CSF B – lymphocyte chemoattractant (CXCL13) in the early diagnosis of acute Lyme neuroborreliosis

• Published in: Journal of neurology Vol. 255; no. 5; pp. 732 - 737
• Main Authors: LJØESTAD, Unn, MYGLAND, Ase
• Format: Journal Article
• Language: English
• Published: Darmstadt Steinkopff-Verlag 01.05.2008; Springer; Springer Nature B.V
• Subjects: Acute Disease; Adult; Aged; Antibodies; Antibodies - cerebrospinal fluid; B-Lymphocytes - immunology; Bacterial diseases; Biological and medical sciences; Biomarkers - analysis; Biomarkers - cerebrospinal fluid; Borrelia; Borrelia burgdorferi - immunology; Borrelia infections; Chemokine CXCL13 - analysis; Chemokine CXCL13 - cerebrospinal fluid; Chemokines; Cohort Studies; Diagnosis, Differential; Diagnostic tests; Female; Human bacterial diseases; Humans; Infectious diseases; Leukocytes; Lyme Neuroborreliosis - cerebrospinal fluid; Lyme Neuroborreliosis - diagnosis; Lyme Neuroborreliosis - immunology; Lymphocyte Activation - immunology; Lymphocytes; Male; Medical sciences; Medicine; Medicine & Public Health; Meningitis; Meningitis - cerebrospinal fluid; Meningitis - diagnosis; Meningitis - immunology; Middle Aged; Multiple sclerosis; Multiple Sclerosis - cerebrospinal fluid; Multiple Sclerosis - diagnosis; Multiple Sclerosis - immunology; Neurology; Neuroradiology; Neurosciences; Original Communication; Pneumoviridae; Predictive Value of Tests; Sensitivity and Specificity; Serologic Tests; Tropical bacterial diseases; Up-Regulation - immunology; Norway; Borrelia burgdorferi; specificity; diagnosis; antibodies; Lyme neuroborreliosis; sensitivity; chemokines; Lyme disease; Nervous system diseases; Spirochaetaceae; Spirochaetales; Borrelia infection; Central nervous system; B-Lymphocyte; Cerebrospinal fluid; Infection; Chemokine; Sensitivity; Specificity; Spirochaetosis; Bacteriosis; Bacteria; Diagnosis
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-008-0785-y

Recent studies have suggested a diagnostic role of the B-lymphocyte attracting chemokine (CXCL13) in the cerebrospinal fluid (CSF) in Lyme neuroborreliosis (LNB). Our aim was to evaluate diagnostic accuracy of CSF CXCL13 in a cohort of 59 consecutive patients referred to hospital for suspected LNB. Thirty-seven patients were classified as definite LNB and used as the reference standard. Seven were classified as probable, and seven as possible LNB. Eight patients did not fulfil case definitions and were used as controls. At presentation, CSF CXCL13 was elevated in all patients with definite LNB, as compared to a positive CSF B. burgdorferi (Bb) antibody index (AI) in 33 of 37. Pre-treatment sensitivity of elevated CSF CXCL13 and positive CSF Bb AI was 100 % (95 % CI = 91–100) and 78 % (95 % CI = 75–96) respectively (p = 0.053). Among the eight control patients, CSF CXCL13 was normal in five and only slightly elevated in three, and Bb AI was negative in five. Specificity of CSF CXCL13 and Bb AI was similar 63 % (95 % CI = 31–86) (p = 1.0). CSF CXCL13 was elevated in 6/7 patients with probable LNB and 3/7 patients with possible LNB. Bb AI was negative in all these 14 patients. An additional control group consisted of 31 patients with multiple sclerosis (MS), 11 with non-inflammatory neurological diseases, and ten with verified non-Lyme meningitis and high CSF cell count. CSF CXCL13 was slightly elevated in 15 MS patients, and in nine meningitis patients. Mean CSF CXCL13 was higher in definite LNB (3524 ng/g CSF protein) than in MS (27 ng/g) and non-Lyme meningitis (23 ng/g) (p < 0.001). Four months post-treatment CSF CXCL13 was normalized in 82 % of patients with definite LNB, as compared to a negative Bb AI in 10 % (p < 0.001). CSF CXCL13 may be a useful supplement in early diagnosis of acute LNB.