Why use the CD57 test?
The CD57 test is offered in some clinical laboratories and is being used by some health practitioners to evaluate and follow patients diagnosed with chronic Lyme disease.
What is Lyme disease?
Lyme disease, the most common vector-borne illness in the United States, is caused by Borrelia burgdorferi and transmitted by the bite of the Ixodes sp. tick (the deer tick).
The disease usually begins with erythema migrans, an expanding skin lesion at the site of the tick bite. Within several days or weeks, there is hematogenous dissemination of the spirochetes, and patients may present with dermatologic, neurological, cardiac, and rheumatologic involvement.
What is chronic lyme disease?
Chronic Lyme disease is a controversial term applied to a broad spectrum of patients, including individuals with Lyme disease and those with post-Lyme disease syndrome (PLDS), as well as patients with no evidence of current or past Borrelia burgdorferi infection. PLDS is defined as the persistence or relapse of nonspecific symptoms (such as fatigue, musculoskeletal pain, and cognitive complaints) in patients who have had Lyme disease and have received an adequate course of antibiotic therapy.
It has been reported that people with “chronic Lyme disease” have a decreased number of natural killer cells (NK cells), as defined by the CD57 marker.
Although acute infections can be treated with antibiotics, failure to treat may result in a chronic, debilitating illness characterized by musculoskeletal and neurologic symptoms. Chronic Lyme disease may be difficult to treat, but also to diagnose
Lower CD57 levels:
The number of CD57 cells is decreased in chronic Lyme disease patients, particularly those with pronounced neurologic symptoms. Patients with low CD57 have significantly more co-infections and persistent immunologic defects than patients with higher counts. In patients that respond to antibiotic therapy, the number will come back to normal following treatment, but in patients with persistent Lyme disease, CD57 levels remain low.
What are white blood cells?
White blood cells (=leukocytes) help the body to fight infections and other diseases.
The human immune system consists of several different types of white blood cells with one category being called Lymphocytes.
Lymphocytes attack antigens (foreign proteins).
Lymphocytes consists of 3 subcategories of white blood cells known as B-Cells, T-Cells, and Natural Killer Cells.
- B-cells – responsible for antibody production
- T-cells – responsible for killing foreign invaders.
- natural killer (NK) cells – responsible for killing foreign invaders.
Natural killer cells versus T-cells:
Natural killer cells are the first line of defense against foreign pathogens and they belong to the innate immune system. They are not specific in their immune response and recognize a wide variety of pathogens.
T-cells, on the other side, belong to the adaptive immune system. They are much more focused and highly specialized.
What are CD markers?
CD stands for cluster designation. CD is a glycoprotein molecule on the cell surface that acts as an identifying marker. Each different marker (or CD) on a cell is named with a number, which signifies the order in which the CD was discovered. Cells that have a certain kind of CD present on their surface are denoted as “+” for that CD type (e.g., a cell with CD57 markers on its surface is “CD57+”.
What are CD57 cells?
- CD57 is a natural killer cell. A below-normal count of CD57+ cells has been associated with chronic Lyme disease. No one knows for sure why CD57+ NK cells are low in Lyme disease patients, but it is important to note that many disease states that are often confused with chronic Lyme (such as MS, systemic lupus, rheumatoid arthritis) are not
associated with low CD57+ counts.
- Borrelia are believed to be capable of reducing the total amount of CD57 natural killer cells in the human body.
- It is generally believed that the lower the amount of CD57 natural killer cells in the body, the more chronic or progressive Lyme disease is, and the higher the amount, the closer a person is to remission.
What are CD8 cells?
The CD8 cells are generally referred to as T-cells, not to be confused with natural killer cells.
Controversy around using this test:
- The utility of this test is controversial. Marques et. al. (2009 Clin. Vaccine Immunol. 16:1249-50) reported that there was no difference between the CD57 NK cell counts among patients with Lyme disease and normal controls.
- There have been instances where high amounts of CD57 natural killers cells have been found in those with chronic Lyme disease, and low amounts of CD57 natural killer cells have been found in those who were believed to be in remission.
Possible treatment options:
There are various stages of Lyme infection, and treatments differ according to the stage of infection. It’s important to be aware of the various treatment options so that you can help your doctor determine what’s right for you. Treatment options include one or multiple rounds of antibiotics (oral, intravenous, intramuscular, etc). When a patient is diagnosed with Chronic Lyme Disease, doctors work to develop an extended treatment plan. Treating Chronic Lyme can last months, years or even longer. Decisions about the treatment of the patient with chronic Lyme disease need to be individually shaped by the clinician’s experience, the patient’s clinical profile and history of antibiotic responsiveness, and the emerging medical literature.
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