REASONS WHY A SERONEGATIVE TEST RESULT MIGHT OCCUR
Recent infection before immune response
Only strain B31 of Borrelia burgdorferi as basis of test, many strains/species missed
Antibodies are in immune complexes
Spirochete encapsulated by host tissue (i.e.: lymphocytic cell walls)
Spirochete is deep in host tissue
Blebs in body fluid, no whole organisms needed for PCR
No spirochetes in body fluid on day of test
Antigenic variability
Surface antigens change with temperature
Utilization of host protease instead of microbial protease
Spirochete in dormancy phase (L-form) with no cell walls
Recent antibiotic treatment
Recent anti-inflammatory treatment
Concomitant infection with babesia may cause immunosuppression
Other causes of immunosuppression
Lab with poor technical capability for Lyme disease
Lab tests not standardized for late stage disease
Lab tests labeled "for investigational use only"
CDC criteria is epidemiological not a diagnostic criteria
Lack of standardized control
Most controls use only a few strains as reference point
Few organisms are sometimes present
Encapsulated by glycoprotein "S-layer" which impairs immune recognition
"S"- layer binds to IgM
Immune deficiency
Possible down regulation of immune system by cytokines
Revised W.B. criteria fails to include most significant antigens