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Waiß C, Ströbele B, Graichen U, Klee S, Gartlehner J, Sonntagbauer E, Hirschbichler S, Tinchon A, Kacar E, Wuchty B, Novotna B, Kühn Z, Sellner J, Struhal W, Bancher C, Schnider P, Asenbaum-Nan S, Oberndorfer S. CXCL13 as a biomarker in the diagnostics of European lyme Neuroborreliosis - A prospective multicentre study in Austria. J Cent Nerv Syst Dis 2024; 16:11795735241247026. [PMID: 38706882 PMCID: PMC11067428 DOI: 10.1177/11795735241247026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Background 'Definite Neuroborreliosis (NB)' is diagnosed with the presence of NB-specific symptoms, cerebrospinal fluid (CSF) pleocytosis and an elevated Borrelia Burgdorferi antibody index. However, some diagnostic uncertainties exist. The B-cell chemokine CXCL13 represents an emerging biomarker for the diagnosis and treatment of NB because its intrathecal concentration rises prior to the Borrelia antibody index and drops rapidly after antibiotic therapy. Nevertheless, due to lacking prospective data, a definite CXCL13 cut-off for the diagnosis of NB is still pending. Objective Definition of a CSF CXCL13 cut-off for the diagnosis of acute and untreated NB in a prospective study setting. Design and methods This multicentre prospective study involved 6 neurological departments treating patients in the Lower Austria district (1.7 million inhabitants). The controls were patients scheduled for a spinal tap but not clinically diagnosed with NB. Demographic data, clinical characteristics and blood counts, as well as inflammatory CSF values and CSF CXCL13-concentration were analysed. Results We recruited 440 adult patients, of whom 42 have been diagnosed as having an acute and untreated 'definite NB'. Three hundred ninety-eight patients were assigned to the control group. The median intrathecal CXCL13 concentration was 2384 pg/ml for patients with NB and 0 pg/ml for controls. The difference was highly statistically significant (P ≤ .001). A CSF CXCL13 cut-off of 271 pg/ml resulted in a sensitivity of 95.2% and a specificity of 97.2% for the confirmation or exclusion of NB. Conclusion Based on our results, we propose a CSF CXCL13 cut-off of 271 pg/ml with Euroimmun-Elisa for the diagnosis of acute and untreated NB. Due to its high sensitivity and specificity, CXCL13 is a strong candidate biomarker for routine NB assessment, especially in clinically unclear cases.
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Affiliation(s)
- Christoph Waiß
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Barbara Ströbele
- Institute of Hygiene and Microbiology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Uwe Graichen
- Department for Health Sciences, Biostatistics and Data Science, Karl-Landsteiner-Private University of Health Sciences (KLPU), Krems an der Donau, Austria
| | - Sascha Klee
- Department for Health Sciences, Biostatistics and Data Science, Karl-Landsteiner-Private University of Health Sciences (KLPU), Krems an der Donau, Austria
| | - Joshua Gartlehner
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Estelle Sonntagbauer
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Stephanie Hirschbichler
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Alexander Tinchon
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Emrah Kacar
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital Tulln, Tulln, Austria
| | - Bianca Wuchty
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Bianka Novotna
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Zofia Kühn
- Department of Neurology, Hospital Wr. Neustadt, Wiener Neustadt, Austria
| | - Johann Sellner
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Walter Struhal
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital Tulln, Tulln, Austria
| | | | - Peter Schnider
- Department of Neurology, Hospital Wr. Neustadt, Wiener Neustadt, Austria
| | | | - Stefan Oberndorfer
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
- Karl Landsteiner Institute for Neurology and Neuropsychology St. Poelten, Krems an der Donau, Austria
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Erhart DK, Klose V, Schäper T, Tumani H, Senel M. CXCL13 in Cerebrospinal Fluid: Clinical Value in a Large Cross-Sectional Study. Int J Mol Sci 2023; 25:425. [PMID: 38203597 PMCID: PMC10779058 DOI: 10.3390/ijms25010425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
C-X-C-motif chemokine ligand 13 (CXCL13) in cerebrospinal fluid (CSF) is increasingly used in clinical routines, although its diagnostic specificity and divergent cut-off values have been defined so far mainly for neuroborreliosis. Our aim was to evaluate the value of CSF-CXCL13 as a diagnostic and treatment response marker and its role as an activity marker in a larger disease spectrum, including neuroborreliosis and other neuroinflammatory and malignant CNS-disorders. Patients who received a diagnostic lumbar puncture (LP) (n = 1234) between July 2009 and January 2023 were included in our retrospective cross-sectional study. The diagnostic performance of CSF-CXCL13 for acute neuroborreliosis was highest at a cut-off of 428.92 pg/mL (sensitivity: 92.1%; specificity: 96.5%). In addition, CXCL13 levels in CSF were significantly elevated in multiple sclerosis with clinical (p = 0.001) and radiographic disease activity (p < 0.001). The clinical utility of CSF-CXCL13 appears to be multifaceted. CSF-CXCL13 is significantly elevated in patients with neuroborreliosis and shows a rapid and sharp decline with antibiotic therapy, but it is not specific for this disease and is also highly elevated in less common subacute neuroinfectious diseases, such as neurosyphilis and cryptococcal meningitis or in primary/secondary B-cell lymphoma.
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Affiliation(s)
- Deborah Katharina Erhart
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (D.K.E.); (T.S.); (M.S.)
| | - Veronika Klose
- German Center for Neurodegenerative Diseases (DZNE)—Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany;
| | - Tatjana Schäper
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (D.K.E.); (T.S.); (M.S.)
| | - Hayrettin Tumani
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (D.K.E.); (T.S.); (M.S.)
| | - Makbule Senel
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (D.K.E.); (T.S.); (M.S.)
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Iversen L, Boesen MS, Zibrandtsen IC. Lyme neuroborreliosis presenting with urinary retention and spastic paraparesis. Pract Neurol 2023; 23:504-506. [PMID: 37532431 DOI: 10.1136/pn-2023-003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
Progressive myelopathy, urinary retention and gait problems are rare presenting features of Lyme neuroborreliosis. A 30-year-old man had 11 months of urinary retention and 3 months of spastic paraparesis. MR scans of the brain and the spinal cord showed leptomeningeal thickening with contrast enhancement. Cerebrospinal fluid showed mononuclear pleocytosis, decreased glucose, increased protein and chemokine ligand 13, with intrathecal Borrelia-specific IgM and IgG antibodies. He received 14 days of intravenous ceftriaxone followed by 14 days of oral doxycycline. Despite improvement at 6 months, he still had severe gait problems. Urinary retention in otherwise healthy people needs investigation, and Lyme neuroborreliosis is a rare cause.
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Affiliation(s)
- Lars Iversen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
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Lionello FCP, Rotundo S, Bruno G, Marino G, Morrone HL, Fusco P, Costa C, Russo A, Trecarichi EM, Beltrame A, Torti C. Touching Base with Some Mediterranean Diseases of Interest from Paradigmatic Cases at the "Magna Graecia" University Unit of Infectious Diseases: A Didascalic Review. Diagnostics (Basel) 2023; 13:2832. [PMID: 37685370 PMCID: PMC10486464 DOI: 10.3390/diagnostics13172832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Among infectious diseases, zoonoses are increasing in importance worldwide, especially in the Mediterranean region. We report herein some clinical cases from a third-level hospital in Calabria region (Southern Italy) and provide a narrative review of the most relevant features of these diseases from epidemiological and clinical perspectives. Further, the pathogenic mechanisms involved in zoonotic diseases are reviewed, focusing on the mechanisms used by pathogens to elude the immune system of the host. These topics are of particular concern for individuals with primary or acquired immunodeficiency (e.g., people living with HIV, transplant recipients, patients taking immunosuppressive drugs). From the present review, it appears that diagnostic innovations and the availability of more accurate methods, together with better monitoring of the incidence and prevalence of these infections, are urgently needed to improve interventions for better preparedness and response.
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Affiliation(s)
- Ferdinando Carmelo Pio Lionello
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Salvatore Rotundo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriele Bruno
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriella Marino
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Helen Linda Morrone
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Paolo Fusco
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Chiara Costa
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Anna Beltrame
- College of Public Health, University of South Florida, Gainesville, FL 33620, USA;
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
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Lundblad K, Zjukovskaja C, Larsson A, Cherif H, Kultima K, Burman J. CSF Concentrations of CXCL13 and sCD27 Before and After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200135. [PMID: 37311645 DOI: 10.1212/nxi.0000000000200135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES In the past decade, autologous hematopoietic stem cell transplantation (AHSCT) has emerged as a treatment for relapsing-remitting multiple sclerosis (RRMS). How this procedure affects biomarkers of B- and T-cell activation is currently unknown. The objective of this study was to investigate CXCL13 and sCD27 concentrations in CSF before and after AHSCT. METHODS This prospective cohort study was conducted at a specialized MS clinic in a university hospital. Patients with a diagnosis of RRMS, treated with AHSCT between January 1, 2011, and December 31, 2018, were evaluated for participation. Patients were included if CSF samples from baseline plus at least 1 follow-up were available on June 30, 2020. A control group of volunteers without neurologic disease was included as a reference. CSF concentrations of CXCL13 and sCD27 were measured with ELISA. RESULTS The study comprised 29 women and 16 men with RRMS, aged 19-46 years at baseline, and 15 women and 17 men, aged 18-48 years, in the control group. At baseline, patients had higher CXCL13 and sCD27 concentrations than controls, with a median (IQR) of 4 (4-19) vs 4 (4-4) pg/mL (p < 0.0001) for CXCL13 and 352 (118-530) vs 63 (63-63) pg/mL (p < 0.0001) for sCD27. After AHSCT, the CSF concentrations of CXCL13 were considerably lower at the first follow-up at 1 year than at baseline, with a median (IQR) of 4 (4-4) vs 4 (4-19) pg/mL (p < 0.0001), and then stable throughout follow-up. The CSF concentrations of sCD27 were also lower at 1 year than at baseline, with a median (IQR) of 143 (63-269) vs 354 (114-536) pg/mL (p < 0.0001). Thereafter, sCD27 concentrations continued to decrease and were lower at 2 years than at 1 year, with a median (IQR) of 120 (63-231) vs 183 (63-290) pg/mL (p = 0.017). DISCUSSION After AHSCT for RRMS, CSF concentrations of CXCL13 were rapidly normalized, whereas sCD27 decreased gradually over the course of 2 years. Thereafter, the concentrations remained stable throughout follow-up, indicating that AHSCT induced long-lasting biological changes.
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Affiliation(s)
- Katarina Lundblad
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | | | - Anders Larsson
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Honar Cherif
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Kim Kultima
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Joachim Burman
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden.
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Smíšková D, Džupová O, Moravcová L, Pícha D. Cerebrospinal fluid CXCL13 in non-borrelial central nervous system infections: contribution of CXCL13 to the differential diagnosis. Infect Dis (Lond) 2023; 55:551-558. [PMID: 37317698 DOI: 10.1080/23744235.2023.2222178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The chemokine CXCL13 in cerebrospinal fluid (CSF) is used as a diagnostic marker of Lyme neuroborreliosis (LNB). However, the elevated levels in other non-borrelial CNS infections and the lack of a clearly defined cut-off value are limitations of the test. METHODS In our prospective study, we evaluated CSF CXCL13 levels in patients with LNB (47 patients), tick-borne encephalitis (TBE; 46 patients), enteroviral CNS infections (EV; 45 patients), herpetic CNS infections (HV; 23 patients), neurosyphilis (NS; 11 patients) and controls (46 patients). The correlation of CXCL13 with CSF mononuclears was determined in all groups. RESULTS Median CXCL13 was significantly higher in LNB group; however, the cut-off value of 162 pg/mL was also exceeded in 22% of TBE patients, 2% EV patients, 44% HV patients and in 55% patients with NS. Sensitivity and specificity were 0.83 and 0.78, respectively, with a Youden index of 0.62. CXCL13 was significantly correlated with CSF mononuclears (p = .0024), but the type of infectious agent had a greater influence on CXCL13 levels. CONCLUSIONS Increased CXCL13 levels are useful for LNB diagnostics, but other non-purulent CNS infections causes should be considered if intrathecal synthesis of borrelia specific antibodies is not confirmed or clinical manifestations are atypical.
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Affiliation(s)
- Dita Smíšková
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Olga Džupová
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Lenka Moravcová
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Dušan Pícha
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
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Courtier A, Potheret D, Giannoni P. Environmental bacteria as triggers to brain disease: Possible mechanisms of toxicity and associated human risk. Life Sci 2022; 304:120689. [DOI: 10.1016/j.lfs.2022.120689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 11/24/2022]
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Incidence and occurrence of tick-borne encephalitis and neuroborreliosis in Germany. Ticks Tick Borne Dis 2021; 13:101867. [PMID: 34936972 DOI: 10.1016/j.ttbdis.2021.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/06/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022]
Abstract
Given the nationwide distribution of the vector, Ixodes ricinus, both neuroborreliosis and tick-borne encephalitis (TBE) might be expected to occur throughout Germany. However, cases of neuroborreliosis and TBE have so far only been reported in certain German states and counties. The aim of this survey therefore was to investigate the possible occurrence of TBE in regions not designated as known risk areas and the spread and incidence of neuroborreliosis throughout Germany. Data were collected by means of a questionnaire which was sent to 305 neurological clinics in Germany. Only twenty-two of them (7.2%) participated in a prospective, and 52 (17%) in a retrospective survey, therefore the significance of the study is limited. Cases of TBE were detected in five counties (Barnim, Dessau-Roßlau, Western Pomerania-Ruegen, Saarbruecken, Uckermark) that were not known so far as areas of risk according to the definition of the German Robert-Koch-Institute (RKI). The median incidence of TBE in various counties was 1.24 cases with a range from 0.19 to 20 cases per 100,000 inhabitants/year. Illnesses from neuroborreliosis were reported from all 61 counties, where clinics participated in the study. The incidence here varied between 0.19 and 23.4 cases with a median of 3.0 cases per 100,000 inhabitants/year. In areas where both diseases occurred, their incidence differed greatly from each other. The survey shows the occurrence of TBE in several counties in eastern Germany that are not defined as risk areas by the RKI and an incidence of neuroborreliosis in Germany that is significantly higher than reported to the public health authorities.
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Berek K, Hegen H, Auer M, Zinganell A, Di Pauli F, Deisenhammer F. Cerebrospinal fluid oligoclonal bands in Neuroborreliosis are specific for Borrelia burgdorferi. PLoS One 2020; 15:e0239453. [PMID: 32977328 PMCID: PMC7518929 DOI: 10.1371/journal.pone.0239453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) oligoclonal bands (OCB) occur in chronic or post-acute phase of inflammatory diseases of the central nervous system. Objective To determine whether CSF OCB in patients with neuroborreliosis (NB) are specific for borrelia burgdorferi senso lato. Methods We performed isoelectric focusing followed by immunoblotting in CSF of 10 NB patients and 11 controls (7 patients with multiple sclerosis, 2 patients with neuromyelitis optica spectrum disease, 1 patient with dementia and 1 patient with monoclonal gammopathy). Immunoblotting was performed using an uncoated as well as a borrelia antigen pre-coated nitrocellulose membrane (NCM). OCB were counted by visual inspection and photometric analysis. OCB were compared between uncoated und pre-coated NCM both in the NB and control group. For validation purposes inter-assay precision was determined by calculating the coefficient of variation (CV) Results Borrelia-specific OCB were found in the CSF of 9 NB patients and in none of the control subjects resulting in a sensitivity of 90% and a specificity of 100%. Number of NB specific OCB were 11±7 bands by photometric analyses compared to 9±5 bands by visual inspection. Validation experiments revealed an inconsistent inter-assay precision between visual and photometric analyses (NB uncoated: visual 28% versus photometric 14%, control subject uncoated: visual 16% versus photometric 24%). Conclusions In CSF samples with positive OCB, Borrelia-specific bands were detected in almost all NB patients and in none of the control subjects. Inconsistent inter-assay precision may be explained by a poor comparability of visual and photometric approach.
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Affiliation(s)
- Klaus Berek
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Di Pauli
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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