• Serology based on ELISA technology may not capture strains of Lyme disease that are found in Canada (Sperling and Sperling 2009, Ogden et al 2011, Rudenko et al 2011).
• Serological tests may not pick up antibodies tied up in complexes (Singh and Girshick 2004).
• CanLyme recommends that clinicians be provided with specific banding results of the Western blot rather than having significant information masked by the American interpretation of antibody patterns.
• IgM response in late disease is considered significant by some authorities (e.g. Deutsche Borreliose-Gesellschaft guidelines, ILADS guidelines, Donta 2007) while being discounted by the IDSA guidelines (Wormser et al 2006). CanLyme considers a late or recurrent IgM response, when accompanied by symptoms of Lyme disease, to be significant.
• Post-treatment Lyme Disease Syndrome is a vaguely described syndrome with no known cause. It may be due to untreated coinfections, persistent infection, immunological dysfunction or residual damage to tissues.
• Lyme disease may be an emerging contributor to chronic disease in Canada and is misdiagnosed as chronic fatigue, myalgic encephalomyelitis and fibromyalgia among other diseases (i.e. Rudenko et al 2011).
• Persistent cystic forms may not be captured by current serological tests yet are biologically significant (Miklossy et al 2008, Margulis et al 2009).
• New ecological studies show that Lyme disease is considerably more complex than was previously understood (Sperling and Sperling 2009, Brinkerhoff et al 2011, Mathers et al 2011, Rydzewski et al 2011).