Charles Ray Jones, M.D.

Addendum Regarding Lyme Serology

There are nine known [Lyme] Borrelia burgdorferi Genus species specific
KDA Western Blot antibodies (bands): 18, 23, 31, 34, 37, 39, 83 and 93.

Only one of these Borrelia burgdorferi genus 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 burgdorferi
genus species specific antibodies for IgM 23 and 39 and excludes the
other seven Borrelia burgdorferi 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
species-specific antibodies in a Lyme Western Blot, 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 a persisting IgM reaction. This is the case with any
infection including a Borrelia burgdorferi induced Lyme disease.

The CDC wrongfully includes five non-specific 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
species-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 species
specific antibodies.

This does not make sense.

The CDC recommends that the Lyme Western Blot be performed only if there
is a positive or equivocal Lyme ELISA. In my practice of over 6000
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. 2/25/04