Figure S3 indicates no unspecific binding on TICKPLEX® for IgM and IgG. Immune evasion and host immune response suppression, modulation, or subversion by Borrelia in LD patients is a common finding [28,30,32,33,71,72,73]. For example, Borrelia can trick the host immune system into producing a strong yet inadequate response while it evades the lymph nodes [34]. We postulate that a universally positive IgM or IgG immune response in TBD patients could be the result of a B-cell-related immune dysfunction, such as unspecific B-cell activation [29,34,74]. Here, CD40LG is linked to immune system disorder.