Tuesday, 22 April 2014

HAS CDC GOT IT WRONG AGAIN FOR LYME DISEASE TESTING?

The Culture tests for Lyme Disease reported on by Dr Sapi posted about earlier here  caused concern for some CDC researchers who rapidly published - crying contamination! here

Recently Morbidity and Mortality Weekly Report (MMWR) here  further criticised the culture methods promptly followed by further comments on Medscape these can be read here  including Dr MacDonald's excellent explanation.

Not that any investigation of the Advanced Laboratory labs has been undertaken! 

From the Director of Clinical Microbiology and Immunology 
New York University School of Medicine 
in response to the criticisms by the CDC of the best Lyme test in the world: here


I have read with great disappointment several reports by the CDC, Fort 
Collins Group, spear-headed by Barbara Johnson, criticizing Advanced 
Laboratory’s culture technique results reported by Dr. Eva Sapi last year, 
as being “probably contaminated”. Worse than that are the numerous lay 
reporters and professional medical news media all jumping on this 
bandwagon without just cause. On top of that, these journalists 
erroneously reported that contamination of cultures did occur when the 
CDC, in fact, did not say or prove that. None of these reporters have had 
the decency to investigate before casting stones. I have personally 
become involved reviewing the great accomplishment of Advanced 
Laboratory’s development of a culture technique reported to have a high 
sensitivity (94%) which is more than double the CDCs supported assay 
techniques sensitivities. In light of the high reported sensitivity of the 
culture assay one would think that the CDC should be involved in aiding 
and supplementing such procedures helping to perfect same (if they feel 
it lacking) for the public good instead of discarding it outright. That does 
not seem to ring right to me. Interestingly the CDC did not criticize the 
culture technique itself (which by the way is excellent in my review) 
instead they assert that they “cannot rule out” contamination of the 
reported results. Yet interestingly, if contamination was so rampant not 
one of the controls was so contaminated and yet they ignore this. And in 
two reports I saw that will be soon published, a supercomputer Blast 
genome of GenBank analysis disputes Johnson’s contamination 
speculation. 

I have firsthand knowledge of Advanced Labs facilities, their personnel, 
and their analytic techniques, which in my professional opinion are 
excellent. 

 Philip M. Tierno, Jr., PhD 

Frm Director of Clinical Microbiology and Immunology 

New York University School of Medicine 

5 comments:

  1. Another excellent article on the subject at http://www.nakedcapitalism.com/2014/01/cdc-trying-block-accurate-lyme-disease-test.html

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  2. Huh, I could have sworn I posted a comment here before saying how interesting this interview is and linked to the source of it in the Examiner, with the full interview with Dr. Tierno.

    Something must have happened to it - don't know what. At any rate, that article you found here:

    http://www.nakedcapitalism.com/2014/01/cdc-trying-block-accurate-lyme-disease-test.html (that link should be clickable)

    is really an interesting article, but what's even more interesting to me are the comments. I'm still reading through them, but the first one which really leapt out at me appears to be an assistant to Dr. Kim Lewis, who is doing research on persistence in Lyme disease. Did you see it? I'm reprinting it here, because I think it's notable:

    COMMENT FROM Larry
    January 16, 2014 at 9:11 am

    My background: Years of studying dormant bacteria that tolerate antibiotics, including tuberculosis and chronic infections with Pseudomonas.

    You’re correct that essential genes can still suffer from drift, but they’re highly constrained in doing so. And one of the advantages of using essential genes is that they’re highly conserved across species, but even more so within genus and species. It’s not unlike making evolutionary inferences from 16S rDNA coding. When tracking lineages of bacteria that thrived in a host for years, it’s often critical to sequence several essential genes to ensure that you genuinely are tracking a lineage and not newly occuring infection results. With that said, I tend to agree with your analysis of geographic spread of the pathogens that cause Lyme disease.

    My PI was awarded money by the Lyme Disease Alliance to investigate this persistent infection/dormancy/unculturability issue of the pathogen. And his assessment of the field is that it was seriously lacking in rigorous study. Now this can be attributed to the main stream medical field considering it a closed topic. The research dollars to support important basic and clinical research are not there for this disease, and that is surprising given that the diagnosis can be quite difficult.

    I think better molecular tools are going to aid in diagnosis. While DNA tests can find dead bacteria, one should not find dead bacteria that cause Lyme disease in people’s bloodstream. And strong efforts to culture rare pathogens are being made. Micheal Surrette is made some advances in finding rare pathogens in Cystic Fibrosis and other conditions by using brute force culture and molecular techniques to bring rigor to the question of what is there in a patient/environment. http://www.surettelab.ca/lab/

    While I don’t think this article is rigorous on the CDC’s assessment of the test, it is good to highlight that Lyme disease is a poorly understood infectious disease that requires more rigorous research. At least by questioning the CDC’s assessment, we can turn around and ask them why there isn’t a good test and why they aren’t funding it.

    ---------

    Good comment.

    CO

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    Replies
    1. Thanks Camp you did post a link on an earlier post on the same subject http://lookingatlyme.blogspot.co.uk/2014/04/more-on-cdc-testing-and-advanced.html?showComment=1398375751522#c5072954269461229443
      Many thanks for you valuable contribution. Yes excellent comment on the article

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    2. You're welcome. I did post a link elsewhere, eh? I see - looks like I goofed. I'll blame my tired brain for that. Oh well, laugh at it and move on.

      You asked how to link things? It's pretty easy. I can't write the html tag here because the browser will automatically change what I write to a link so you don't see the tag - but go to my website and look at options on tags that people can use above my comment box. One is them is a href, for a link. Just follow that format in your comments and it should wok out fine.

      Totally unrelated: I envy that your replies to comments works. Mine is broken, and I'm trying to figure out why. No one can reply to comments in my blog - but people can leave comments in general. It's weird.

      Re Larry's comment above: I think we are pretty much on the same page, regarding Dr. Lewis' assessment here:

      " And his assessment of the field is that it was seriously lacking in rigorous study. Now this can be attributed to the main stream medical field considering it a closed topic. The research dollars to support important basic and clinical research are not there for this disease, and that is surprising given that the diagnosis can be quite difficult."

      Yes. I would agree this is a field seriously lacking in more rigorous study, and not enough has been done because the door was prematurely closed on what Lyme disease is and isn't. Too many assumptions have been made too early there.

      Larry also said something I considered provocative here:

      "While DNA tests can find dead bacteria, one should not find dead bacteria that cause Lyme disease in people’s bloodstream."

      Now this is very interesting, and I would like to hear more microbiologists and immunologists weigh in on this. Somewhere I'd read (god knows where now, would take hunting) that dead Borrelia can be found in the host months after treatment. (Yes, we can argue about the fact that live ones are, too, and are uncultivable.) My question is how long SHOULD one expect to see ANY dead bacteria if something is properly treated? Just wondering about that.

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    3. Thanks Camp I will have a look at your blog and see if I can figure out the links thing.
      Yes the DNA and finding live or dead bacteria is interesting and I thought I'd heard Dr MacDonald talk about this on LNE but it is so difficult trawling through the numerous posts he has made and I often find I get side tracked as so many are so interesting. I suppose the quickest way would be to ask the question on LNE and ignore the usual suspects!

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