by Jennifer Miller, PhD is the director of research and development as well as the assistant lab director at Galaxy Diagnostics. Dr. Miller holds a doctorate in microbiology and brings an exceptional and diverse background in microbiology research and education, including over 20 years of experience with vector-borne pathogens. She recently sat down with us to film answers to a set of questions our team has received from patients and healthcare providers.
A list of the questions can be seen below. The answers are available on YouTube with captions, and here we have provided transcripts with slight edits for ease of reading.
1. What do people get wrong about Lyme borreliosis?
Transcript: That’s a very difficult question to answer, quickly I’ll try and sum up a couple key points. One of the major misconceptions about Lyme disease is that people develop symptoms that match what they learn about in textbooks. People that develop Lyme disease really are a wide variety of people who are different genetically who are different immunologically. So there is no one size fits all to what constitutes a Lyme disease infection.
There are people that get horribly ill right away, there are people that don’t get sick at all. Going back to the people that get sick right away, one of the number one misconceptions of Lyme disease is that you have to develop a bulls-eye rash to be considered to be Lyme disease positive. In reality, numbers in the literature vary but only 25 to 30 percent of all individuals that have been bitten by a tick ever get a bulls-eye rash.
The reasons for this are not well understood, but are thought to be tied to differences in host immunological and genetic responses. Just because you don’t get a bulls-eye rash doesn’t mean that you don’t have Lyme disease.
I think understanding that Lyme disease is a complex infection with a wide variety of symptoms that are often misunderstood for other illnesses and that that misunderstanding can delay diagnosis of Lyme disease and then people reach a state where other complications develop because the delay in diagnosis.
So I think that there’s a lot of misconceptions about Lyme disease sort of being a one to one textbook or linear disease when in reality it is much more complicated than that.
2. What do doctors need to know about bartonellosis (cat scratch disease)?
Transcript: Bartonellosis is a collection of infections. There are many dozens and multiples of Bartonella species. And these Bartonella species can cause a wide range of different clinical pathologies. There is way more to Bartonella than the textbook cat scratch disease that physicians often learn about. And so in order to completely understand the complex clinical presentation of Bartonella, one really has to consider that all of these different species are transmitted by different types of organisms, including ticks, fleas and lice. Some Bartonella species are transmitted by keds or other lesser known insects.
And so these species can cause so many different clinical symptoms that I think it is way more appropriate to view Bartonella as a collection of infections and to use the word “bartonellosis.”
The other thing I would tell physicians is that there are a lot of clues to what Bartonella does in the veterinary medical literature. And one of the concepts of One Health is to marry what we’ve learned through animals—in this case companion animals such as dogs, cats, horses—and marry what we see in those to what can be seen in humans and collaboratively apply scientific knowledge across the veterinary and medical world. I would like for physicians to consider that veterinary literature when thinking about bartonellosis.
3. What research is needed to advance Lyme disease diagnostics and therapeutics?
Transcript: The problem with Lyme disease is that the current assays rely on antibody responses to the organism and we now know that not all individuals with Lyme disease produce a textbook antibody response. Some people don’t seem to produce very many antibodies at all so we need testing modalities that get away from looking at the antibody response.
We need testing modalities that are able to directly detect the presence of the organism in a tissue site, or we need molecular diagnostics like PCR or next generation derivatives of multiple PCR targets in order to be able to detect organisms.
The key with molecular modalities is they need to be sensitive enough to detect organisms that are present in very low levels without all of the host DNA that’s present sort of obscuring the forest for the trees. This is one of the major challenges with developing a molecular diagnostic for Borrelia.
4. Why is direct detection important for accurately diagnosing stealth infections?
Transcript: Because if you don’t directly detect, then you don’t have that one-to-one correlation between the clinical symptoms and actual evidence of the organism. And this is where serology often fails. If you have an antibody response to a pathogen it just means you were exposed. It doesn’t mean that the organism is still present inside you.
If you’re still having symptoms figuring out whether those symptoms are a direct one-to-one with the organism or whether a sort of off-target effect of the immune system can be very hard. This is especially true with stealth organisms that cycle in and out of the bloodstream and hide in the body in very low concentrations. Whereas with direct detection you can show one-to-one the organism is present and it’s a stronger correlation with the patient’s symptoms.
5. What makes Galaxy Diagnostics special?
Transcript: I think there’s two things. One we are driven by science. Everything that that we focus on has been published in peer-reviewed scientific literature, often in more than one publication. And I think that having that scientific verification and validation is very important to any diagnostic assay.
Second thing is I would say our customer service. We are a small company and all of our technologists participate in customer service. They care about the patient. And when they answer the phone the clients are actually talking to people that run the actual assays. And I think that that duality is very important when trying to convey expertise and sensitivity to any particular client question.