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Follow-up studies on 56 patients who suffered from antibiotically untreated, acute, monophasic neuroborreliosis five to 23 years ago revealed significant positive levels of IgG antibodies to Borrelia burgdorferi (Bb) in the serum and cerebrospinal fluid (CSF) of 20 patients (IFT, ELISA, Bb-specific IgG Western blot, Bb-specific IEF-IgG immunoblot). Nine of 10 tested patients had a definitely positive T-cell proliferative response to whole B. burgdorferi, with a mean (+/- -SEM) stimulation index of 7.2 +/- 1.8. Because the patients studied exhibited no, or only mild to medium sequelae without any evidence of a chronic-progressive
disease, we interpret the long-term persistence of specific T- and B-lymphocyte responses to B. burgdorferi as an "immunological scar syndrome". Finally, diagnostic criteria of active neuroborreliosis are proposed.