In this episode of Looking at Lyme, we go to Augsburg, Germany to learn about diagnostic testing with Dr. Armin Schwarzbach, MD, PhD.
Dr. Schwarzbach is a specialist in laboratory medicine and infectious diseases, having worked in the field for over 20 years. He recalls one of his patients who was diagnosed with Multiple Sclerosis and tested positive for a test that was then called a lymphocyte transformation test for Borrelia burgdorferi even though she subsequently tested negative for antibodies to the bacteria. The patient had not responded to previous treatment for her MS (with steroids) but recovered after being treated for Lyme disease.
“[The Western Blot] is a screening test for transmission of Borrelia burgdorferi but not an activity test…I never have seen such cases where there are no antibodies, but cellular immune reactions.”Dr. Armin Schwarzbach
After recognizing that routine antibody tests for Lyme disease were unreliable, Dr. Schwarzbach decided to explore other methods of cellular analytics for patients with tick-borne illnesses based on cellular immune reactions. Although these tests are now performed in some other labs in Germany, Dr. Schwarzbach points out that many countries, including Canada, are not currently offering these types of tests. Canadian patients currently have to arrange to have their blood samples shipped to Germany to access the tests done at his laboratory.
“When I travelled around and people contacted me [I found that] nobody is doing the test in Canada, (or in many other countries).”Dr. Armin Schwarzbach
B cells and T cells
Dr. Schwarzbach describes the difference between direct and indirect testing. Direct testing, including cultures and PCR (polymerase chain reaction) tests, look for direct evidence of a pathogen. Indirect testing, including antibody and t-cell tests, look at the body’s immune response to a pathogen. He differentiates between B cells, or antibodies in the form of proteins, and T-cells which are living cells called lymphocytes. Dr. Schwarzbach points out that in the US, the Centre for Disease Control (CDC) actually prefers a T-cell test for tuberculosis, but does not yet accept this test for Lyme disease.
“B cells are the antibodies and the T cells are the lymphocytes. Antibodies are proteins, lymphocytes are living cells…in the whole diagnostic world I think (T cells) are underrepresented.”Dr. Armin Schwarzbach
Antibody anomalies with Lyme disease
Dr. Schwarzbach also explains one of the other anomalies seen in Lyme disease patients. With other infections, IgM antibodies are normally produced early in the infectious process and IgG antibodies in the long term. In Lyme disease, they are observing the persistence of IgM antibodies but not IgG antibodies. He collaborated with professor Dr. Leona Gilbert, who was leading research on multiple tick borne diseases as well as persister forms and intracellular forms of Borrelia burgdorferi, sometimes called round bodies, cysts, or L-forms. Dr. Leona Gilbert discussed her research with Sarah in Season One of Looking at Lyme.
Testing for multiple infections
This research led to the creation of a test panel called the TickPlex, which includes various co-infections and opportunistic infections. Dr. Schwarzbach notes that a patient can test positive for multiple infections even if they test negative for Lyme disease. He explains that co-infections (also called tick-borne or vector-borne infections) are caused by pathogens found in vectors such as ticks, whereas opportunistic infections are already in our bodies and are normally kept under control by our immune system. When our immune system is not functioning properly, these opportunistic infections can re-activate, creating further health issues for patients with tick-borne infections such as Lyme disease.
“The TickPlex was developed because…we saw together with professor Gilbert that there are persister forms…we said why should we not test for these persister form antibodies…and that was a breakthrough because we found around 98% now with a persister form of antibodies.”Dr. Armin Schwarzbach
The three “I’s” of infection
Dr. Schwarzbach explains that one of the biggest roadblocks to better testing is that many authorities don’t accept the concept of chronic infection. He hopes this will improve with the increased use of other testing modalities such as the TickPlex test. He discusses diagnostics for infections using the three “I’s”; IgA, IgG and IgM antibodies, immune dysfunction tests, and inflammatory markers. Another test for Borrelia burgdorferi and SARS-CoV-2 is the I-spot, which can test both for past and current infection, and biopsy or tissue testing. Dr. Schwarzbach points out that all of these tests are helpful not only for initial diagnosis, but also for monitoring patient progress and treatment effectiveness. He also notes that test results need to be considered in conjunction with what is happening clinically with patients, and with what patients are experiencing.
“What I see in this model with the three ‘I’s’ with SARS CoV-2, we diagnose it with antibodies, IgG, IgA…the second ‘I’ is the immune dysfunction…and the (third) ‘I’…is inflammation, the inflammatory markers…(we can) help therapists and to give additional information about infection, inflammation and immune dysfunction.”Dr. Armin Schwarzbach
The COVID connection
What do Lyme disease, COVID and HIV infections have in common? They all can all cause reactivation of dormant infections in our bodies such as Epstein-Barr, Herpes Simplex, Coxsackie and Cytomegaloviruses as well as imbalances in yeast, mold and gut bacteria. In fact, in a recent study, 66.7% of long COVID patients were found to have reactivation of Epstein-Barr Virus. Dr. Schwarzbach points out that these patients may have other opportunistic infections which require diagnostic testing. He even developed a checklist to help clinicians determine which opportunistic infections may be active in their patients.
“I accept chronic infections… but the majority of doctors don’t accept this. They say yes you can have a current or recent infection… but it cannot get chronic. This is the struggle we have politically… I’m fighting for the acceptance of chronic infection, and this we can do by these wonderful blood tests.”Dr. Armin Schwarzbach
New directions in testing
Looking to the future, Dr. Schwarzbach hopes to develop tests for biofilms, parasitic infections, gut viruses and bacteria, as well as yeast and mold. Thank you Dr. Schwarzbach for filling us in on the latest testing for infections that can be associated with Lyme disease! Remember to keep an eye out for ticks even as the weather gets cooler, and stay safe in the outdoors!
- Armin Labs
- Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation
- Heading to Finland to find ways to accurately diagnose tick-borne diseases
- TickPlex – First Immunoassay for persister forms
- Evaluating polymicrobial immune responses in patients suffering from tick-borne diseases
- Coinfections checklist (PDF)
“(With the TickPlex test) we found also that all of these patients had multiple infections, so called co-infections from tick bites or re-activated infections, we name opportunistic infections; viruses and so on…so (Dr. Gilbert) designed a panel for that.”Dr. Armin Schwarzbach
Get an education grant
For physicians and healthcare professionals! Are you a doctor, nurse, physiotherapy, or an accredited healthcare professional? See our eligibility requirements and find out more.