Diagnostik og diagnostiske problemer

Diagnosen Borreliose, Lyme disease bør baseres på både kliniske og laboratorie data såvel som på oplysninger om flåtangreb eller ophold i flåtbefængte områder.
Diagnostikken er vanskelig, da Borrelia bakterien er vanskelig at dyrke og vanskelig at påvise, da den er en dårlig antistofdanner, samt at den hyppigt befinder sig intracellulært.

Der findes ingen enkeltstående laboratorieprøve, som kan hhv. bekræfte eller afkræfte diagnosen Borreliose.
Erkendelsen af, at de foreliggende laboratorieprøver er utilstrækkelige, har ført til nedsættelse af en tværfaglig forskningsgruppe i EU regi til udvikling af en bedre diagnostisk metode,
”Highly sensitive and specific low-cost lab-on-a-chip system for Lyme disease diagnosis” (FP7 scientific project of the European Union).

Følgende er citeret fra ILADS (International Lyme and Associated Diseases Society) folder “What Every Primary Care Physician Should Know About Lyme Disease”.

Physical Exam in Lyme Disease:
Lyme disease patients may have exam findings when carefully assessed but findings may be few or absent in some cases. In addition to a general exam detailed neurologic, dermatologic and rheumatologic exams should be performed.

Serologic testing in Lyme Disease:
Borrelia burgdorferi is very difficult to culture, thus serologic tests are used to detect the presence of antibodies to Bb.

In 1995 the CDC, in a move to standardize testing procedures and Western blot interpretations, published guidelines for laboratory testing in Lyme disease.(MMWR 1995; 44:590-1). The CDC recommended a two-tier testing algorithm. Step 1 is an ELISA or IFA; positive or equivocal results advance to step 2, IgM and IgG Western blotting. Samples testing negative in step 1 are not tested further. The purpose of standardisation was to establish parameters for laboratory confirmation af Lyme disease surveillance cases, not clinical diagnosis. (Mead P. CT Dept of Public HealthHearing Jan 29, 2004).

Two-tier testing doesn’t work:
The step 1 tests are insufficiently sensitive to be used as “screening” tests. (Trevejo R, JID 199;179:931-8). Western blots, increase specificity but following a step 1 test, further decrease overall sensitivity. The bands included in the Western blot interpretation schemes were chosen on a statistical, rather tha a clinical, basis. (Dressler F. JID 1993; 167:392-400). Recently, the C6 peptide ELISA alone was proposed as an alternative to the two-tier approach. Unfortunately, the C6 ELISA also lacks adequate sensitivity for clinical use. (Bacon R.J. Infect Dis 2003; 187:1187-99).

Given the state of the diagnostic testing, Lyme disease, like many other diseases, is a clinical diagnosis; with testing playing a supportive role.
Desværre er ovenstående erkendelser ikke trængt ind hos hverken Sundhedsstyrelsen eller Statens Serum Institut, hvilket har til følge, at flere tusinde danskere går udiagnosticerede og kronisk lidende rundt.

Overlæger på Skejby Universitetshospital gider ikke værdige relevante laboratorie resultater fra udlandet et blik. Resultater, der påviser Borreliose og co-infektioner hos danske patienter, som er diagnosticeret negative ved gentagne tests i det danske sundhedssystem. Dette burde være en opgave for Sundhedsministeren at se på!