Original sentence: However studies show the Western blot IgM has a specificity of 94-96% for patients with symptoms suggestive of Lyme disease with infection by Borrelia burgoferi
Edited sentence: As in syphilis, late CNS lyme can occur in the absence of positive antibody serology, for multiple reasons including abrogation of serum antibody response by intercurrent antibiotic treatment for another infection which however is not powerful enough to remediate the CNS borreliosis.Because of this, one cannot rule out CNS disease in American patients based on CSF results, which are often normal.Because the spirochete has since been found to differentially express surface proteins according to stage and even tissue type of the infection, these criteria remain severely deficient.Brain biopsy might be helpful, but is not commonly performed for lyme neuroborreliosis for unknown reasons.However studies show the Western blot IgM has a specificity of 94-96% for patients with symptoms suggestive of very early Lyme disease with infection by Borrelia burgoferi.If an organic brain is identified through these tests, and everything else is ruled out, neuropsychiatric lyme encephalopathy should become the foremost consideration in the differential diagnosis unless proven otherwise, as it is the most common vector-borne disease in the United States.In North American chronic neuroborreliosis, as opposed to European disease, intrathecal antibody production is not always seen.In these cases, the diagnosis becomes as dependent upon 'ruling out' as on 'ruling in'.PCR provides definitive diagnosis, but is only positive 30% of the time in neuroborreliosis patients.Serologic testing for late CNS disease is not dependable.Serum antibody testing can be helpful here, but again a negative result does not rule out the infection.Testing for lupus and syphilis, along with brain imaging such as MRI and SPECT, can help clarify the situation, as can comprehensive neuropsychological testing.The current CDC surveillance criteria were developed primarily utilizing individuals suffering from early, acute disease