Domenick Braccia, D.O., Lyme Desease Specialist

Lyme disease Symptoms vs. the Lyme bacteria – A big difference

For most patients, diagnosis of Lyme disease remains clinically based, which means a diagnosis based primarily on symptoms of Lyme disease is made because there is no test available that is 100 percent accurate to rule out or confirm the infection. False positive results and false negative results are common. However, for Dr. Braccia, symptoms of Lyme disease alone are not enough. At the Haverford Wellness Center he goes the extra mile to make sure the infection is present before he starts treatment. Accordingly, the patient’s entire clinical picture is taken into account when diagnosing and treating Lyme disease. The fact is that there is NO test available that can accurately diagnose Lyme disease, and a negative test does not mean a patient does not have Lyme disease.

Lyme Testing is a problem

Amazingly, the lack of an accurate diagnostic test also means that most medical professionals cannot precisely determine whether someone is cured. This leads to contradictory protocols and results in treatment guidelines that are more guesswork than many patients prefer, and less exact than many physicians and health insurance companies are comfortable with. Again, however, Dr. Braccia takes the approach that he wants scientific proof that the organism is gone, and not just symptom recovery. Just as symptoms are not used to establish a Lyme disease diagnosis, the lack of symptoms is not used to determine that patients are cured of Lyme disease. Dr. Braccia wants proof that the Lyme bacteria are gone, which is more easily said than done. For all of the same reasons an accurate diagnosis is difficult, a definitive cure is just as complicated.

Common Lyme Testing problems and false results

The most common and current tests available today are limited to determining if antibodies to the Bb organism exist. The body creates antibodies after being exposed to the Bb organism. Lyme antibodies can remain in a person’s body long after the Lyme organism has been eliminated. This means that a positive Lyme antibody test does not accurately indicate if active Lyme bacteria continue to be present in the body. The ELISA and Western Blot tests are the most common tests currently used to confirm the presence of Bb antibodies. The first step calls for a test such as the ELISA to be conducted. If positive, a Western Blot test is done in hopes of confirming that Lyme antibodies exist. However, even if Lyme antibodies exist, it does not mean that the patient has Lyme disease.

Further complicating matters is the fact that antibody tests can confuse Lyme antibodies with antibodies created by other complications in the body, including antibodies created in reaction to bacteria other than the Bb organism. This means that most of these two tests are not completely accurate. It also means that it is common to receive false positive and false negative results when using the ELISA or Western Blot tests. In other words, a negative test result cannot guarantee that Lyme antibodies do not exist. Conversely, a positive test result cannot guarantee that a patient actually has Lyme antibodies in his or her system. In both cases, accurate positive antibody test results do not mean that active Lyme bacteria are in the system.

The PCR Test – the gold standard for Lyme disease tests

The PCR test is not as well known, but it is very effective. The Polymerase Chain Reaction (PCR) test confirms that Lyme bacteria are present in the body. The PCR test is relatively new, and it is designed to confirm that Lyme bacteria DNA are present. A positive PCR test almost always guarantees that Lyme disease is present, depending upon the accuracy of the lab that performed the work. A negative PCR does not prove Lyme is not present; however, there are PCR strategies that can help confirm this. The second note on testing has to do with the fact that test results often vary depending upon which lab performs the test. Both of the labs Dr. Braccia uses specialize in Lyme testing.

C6- Peptide Test – the newest entry for Lyme tests

The Lyme C6 Peptide ELISA is very different that the earlier Lyme ELISA test. It was developed at Tulane University and available since 2000. It can confirm exposure in more that 60% of patients. The chance of a false positive result is less than 1%. While this new test can confirm that an individual is infected with Lyme disease, there is still no test available that confirms a negative result proves that an individual does NOT have Lyme disease. The hunt for better tests goes on.

Co-infections – more confusion

Testing for Babesia, Anaplasma, Ehrlichia, and Bartonella, which are other tick-transmitted organisms, should be performed. The presence of co-infection with these organisms points to probable infection with the Lyme spirochete as well. If these co-infections are left untreated, their continued presence increases morbidity and prevents successful treatment of Lyme disease.

Based on Dr. Braccia’s 22 years of experience, and one-of-a-kind methodical Lyme research, he has a wealth of knowledge that allows him to accurately diagnose Lyme disease. In addition, 86% of his patients no longer have the Lyme bacteria in their bodies.
Dr. Braccia’s knows that the conditions surrounding Lyme disease and diagnosis are difficult to understand, but he believes he can have an impact on this nasty disease.

Our antibiotic treatments are longer than most and often intravenous

Some health care professionals are more conservative in the approach to Lyme disease and often do not go much beyond a relatively short-term oral antibiotic therapy. This group believes that in almost all cases, one or two courses of oral antibiotics are all that are required to eradicate the bacteria. They believe that persistent, chronic Lyme disease symptoms are not the result of an ongoing infection of active Lyme bacteria in the body but rather, are probably the result of a dysfunctional autoimmune system response or some other process occurring in the body. Peer reviewed medical literature describing late stage Lyme disease consistently shows the involvement of the central nervous system. Therefore, the only antibiotics that cross the blood-brain barrier, and have the hope of eradicating the Lyme disease bacteria can ONLY be administered intravenously.

Feeling worse before feeling better

Sometimes a reaction to antibiotics occurs when symptoms recur, flare up, or become exaggerated. Some call it a healing crisis, while others describe it as getting worse before you get better. This usually occurs within days to weeks of starting antibiotic therapy. When antibiotics directly kill Lyme bacteria or work with the body’s immune system to kill the organism, toxins are released that cause either direct reactions or indirect actions through stimulation of the immune system. In simpler terms, the reaction occurs when Lyme bacteria are killed off more quickly than the body’s organs, such as the kidneys and liver, are able to process them. This increases the number of toxins in the blood stream, and the higher the toxin count, the more severe the symptoms the patient experiences.

Effective long-term monitoring

After patients are feeling better, Dr. Braccia still wants to make sure that the Lyme disease is truly gone. Follow-ups are important. Most of the time he finds that chronic Lyme disease is not a relapse, but the bacteria were never truly wiped out the first time. Dr. Braccia wants to be sure, and again, his definition of a cure is that the bacteria are gone.