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