More NVMM fairy tales

Recently, the Dutch Society of Medical Microbiology (NVMM) circulated a new publication (1), which once again tries to sweep the problems with Lyme serology under the carpet, this time for an international audience and presumably hoping that this kind of misinformation will end up even higher in the citation indices and will be reproduced in other countries. In brief, the publication looks at Lyme serology in a carefully selected group of model patients and then simply extrapolates this to all patients with Lyme disease. The predictable conclusion is that Dutch Lyme diagnostics are in good shape (well, apart from those many “false positives”). I will not go deeper into the article here, because that would be paying too big a compliment to this kind of junk science and the article is largely a reiteration of earlier work anyway (2). I did not expect anything else from authors like Van Dam, Brandenburg and Van Burgel, since they have been preaching the IDSA gospel for years, in which the near-infallibility of Lyme serology plays a central role. However, it is disheartening to see that several other authors dared to put their names under this article, especially after the heated discussions about Lyme diagnostics in recent years.

Fortunately, there are still countries where researchers do NOT heedlessly believe in these American fairy tales (or are forced to pretend that they believe, in fear of losing their jobs, funding or publication opportunities). Recently, another Chinese publication appeared that compared Lyme serology and PCR sequencing (3). This study was conducted in the Chinese province of Hainan, a subtropical island where, according to the IDSA doctrine, Lyme disease cannot occur anyhow, so you have been warned: this concerns subversive information. And as you probably know, PCR and DNA sequencing are being used more and more in diagnostics of infectious diseases and they are admissible and sufficient for judges to put people behind bars for life, but for Lyme disease diagnostics, these techniques are absolutely unacceptable! We strongly advise you therefore to stop reading here 😉

The Chinese researchers compared the results of the standard two-step protocol for Lyme diagnosis (IFA / EIA test with a Western Blot confirmatory test) and a nested-PCR assay with sequencing confirmation in patients with suspected Lyme (with arthritis or neuroborreliosis symptoms). A direct comparison with the serological tests used in the Netherlands is not possible, because the researchers used their own in-house tests rather than the test kits from primarily US manufacturers that are prevalent here. That does not alter the fact that the results of the study are remarkable: out of 259 patients, 43 were found positive in the IFA test (16.6%) and six of them were confirmed through the Western Blot confirmatory test; i.e. only 2.3% tested positive according to the two-step protocol (and 14.3% were “false positive”, according to the NVMM interpretation). PCR sequencing found 27 positives (10.4%), but none of these tested positive according to the two-step protocol (so more “false positives” according to NVMM)! The sequencing results showed that in most cases there was an infection with B. garinii, and in smaller numbers with B. afzelii or B. valiasiana – as can be expected in China, where the common species of Borrelia broadly resemble those in Europe.

If I were to analyse in the same way that Ang et al do in their article on serology, the conclusion would be that serology with two-step protocol has a sensitivity of 0%. After all, PCR sequencing is hard evidence of a Borrelia infection (despite what the NVMM fairy tales claim) and none of these cases were found using serology!! Bb-PCR2 (2)I would also declare that the 27 PCR positive cases (unambiguously proven Borrelia infection plus appropriate symptoms), along with similar cases from previous articles, are very characteristic Lyme cases and re-examine these in a nationwide evaluation of diagnostic tests. The results would presumably be that PCR sequencing has a sensitivity (and specificity) of almost 100% and that serology is utterly worthless. But I am not going to give you such an analysis, because unlike the NVMM representatives, I try to remain unbiased.

A comprehensive analysis of the Chinese investigation would be taking it too far and besides, not all details are available. But it sketches the same picture as several previous comparisons of Lyme serology and PCR sequencing (4): the two diagnostic techniques often produce significantly different results and given the very high evidential value of PCR sequencing, it is impossible to maintain that serology – and particularly the two-step protocol –yields good results. Presumably, both techniques have important – but different – limitations. The Chinese researchers concluded- and I fully second that – that for Lyme diagnostics both techniques should be used side by side. If, as a follow-up, a close examination of the major differences between the two were to be performed, I am convinced that this would yield lots of discoveries that will improve Lyme diagnostics.

It is evident that nothing but lies and deceit can be expected from NVMM microbiologists. Hopefully, the Chinese will persevere in their efforts to improve Lyme diagnostics, in order that the IDSA/CBO/NVMM fairy tales can be exposed for what they are: myths instead of diagnostics of a serious infectious disease.

references:

(1) A Dutch nationwide evaluation of serological assays for detection of Borrelia antibodies in clinically well-defined patients
http://www.ncbi.nlm.nih.gov/pubmed/26286381

(2) Commentaar op artikelen van het Consensusberaad Lyme Laboratorium Diagnostiek
https://www.tekenbeetziekten.nl/wp-content/uploads/2013/11/commentaar_NTMM.pdf

(3) Test of 259 serums from patients with arthritis or neurological symptoms confirmed existence of Lyme disease in Hainan province, China.
http://www.ncbi.nlm.nih.gov/pubmed/26309619

(4) Chinese verlichting
https://www.tekenbeetziekten.nl/chinese-verlichting/

 

Published september 2015

Aangepast: 23 november 2015