1. Recent infection before immune response
2. Antibodies are in immune complexes
3. Spirochete encapsulated by host tissue (i.e.: lymphocytic cell walls)
4. Spirochete is deep in host tissue (i.e.: fibroblasts, neurons, etc.)
5. Blebs in body fluid, no whole organisms available for PCR
6. No spirochetes in body fluid on day of test
7. Genetic heterogeneity (300 strains, 100 in U.S.)
8. Antigenic variability
9. Surface antigens change with temperature
10. Utilization of host protease instead of microbial protease
11. Spirochete in dormancy phase (L-form) with no cell walls Additional Reasons for False Lyme test
12. Recent antibiotic treatment
13. Recent anti-inflammatory treatment
14. Concomitant infection with babesia may cause immunosuppression
15. Other causes of immunosuppression
16. Lab with poor technical capability for Lyme disease
17. Lab tests not standardized for late stage disease
18. CDC criteria is epidemiological not a diagnostic criteria
19. Lack of standardized control
20. Most controls use only a few strains as reference point
21. Few organisms are sometimes present
22. Encapsulated by glycoprotein “S-layer” which impairs immune recognition
23. “S”- layer binds to IgM
24. Immune deficiency
25. Possible down regulation of immune system by cytokines
26. Revised Western Blot test criteria fails to include most significant antigens