Limitations and Confusing Aspects of Diagnostic Testing for Neurologic Lyme Disease in the United States.

Theel ES, et al. J Clin Microbiol. 2018.


In the United States, laboratories frequently offer multiple different assays for testing of cerebrospinal fluid (CSF) samples to provide laboratory support for the diagnosis of central nervous system Lyme disease (CNSLD). Often included among these diagnostic tests are the same enzyme immunoassays and immunoblots that are routinely used to detect the presence of antibodies to Borrelia burgdorferi in serum. However, performing these assays on CSF alone may yield positive results simply from passive diffusion of serum antibodies into the CSF. In addition, such tests are only United States Food and Drug Administration-cleared and well-validated for testing serum, not CSF. When performed using CSF, positive results from these assays do not establish the presence of intrathecal antibody production to B. burgdorferi and therefore should not be offered. The preferred test to detect intrathecal production of antibodies to B. burgdorferi is the antibody index assay, which corrects for passive diffusion of serum antibodies into CSF and requires testing of paired serum and CSF collected at approximately the same time. However, this assay also has limitations and should only be used to establish a diagnosis of CNSLD in conjunction with patient exposure history, clinical presentation and other laboratory findings.



ALL testing for tick-borne infections is abysmal.  Diagnosis should still be clinical, which is why medical practitioners MUST become educated on this beast.

Also, the past is riddled with thousands who have not made the “antibody” cut and have been essentially left to die.  Trust me when I say there are far more false negatives than positives!

For instance, read about the story of Vicki Logan:

Please read the entire article as zinger after zinger is exposed as to the corruption involved, but Liegner requested an autopsy on Vicki and the pathologist not only refused, he refused to even let an outside pathologist use the facilities to perform it.

The reason? Wait for it…..

……danger of infection to himself and his staff.

I thought Lyme disease was benign and similar to the common cold – easily cured with 21 days of doxy?

By now you know that Liegner wasn’t about to let the ball drop and found a way to get Vicki to the Chief of Neuropathology at Columbia Presbyterian where her autopsy results are now available to all. Without this critical step, propelled by Liegner, the pathologist at Hudson Valley Hospital would have successfully prevented medical knowledge of chronic and neurologic Lyme disease as well as the cause of her hypotension, a missed diagnosis of myocardial infarction.

Then there’s this little gem proving seronegativity with active infection occurs:

Seronegative Chronic Relapsing Neuroborreliosis.

Lawrence C.a · Lipton R.B.b · Lowy F.D.c · Coyle P.K.d

aDepartment of Medicine, bDepartment of Neurology, and cDivision of Infectious Diseases, Albert Einstein College of Medicine, and dDepartment of Neurology, State University of New York at Stony Brook, New York, NY., USA
Eur Neurol 1995; 35:113–117 (DOI:10.1159/000117104)


We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.