathogens. Overall, the test therefore does not allow any statement to be made about the activity, course and prognosis of Lyme disease.

Aerzteblatt.de 26/2007