I hope that you all enjoyed my last let's talk lyme blog about PANS and the Lyme connection!
I know the many references explaining Lyme disease out there but for the sake of this blog, I feel it necessary to lay groundwork to provide deeper understanding of the disease and why perhaps it is so often missed in lab work.
The immune system being a dude is tongue-in-cheek and meant to be taken lightheartedly. No dig on my male counterparts, you are all loved and respected! By nature men tend to complete a task before moving onto the next and do so expertly! Or so I'm told by my husband. Multitasking is another beast. Some can but as a collective group, men do not multitask well.
Those of you entrenched in treatment with your children or perhaps yourself have witnessed shifting laboratory results. Many people have a multitude of symptoms with relatively "clean" labs while others may show multiple band on a Lyme Western Blot or other tick-borne diseases and feel perfectly fine at the moment. You begin treatment, many feeling better but your repeated labwork looks worse! I have many patients with a perplexed gaze and state "but I'm better or my child is better! How can the labs be worse?"
I sum it up in one phrase, "The Immune system is like a dude." I usually get a chuckle or two with that comment.
What I mean by this is simply the immune system can only identify and recruit an aggressive assault on very few antigens at a time. It is horrible at multitasking especially when it can not "see" the antigen. When the immune system finds itself overwhelmed, it simply tucks the bacteria or virus away, not producing antibodies to it because it simply cannot deal with multiple insults effectively.
Simply stated, the immune system response occurs as T cells typically activate first utilizing T helper cells when an antigen is sensed as the initial immune response. This cascade effect of activation triggers other T cells that differentiate to perform specific functions as needed to abate an infection. The end result typically is B cell activation that then produce antibodies or "memory" of the antigen as well as plasma cells. This explanation is severely simplified as the immune system response is highly advanced with interconnected processes. What's important to know is the immune system's relationship with the unique nature of the spirochete that causes Lyme disease.
If the immune system's response is so robust how could Lyme disease possibly out maneuver it?
When a tick bites its victim, the spirochete that causes Lyme disease is passed thru the tissues. Released with the spirochete, the tick passes saliva as well which contains a film like substance. This film coats the spirochete as it enters the body rendering it invisible to the immune system. T cells are not activated initially and the immune system remains at a steady state. The spirochete has a unique structure called a flagellum, a tail-like structure. This structure helps propel the spirochete thru tissues and mucous that would typically stop the organism.
The movement of the flagellum stimulates the immune system, activating the T cells and triggering a full immune cascade. Given the constant movement of the spirochete and its stealthy shapeshifting mechanisms, the immune system is blind. As the immune system's B cells form antibodies to the original antigen identified, the spirochete has the ability to change its outer surface protein antigen to further evade death.
Knowing the antigen is still active, the immune system continues to mount a blind assault only creating extensive inflammation in the body and causing cell/tissue damage without effectively touching the spirochete.
As the inflammation mounts, further damage occurs to the skin, joints, brain and nerve endings. The full immune response intensifies the inflammation by creating toxic compounds and by-products. This would explain the widespread and varying symptoms that many patients describe.
As the immune system begins to fatigue and the spirochete lingers, structural mutations and abnormalities in the lymph tissues occur. These are the "germinal centers" and key in producing B cells or memory cells that create lasting antibodies. This would explain why a person may experience ongoing symptoms after a known exposure but have lab results that do not reflect it. The immune system is now dysfunctional and cannot produce the necessary antibodies that typical bloodwork would detect.
This is a very simplistic explanation of the immune response with Lyme disease and other co-infections. Essentially to give you a sense of what is happening in the body and why symptoms are experienced. There are many layers that determine each individual's experience with tick-borne illnesses and response to treatment.