Understanding the Western Blot by Dr. Ray

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This material is from Ray , M.D. New Haven, CT

UNDERSTANDING LYME WESTERN BLOT

There are nine known borrelia burgdorferi genus specie specific KDA Western Blot

antibodies (bands): 18

23 30 31 34 37 39 83 and 93. Only one of these Borrelia burgdorferi genus specie

specific bands is needed

to confirm that there is serological evidence of exposure to the Borrelia

burgdorferi spirochete and can

confirm a clinical diagnosis of Lyme disease. CDC Western Blot IgM surveillance

criteria includes only

two Borrelia burgdorferi genus specie specific antibodies for IgM 23 and 39 and

excludes the other seven

Borrelia burgdorferi genus specie specific antibodies. CDC Western Blot IgG

surveillance criteria

includes 18 23 30 37 39 and 93 and excludes bands 31 34 and 83.

It does not make sense to exclude any Borrelia burgdorferi genus specie specific

antibodies in a Lyme

Western Blot IgG and to include only two of these antibodies in IgM because all

the antibodies in IgG

were once IgM. IgM converts to IgG in about two months unless there is a

persisting infection driving

IgM reaction. This is the case with any infection including the Borrelia

burgdorferi induced Lyme

disease. CDC wrongfully includes five nonspecific cross-reacting antibodies in

its Western Blot

surveillance criteria: 28 41 45 58 and 66.

This leads to the possibility of false positive Lyme Western Blots. There can be

no false positives if only

Borrelia burgdorferi genus specie specific antibodies are considered. One can

have a CDC surveillance

positive IgG Lyme Western Blot with the five non-specific antibodies without

having any Borrelia

burgdorferi genus specie specific antibodies. This does not make sense. CDC

recommends that the Lyme

Western Blot be performed only if there is a positive or equivocal Lyme ELISA.

In my practice of over

7000 children with Lyme disease, 30% with a CDC positive Lyme Western Blot have

negative ELISA’s.

The Lyme ELISA is a poor screening test. An adequate screening test should have

false positives not

false negatives.

Rev.8/23/04