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Does anyone know what the P41 band is on the Lyme test?


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#1 Phasmid

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Posted 24 May 2010 - 08:34 AM

I am asking this for another mom.

Have you had Lyme test, and had a positive P41 band show up?

Does anyone know the significance of P41? I believe Dr. Trifiletti may have said this may indicate a flagellated microbe.
How is one treated for Lyme; what antibiotics are working the best? For how long?

The child was treated with azithromycin and biaxin.

Thanks


#2 Fixit

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Posted 24 May 2010 - 08:59 AM

my ds has band 41 also on igenex...so i too am curious???

#3 Phasmid

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Posted 24 May 2010 - 09:56 AM

I am responding to my own question, by posting an older comment by Dr. Trifiletti to someone's similar question. I pasted below:

"I call the patients who ONLY show p41 IgG/M positivity "Lyme-like illness" just to keep an open mind. I'm aware this could be Borrelia burgerdorfi (Bb) Lyme disease. In fact, with this finding it's our obligation to do the best we can (and it's very hard, I know) to rule Bb infection in our out. However, p41 is a very interesting protein. It is called FLAGELLIN, so these patients have anti-flagellin antibodies. The p41 is a major component of the bacterial tail found in those bacterial that are flagellated, i.e. have a motile tail, similar in function to that on a sperm cell. Now p41 is found on many bacteria that (seemingly) have nothing to do with what generally think about. It is NOT found in streptococci or mycoplasma, so infection with those can't be confounding this result. Spirochetes, in general, are flagellated, so there are many possible non-Bb candidates.
BUT THE PLOT THICKENS ...
p41 is found on many enteric (pathogens such as Campylobacter, Giardia, etc.) The interesting thing is that the immune response to p41 is HIGHLY specific. p41 activates Toll-like receptor #5 (TLR5), and another (minor) pathway. Furthermore, p41 is the only known activator of TLR5. Recently, it has been shown that TLR5 knockout mice develop severe colitis. It is now widely believed that the physiological function of TLR5, which is highly expressed in gut endothelial lining, is to protect us from nasty food-borne bacteria.

http://www.ncbi.nlm.nih.gov/pubmed/18066550

Now, is there any example of a flagellated enteric pathogens leading to a NEUROimmune response - absolutely! Camyplobacter is the major cause of Guillain-Barre syndrome (don't worry if you don't know what that is)

http://www.ncbi.nlm.nih.gov/pubmed/20157729

But pathogenic Campylobacter, while flagellated, plays a trick on the immune system to avoid TLR5.
So this could be the link to stomach pain experienced by many of our patients before the onset of PANDAS. See Dr.K's discussion on "adolescent variant" of PANDAS!

Dr. T., Have you ever tested your patients who are band 41 positive with the Igenex test to see if they have bands 31 and 34 also?

No, I literally began finding this over the past few weeks. If you just ask for "Lyme titers", you will come up empty as Western blot done only as a reflex if titer exceeds a pre-defined threshold (<0.91 in my geographic area).

Now I routinely ask for LYME WITH WESTERN BLOT, and we find the p41 IgG and IgM bands in almost all "PANDAS" patioents (LabCorp testing in most patients).

There is so much BS about lime out there I have to follow my gut instincts (no pun intended)

You bet these patients need thorough Igenex testing for p31 and p34 at least. Would you also recommend the Igenex co-infection panel?


I'm going to start to screen for common flagellated enterics as well.

Dr. T"


#4 bgbarnes

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Posted 24 May 2010 - 10:50 AM

I am responding to my own question, by posting an older comment by Dr. Trifiletti to someone's similar question. I pasted below:

"I call the patients who ONLY show p41 IgG/M positivity "Lyme-like illness" just to keep an open mind. I'm aware this could be Borrelia burgerdorfi (Bb) Lyme disease. In fact, with this finding it's our obligation to do the best we can (and it's very hard, I know) to rule Bb infection in our out. However, p41 is a very interesting protein. It is called FLAGELLIN, so these patients have anti-flagellin antibodies. The p41 is a major component of the bacterial tail found in those bacterial that are flagellated, i.e. have a motile tail, similar in function to that on a sperm cell. Now p41 is found on many bacteria that (seemingly) have nothing to do with what generally think about. It is NOT found in streptococci or mycoplasma, so infection with those can't be confounding this result. Spirochetes, in general, are flagellated, so there are many possible non-Bb candidates.
BUT THE PLOT THICKENS ...
p41 is found on many enteric (pathogens such as Campylobacter, Giardia, etc.) The interesting thing is that the immune response to p41 is HIGHLY specific. p41 activates Toll-like receptor #5 (TLR5), and another (minor) pathway. Furthermore, p41 is the only known activator of TLR5. Recently, it has been shown that TLR5 knockout mice develop severe colitis. It is now widely believed that the physiological function of TLR5, which is highly expressed in gut endothelial lining, is to protect us from nasty food-borne bacteria.

http://www.ncbi.nlm.nih.gov/pubmed/18066550

Now, is there any example of a flagellated enteric pathogens leading to a NEUROimmune response - absolutely! Camyplobacter is the major cause of Guillain-Barre syndrome (don't worry if you don't know what that is)

http://www.ncbi.nlm.nih.gov/pubmed/20157729

But pathogenic Campylobacter, while flagellated, plays a trick on the immune system to avoid TLR5.
So this could be the link to stomach pain experienced by many of our patients before the onset of PANDAS. See Dr.K's discussion on "adolescent variant" of PANDAS!

Dr. T., Have you ever tested your patients who are band 41 positive with the Igenex test to see if they have bands 31 and 34 also?

No, I literally began finding this over the past few weeks. If you just ask for "Lyme titers", you will come up empty as Western blot done only as a reflex if titer exceeds a pre-defined threshold (<0.91 in my geographic area).

Now I routinely ask for LYME WITH WESTERN BLOT, and we find the p41 IgG and IgM bands in almost all "PANDAS" patioents (LabCorp testing in most patients).

There is so much BS about lime out there I have to follow my gut instincts (no pun intended)

You bet these patients need thorough Igenex testing for p31 and p34 at least. Would you also recommend the Igenex co-infection panel?


I'm going to start to screen for common flagellated enterics as well.

Dr. T"

We have a positive on 41 too....

#5 jjk4

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Posted 24 May 2010 - 10:52 AM

I am asking this for another mom.

Have you had Lyme test, and had a positive P41 band show up?

Does anyone know the significance of P41? I believe Dr. Trifiletti may have said this may indicate a flagellated microbe.
How is one treated for Lyme; what antibiotics are working the best? For how long?

The child was treated with azithromycin and biaxin.

Thanks


Hi, my daughter had band 41 on standard Western Blot on 2 different tests but was considered negative for Lyme according to CDC guidelines. We were not seeing improvement in her symptoms on Augmentin so we consulted with a LLMD. My Lyme doctor felt in isolation, band 41 is not of huge concern if all other bands have been properly tested and that coinfections have been ruled out. In our case, that was not done until we saw him. He has years of pediatic lyme care experience and feels that the co infection Bartonella can be the cause of neuropsychiatric symptoms.
The diagnosis of Lyme is a clinical one and treatment is chosen based on the individual need and response. So, I am not sure if there is a "best" antibiotic. We were told treatment will be for at least 4 months and should continue for 2 months beyond symptom resolution to ensure the bacteria has been treated beyond it's life cycle.
Our daughter has been on zythromax, bactrim, and tindamax for 3 months with good results. I was told that her program addresses active Lyme, Bartonella, and any bacteria that has developed a biofilm or changed into a dormant cyst form. The goal is to treat long enought to get to all the bacteria and minimize the risk of relapse once treatment is completed.
Hope this info helps.
Joanne

#6 Fixit

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Posted 24 May 2010 - 11:19 AM

I am asking this for another mom.

Have you had Lyme test, and had a positive P41 band show up?

Does anyone know the significance of P41? I believe Dr. Trifiletti may have said this may indicate a flagellated microbe.
How is one treated for Lyme; what antibiotics are working the best? For how long?

The child was treated with azithromycin and biaxin.

Thanks


Hi, my daughter had band 41 on standard Western Blot on 2 different tests but was considered negative for Lyme according to CDC guidelines. We were not seeing improvement in her symptoms on Augmentin so we consulted with a LLMD. My Lyme doctor felt in isolation, band 41 is not of huge concern if all other bands have been properly tested and that coinfections have been ruled out. In our case, that was not done until we saw him. He has years of pediatic lyme care experience and feels that the co infection Bartonella can be the cause of neuropsychiatric symptoms.
The diagnosis of Lyme is a clinical one and treatment is chosen based on the individual need and response. So, I am not sure if there is a "best" antibiotic. We were told treatment will be for at least 4 months and should continue for 2 months beyond symptom resolution to ensure the bacteria has been treated beyond it's life cycle.
Our daughter has been on zythromax, bactrim, and tindamax for 3 months with good results. I was told that her program addresses active Lyme, Bartonella, and any bacteria that has developed a biofilm or changed into a dormant cyst form. The goal is to treat long enought to get to all the bacteria and minimize the risk of relapse once treatment is completed.
Hope this info helps.
Joanne


So are you actually going after band 41......Scott doesn't seem to think it is of concern either...but maybe it is a marker for some other bacteria,,,i guess as dr T indicated????
is the zith, bactrim and tindamax for lymes?
is it just for some other infectiona that 41 might be indicating?

how long before you started to see results??/ 1 month...just now???

i'm asking as my head is getting cloudy and i really cant' anything straight anymore......is it maybe just and inflammation marker...
.it that what TLR5 marks or is tlr5 a marker for a food bacteria...
ds also has dybosis, from what i can gather,,,all his bacteriaa, funguses and yeasts seem off???

are my questions making sense??/
or

#7 michaeltampa

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Posted 24 May 2010 - 11:23 AM

There are some lyme doctors who will treat as lyme with just band 41 positive if clinical symptoms are there as well. There are other infections that band 41 can indicate, and H.Pylori is one of them. Some believe the other possibilities that can cause band 41 to be positive are different enough in presentation that they can tell based on symptoms. In the end, some doctors treat the band 41 people with lyme symptoms as if they have lyme, since they see improvement in health as a result. If you're treating with antibiotics, you really don't know for sure what all you're killing and treating, but it's good to keep in mind the ultimate goal is health of the patient (as opposed to being certain of what the problem is/was).

By the way, the CDC guidelines are for tracking purposes, and not meant for diagnostic purposes.

Michael

#8 p_mom

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Posted 24 May 2010 - 12:51 PM

Both my sons are positive 41 band....so am I.....so is my brother. What gives? (nobody else tested)

#9 Phasmid

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Posted 24 May 2010 - 01:19 PM

So since P41 is a marker for flagellin which is a protein found in the flagella of bacteria, there is no way to determine which bacterial species it might be. So that is why P41 is just used in addition to the other markers, just an added piece of information such as "And, the organism is a flagellate." Since flagellated bacterial products enter our bodies through breathing, eating, and taking vaccines, we would expect to all have positive P41 bands?

#10 jjk4

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Posted 24 May 2010 - 01:31 PM

I am asking this for another mom.

Have you had Lyme test, and had a positive P41 band show up?

Does anyone know the significance of P41? I believe Dr. Trifiletti may have said this may indicate a flagellated microbe.
How is one treated for Lyme; what antibiotics are working the best? For how long?

The child was treated with azithromycin and biaxin.

Thanks


Hi, my daughter had band 41 on standard Western Blot on 2 different tests but was considered negative for Lyme according to CDC guidelines. We were not seeing improvement in her symptoms on Augmentin so we consulted with a LLMD. My Lyme doctor felt in isolation, band 41 is not of huge concern if all other bands have been properly tested and that coinfections have been ruled out. In our case, that was not done until we saw him. He has years of pediatic lyme care experience and feels that the co infection Bartonella can be the cause of neuropsychiatric symptoms.
The diagnosis of Lyme is a clinical one and treatment is chosen based on the individual need and response. So, I am not sure if there is a "best" antibiotic. We were told treatment will be for at least 4 months and should continue for 2 months beyond symptom resolution to ensure the bacteria has been treated beyond it's life cycle.
Our daughter has been on zythromax, bactrim, and tindamax for 3 months with good results. I was told that her program addresses active Lyme, Bartonella, and any bacteria that has developed a biofilm or changed into a dormant cyst form. The goal is to treat long enought to get to all the bacteria and minimize the risk of relapse once treatment is completed.
Hope this info helps.
Joanne


So are you actually going after band 41......Scott doesn't seem to think it is of concern either...but maybe it is a marker for some other bacteria,,,i guess as dr T indicated????
is the zith, bactrim and tindamax for lymes?
is it just for some other infectiona that 41 might be indicating?

how long before you started to see results??/ 1 month...just now???

i'm asking as my head is getting cloudy and i really cant' anything straight anymore......is it maybe just and inflammation marker...
.it that what TLR5 marks or is tlr5 a marker for a food bacteria...
ds also has dybosis, from what i can gather,,,all his bacteriaa, funguses and yeasts seem off???

are my questions making sense??/
or


Sorry if my post was not clear. Band 41 was the only one that was present when the 10 bands were tested per the CDC Western Blot standards. When we redid the Western Blot with IGENEX per our LLMD, we found numerous other bands present which were indicative of Lyme exposure(18, 31, 34, 41, 93). The coinfection Bartonella was also found. So, the Bactrim is to treat the Bartonella and the Zythromax and Tindamax are to treat the Lyme. The first 3 weeks of treatment were challenging but then at about the 1 month mark, we started to see more improvements. She is not 100% yet but doing so much betther than before we started the program in March. Hope this helps to clarify things.
Joanne

#11 justinekno

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Posted 24 May 2010 - 03:17 PM

Was your daughter already on antibiotics when she did the tests? My son was on antibiotics when we did the western blot (cdc) and he was positive onlt for the 41 band. I'm wondering if the antibiotics impacted his result. We had herxing while on zithromax and now we're thinking we have some lyme-like disease going on as well as PANDAS.

Sorry if my post was not clear. Band 41 was the only one that was present when the 10 bands were tested per the CDC Western Blot standards. When we redid the Western Blot with IGENEX per our LLMD, we found numerous other bands present which were indicative of Lyme exposure(18, 31, 34, 41, 93). The coinfection Bartonella was also found. So, the Bactrim is to treat the Bartonella and the Zythromax and Tindamax are to treat the Lyme. The first 3 weeks of treatment were challenging but then at about the 1 month mark, we started to see more improvements. She is not 100% yet but doing so much betther than before we started the program in March. Hope this helps to clarify things.
Joanne


Justine

#12 jjk4

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Posted 24 May 2010 - 03:50 PM

Was your daughter already on antibiotics when she did the tests? My son was on antibiotics when we did the western blot (cdc) and he was positive onlt for the 41 band. I'm wondering if the antibiotics impacted his result. We had herxing while on zithromax and now we're thinking we have some lyme-like disease going on as well as PANDAS.

Sorry if my post was not clear. Band 41 was the only one that was present when the 10 bands were tested per the CDC Western Blot standards. When we redid the Western Blot with IGENEX per our LLMD, we found numerous other bands present which were indicative of Lyme exposure(18, 31, 34, 41, 93). The coinfection Bartonella was also found. So, the Bactrim is to treat the Bartonella and the Zythromax and Tindamax are to treat the Lyme. The first 3 weeks of treatment were challenging but then at about the 1 month mark, we started to see more improvements. She is not 100% yet but doing so much betther than before we started the program in March. Hope this helps to clarify things.
Joanne



My daughter was not on abx for the first test; on Augmentin 2 months at the time of the second test; and on Augmentin 6 months at the time of the third test thru IGENEX. So, you can test while on abx. I think it is most important that all bands are properly evaluated and that suspected co infections are ruled in or out. If you are thinking that a tick born bacteria is at work here in addition to strep, perhaps seeing a Lyme literate doctor will help to direct how to further test and treat. Good Luck.
Joanne

#13 MomofJacob

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Posted 27 October 2010 - 05:39 PM

Our ds tested positive on IGenex band 41 (3+ symbols), and on band 31 (1 + symbol) and INDETERMINATE on bands 34 and 39. I would greatly appreciate any help.

#14 sf_mom

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Posted 27 October 2010 - 05:52 PM

This is a positive result via Igenex and an LLMDs would treat accordingly. Band 31 and 34 are HIGHLY LYME specific. If you like further confirmation you can follow this test with provocation DNA testing or 30-31kDA Epitope Confirmation Test. Again, I would let a good LLMD sort it all out for you. You will also need to eventually look into co-infections.

I look forward of hearing your stories of recovery and please come visit us over at the LYME forum.

-Wendy

#15 sf_mom

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Posted 27 October 2010 - 06:00 PM

Our older son and younger daughter were BAND 41 positive only. On the Igenex results there are very specific instructions about requiring additional testing if one of the double starred bands is positive..... BAND 41 is a double starred band.

I am so grateful we followed those instructions because we were able to find DNA of Lyme in our older 6 year old son's urine and just yesterday discovered our 3 year old son who we did not originally test for Lyme is tri-infected with BABESIA/BARTONELLA/Lyme (he does make antibodies). In our case the presence of band 41 hinted at congenital LYME for our daughter and older son which I understand is common. Again, this would take a good LLMD to sort it all out with proper testing.

Edited by SF Mom, 27 October 2010 - 06:03 PM.





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