for genus Borrelia kendes 2 human patogene species, dem der forårsager
ti1bagefaldsfeberen (febris recurrentis) og B. burgdorferi
recurrens feber kun forekommer i visse subtropiske og tropiske egne, er
Lyme borreliose den eneste relevante borreliose i
og DNA-studier af B. burgdorferi isolater
har vist, at denne species er heterogen, og for nylig* er der på basis
af forskelle i ribosomal-RNA-genet foreslået en klassifikation i 3
Alle hidtidige US isolater tilhører genotype
alle 3 genospecies forekommer over alt i Europa, dog med overvægt af
type 2 og 3. Forsøg på
de kliniske manifestationer med genospecierne tyder på, at type 1 er
mere artritogen, hvorimod type 2 synes associeret til neuroborreliose
og type 3 mere til dermatoborreliose.
Denne hypotese kunne
forklare den høje frekvens af Borrellia-artrit i USA, men også det
forhold at f.eks. patienter med neuroborreliose kun sjældent har eller
har haft artrit eller acrodermatitis chronica atrophicans (ACA)."
side 802: "Kronisk seronegativ Lyme borreliose forekommer efter vores opfattelse
" ... translated: "Chronic seronegative Lyme borreliosis does not
exist in our opinion". Hansen provides no supporting
reference for that "expert opinion", which had actually already been
disproven by culture proven, late seronegative cases, even some with
culture proven relapse after conventional antibiotic treatment, that is
normally thought to be curative! - see http://lymerick.net/persistent-borreliosis.htm
for references ...
*) Baranton G, Postic D, Saint Girons I, Boerlin P,
Piffaretti JC, Assous M, Grimont PA. Delineation of Borrelia
burgdorferi sensu stricto, Borrelia garinii sp. nov., and group VS461
associated with Lyme borreliosis. Int J Syst Bacteriol
378-83. PMID: 1380285 PDF
RN. Polymerase chain reaction primers and probes derived from
flagellin gene sequences for specific detection of the agents of Lyme
disease and North American relapsing fever. J Clin Microbiol 1992 Jan;
30(1): 99-114. PMID: 1734073 PDF
studies suggest that there is sufficient diversity within the
flagellin gene sequences of closely related Borrelia species to
differentiate them into groups and to pursue taxonomic studies both
within and between species."
Hansen et al. knew all
about the uncertainties of his Borrelia
afzelii DK1 flagella based serology test, at
least from late 1993 and onwards!
Furthermore - surprisingly - the IgG cut-off value was suddenly INCREASED from OD 0.160 to 0.240, i.e. 1.5 times, between Jan 1992 and April 1992
which are the submission dates for two articles, where the
first used IgG cut-off 0.160, while the latter - printed in Neurology
1993 - used a IgG cut-off 0.240
and without even mentioning the
increase in IgG cut-off in the latter article?! -
which is is unfortunately not a free download PDF, so I had
to enter the full
text, but that also let me add notes / quotes on cut-off etc.
relevant underlying references in http://lymerick.net/8423881.html
does not seem to come from a new validation study in a peer-review published
article, furthermore the increase in IgG cut-off value, came
concurrent with the same authors
- in Brain 1992 Apr
;115 ( Pt 2):399-423. stated their viewpoint: on page 418: "A negative IgG test in
serum may only exclude neuroborreliosis if the disease duration exceeds 3
- or as stated on the webpage on the Borrelia antibody test
(PDF print 20100526
documentation just in case it is later altered) by Statens Serum
" IgG resultatet [i serum] er altid positivt ved 2.
og 3. stadie manifestationer med sygdomsvarighed > 3 måneder." which
translates into "IgG result [in serum] is always positive in 2nd and
3rd stage manifestations with disease duration more than 3 months"
- that POSTULATE has ever since been used to outrule Borrelia infection with
100% certainty, if the
patient doesn't develop a positive flagella IgG at latest 3 months
Patients (and their doctors) who suspect to suffer from IgG
seronegative borreliosis is denied further testing by direct Borrelia
detection methods, and wheneven the patient, who has invested a lot of
money in testing abroad, comes home to Denmark with an array of
other positive immune tests for Borrelia - like LineBlots, other
EIAs, LTT - and even being positive by direct detection methods like
direct fluorescent immunestain showing presence of material that react
with added stain marked Borrelia antibody, thus is Borrelia
antigen - everything is being discarded because the patient test negative on the danish flagella antibody test!
- despite Oksi
in J Clin Microbiol 1995 (PDF) Hansens/DAKOs test missed 24/41 (58%) culture or PCR verified LATE Borrelia
cases of disease duration longer than 3 months!!
- furthermore these authors chose to IGNORE this legitimately raised critique of their flagella antibody test
is not mentioned / not discussed in the Borrelia clearing report from
2006, where Hansen also "forgot" to mention his CONFLICT OF INTEREST by
his earning money of sale of the very same TEST, that he and
co-authors whole-heartedly recommend as the only Borrelia test needed
for danish doctors and since supported by the DANISH NATIONAL BOARD OF
HEALTH (Sundhedsstyrelsen, SST)!
- and the latter have ignored my
repeated suggestions to give Hansen
et als. work at through critical review, I have pointed out the discrepant results, which was dismissed by SST ...
Everything written and said since 1992, must be
the light of what Hansen et al. already knew or - as experts - should have known back then!
co-authors - and not the least the danish danish medical
authorities - have ever
since maintained the dogmatic stances that, despite culture proven
- the best EVIDENCE ONE CAN EVER GET, the gold standard diagnostic
methods! - have been published against
their common VIEWPOINTs, they have maintained the stance that:
Hansen et al. have
either been illiterate or have chosen to
IGNORE important peer-review published literature giving 100% certain - i.e.
culture verified - evidence
AGAINST these 3 postulates!
- chronic seronegative Borreliosis does not exist
- relapses of Borreliosis after 'curative' antibiotic
treatment does not exist
- a negative flagel ELISA IgG in serum - later than 3
months after symptom debut - outrules (neuro-) borreliosis with 100%
And not until NOW - in 2010 - Hansen has just admitted that he earns lots of money on the sale of his
serology test ...
et al. J Clin Microbiol 1995
) examined 41 patients, all
had been sick for at least 3 month
half had been sick > 1 year; 12
cases were CULTURE
and 39 had pos.
PCR for Borrelia
(10 pos. on both) (see table 2 in PDF
on the other two serology test that was also compared /
FL-ELISA UNFORTUNATELY HAD A FALSE SERUM NEGATIVE OUTCOME in 6/12 (50%)
culture pos. and
in 24/41 (58%) of culture+PCR positive LATE BORRELIOSIS CASES!
- the difference could have been because Finnish borreliosis may
differ from danish Borreliosis? - therefore it should have been
repeated on danish patients ill > 3 months with by antigen test
verified Borrelia infection
- but Hansen and Lebech did not repeat the study on danish chronically ill patient group ...
2008 I suggested the local university hospital microbiology department
to repeat this study in Denmark, because as medical consultant in
the Patient Society DanInfekt I can probably find the ideal patients
for participating in such a study; I suggested culture and specific
immune stain for Borrelia - the answer was "our laboratory lack
experience and expertise" (you can't get that ever, if you are not
willing to try and make the effort!) , lack of ressources (which make
it into a political question!) and NO INTEREST. The lack of
interest is the main block, since the other things could be solved, if
the interest was there to FIND THE TRUTH!
In 2001 I asked
the same microbiology department for suggestions for supplementary
test they could provide, after diagnosis in USA with triple tickborne
co-infections, and suggested co-work on a pilot-study on 20 chronically
ill tickborne patients, evaluation of simple stained blood smears for
co-infections babesia, ehrlichia/anaplasma and other bugs infecting
blood cells ... the answer was "too controversial"?!
they tend to reject all findings, because they have not been re-found
by danish microbiologists! - THEY HAVE NOT SINCERELY TRIED TO RE-FIND
AND HAVE ALWAYS REJECTED SUGGESTED CO-WORK, and gave clear
explanation in 2008, they are NOT INTERESTED in doing any type of
research, that might find the same results as Oksi et al. published
back in 1995!
THEIR INTEREST DOES NOT LIE IN HELPENG SICK PATIENTS.
moreover Hansen et al. have ignored Oksi et al's finding, i.e. omits
reference and avoid the discussion of why so many finnish patient
Borreliosis outruled by Hansens test! - in the danish
clearing / consensus report on Borreliosis
published in 2006, revised in 2010, by Hansen declaring his CONFLICT OF
INTEREST, i.e. that he co-owns the serology test and earn money on sale
- that report was co-authored by Hansen and Lebech and continue
recommend only using Hansens test for diagnosis of Borrelia infection
in Denmark (SIC)!
Extra concern about the high failure rate of the danish serology
tests in ACTIVE borreliosis cases of longer than 3 months duration, was
raised when Strle et al.
(Slovenia) published their findings of differences in mainly
findings in culture verified neuroborreliosis cases caused by Borrelia garinii
(23 pt.) vs. Borrelia
afzelii (10 pt.)
of 10 patients (70%) who had been ill
for at least 6 months to 7 years with in spinal fluid culture
neuroborreliosis did NOT have positive
spinal-Borrelia index on DAKO/OXOID test
and would thus
not have gotten
the correct diagnosis - neuroborreliosis - if culture had not
F, Ruzić-Sabljić E, Cimperman J, Lotric-Furlan S, Maraspin V.
Comparison of findings for patients with Borrelia garinii
afzelii isolated from cerebrospinal fluid. Clin Infect
Dis. 2006 Sep
15;43(6):704-10. PMID: 16912943 PDF
There was only one significant difference in patients symptoms; the B. garinii
had painful meningoradiculitis, Bannwarths syndrome, probably bringing
them fast to doctor, hospital admission (in neurology department) and
to be investigated for
Borreliosis very EARLY in the course of the Borrelia infection,
a permanent cure by antibiotic treatment is far the best, compared to
patients that have been sick much longer than 3 months ... perhaps
because doctors OUTRULE Borrelia infection, when they test negative on
Borrelia serology test?
With respect to all
the other symptoms there were no significant differences,
Table 2 symptom list ranked after number (%)
of patients (decreasing) who had the symptoms in B. garinii vs. B. afzelii groups:
(100%) vs. 9 (90%)Headache
16 (70%) vs. 9 (90%)Fatigue
19 (83%) vs. 8 (80%)Malaise
18 (78%) vs. 8 (80%)Arthralgias
8 (35%) vs. 7 (70%
vs. 0 (0%)
- ONLY significant differenceMeningeal
14 (61%) vs. 1 (10%) -
meningeal signs and lab. findings usually abate spontaneously in months
to years after primary infection, despite spirochetes may be persistent
and intermittendly active!Paresthesia
vs. 6 (60%
(22%) vs. 6 (60%
13 (57%) vs. 4 (40%) - disc degeneration and prolapses seem common in late borrelia ... removed disc tissue has shown pos. on PCR!Sleepiness
12 (52%) vs. 3 (30%)Concentration
4 (17%) vs. 5 (50%
8 (35%) vs.
3 (13%) vs. 4 (40%
>38oC 8 (35%) vs. 1 (10%)Peripheral
8 (35%) vs. 1 (10%)Nausea
6 (26%) vs. 3
1 (4%) vs. 3 (30%
(4%) vs. 1 (10%)Heart
1 (4%) vs. 0 (0%) - hence patients infected
with Borrelia afzelii
was just as ill as were the patients infected with Borrelia garinii, but the danish serology test failed to diagnose most of the patients with culture verified Borrelia afzelii neuroborreliosis!
important difference was in the DURATION OF SYMPTOMS BEFORE CORRECT
DIAGNOSIS (table 1):
duration of symptoms
(7 days to 22 months) vs. Ba: 9 months (4 days to
No. (%) of patients with duration
of symptoms <= 6 months Bg: 22 (96%) vs. Ba: 3 (30%)
indicating potential CNS involvement Median duration of symptoms
(range) Bg: 19 days (1 day to 21 months) vs. Ba 7.5 months (4 days to 6
laboratory measures, tables 3 and 4:
in CSF: Median value x 106
cells/L (range) Bg: 176 (1–991) vs. Ba: 2 (0–213);
No. (%) of patients with >5 x 106
Bg: 19 (83%) vs.
in CSF: Median g/L (range) Bg:
0.77 (0.23–3.1) vs.
No. (%) of
patients with >0.45 g/L Bg: 20 (87%) vs. Ba: 2 (20%)
antibodies (DAKO EIA)
: Bg: IgM 3 (13%) vs.
18 (78%) vs. Ba: 8 (80%)
borrelial antibody production: Bg:
IgM 2/21 (10%) vs. Ba: 0/5 (0%); Bg: IgG 13 (57%) vs.
9/10 (90%) with culture proven Borrelia afzelii
neuroborreliosis were IgG index NEGATIVE in their CSF, despite 7/10
(70%) had disease duration from 6 months up to 7 years!
=> Exactly because of failure of the danish serology
test to detect currently active Borrelia
infection, danish doctors need access
to DIRECT BORRELIA ANTIGEN DETECTION METHODS, to be done in
for chronic / relapsing borreliosis, without having to discuss
the issue with very
reluctant danish microbiologists, who have so far refused to provide ud
with direct detection methods like
culture, microscopy with specific immune stain for Borrelia burgdorferi
as explained by for instance Barbour 1988, Reed 2002: http://lymerick.net/Borrelia-culture.html
However, neither Statens Serum Institut in Copenhagen (the danish state
microbiology institute) nor our local microbiologists will do any Borrelia
antigen test; this was confirmed in 2009 by the Danish
Board of Health
(Sundhedsstyrelsen), who recommend doctors to ask the local microbiologists for help
which we have already tried many times, without getting any direct tests for
Borrelia done ever!
- therefore many danish patients suspecting chronic/late or
relapsing Borreliosis have been forced to seek medical attention
outside Denmark (Germany, USA) for 100% self pay, with is not fair, since we have
already paid over (the worlds highest) taxes for our right to get the best possible medical care in the World here in Denmark!
These microbiology doctors forget to obey the International Code of Medical Ethics
doctor owes to his
patient complete loyalty and all
the resources of his science.
Whenever an examination
treatment is beyond his capacity he should summon another doctor who
has the necessary ability.
the danish microbiologist find that culture, microscopy, and PCR to expensive,
too difficult, too laborious - as stated in the danish consensus / clearing report paper
- these people have an obligation to refer the patients in need to
foreign laboratories, at the cost of the danish laboratory that fail to
provide scientifically well established and useful diagnostic
methods, that has been known and described, since before the time
Hansen et al. began development of their Borrelia flagella serology test!
It is really neither extremely expensive, nor is there much work in drawing a large volume blood-sample,
centrifugating it and thereafter attempting culture of it in commercially
medium (SigmaAldrich) and wait for signs of positive culture, as clots accumulate in the bottom of
the culture tube, as was desribed in 1988
(the B is BSK).
does not cost much (not more than Hansen serology test that fails
detecting Borrelia in 58%, thus is a waste!) and there is not much
work in looking for spirochetes and
alternative structures in the microscope .... and when
positive result, send
some of the cultured material abroad for eventual PCR, and/or do a
specific immune stain
with commercially available Borrelia
antibodies (KPL - this is polyclonal but absorbed for relapsing fever Borrelia and specific for Borrelia burgdorferi sensu
lato, however does not allow strain identification) ....
the only minus is that in order to find nice moving
spirochetes, taking the BLOOD SAMPLE MUST BE TIMED OPTIMALLY TO
DAY ONE OF A NEW FLARE-UP
, which is sign that some spirochetes have
just entered the blood stream from the tissues, and by doing that
create a lot of immune response, proinflammatory cytokines (esp. TNF),
immune complexes etc. ...
- or it should be just as simple as when finding a spirochete in a syphilis cancre, accept that finding live, moving
in the blood (or in other fluids, or in patients tissues) of a chronically ill patient by simple microscopy
should be enough to justify trial antibiotic treatment of the
patient, also in cases when the spirochete can not be specifically named
- which is actually not because it is not possible to investigate it, but
just because our laboratories don't want to spend money on the
more specific tests methods like PCR.
For instance Bozsik found that 107
of 143 (75%)
of his cases with live
(moving) spirochetes found in their blood by dark-field microscopy, were confirmed by
to belong to Borrelia burgdorferi
sensu lato, see http://lymerick.net/videomicroscopy.htm
... My own example videoes from blood microscopy
illustrates this among many others, see http://lymerick.net/MK-videomicroscopy.html
shows that correct timing of blood sample to the patients
clinical relapse cycle is the essence for detecting
spirochetes, which was suggested by Hardin,
Steere et al. (1979 PDF
) finding that IgG immune complexes fluctuated
in amount, was high during episodes of recurrent disease activity
and by Brorson finding that young "cyst" (granules?) are around 9 days
to convert back to spirochete form again, while it took 4 weeks
for older cysts to convert back to spirochaete form
this is usually reflected in the patients cyclical symptomatology,
if/when the patient can be persuaded to keep a very detailed symptom diary
Brorsons findings were acknowledged by Burgdorfer himself already in 1999: http://lymerick.net/1999-Burgdorfer-keynote.pdf
- while Hansen
answered a project participant in 2001 (I have this in copy of the patient hospital charts):
not form 'cysts'" (look for yourself in http://lymerick.net/2001-AdverseConditions.pdf
) and "Borrelia does not go intracellular" http://lymerick.net/Bb-intracellular.htm
OF WELLDOCUMENTED MICROSCOPY FINDINGS BY MANY DIFFERENT INVESTIGATORS OVER MANY
DECENNIALS IS SIGN OF HANSEN (and his peers) IGNORANCE AND ARROGANCE!