Diagnostic performance of cerebrospinal fluid chemokine CXCL13 and antibodies to the C6-peptide in Lyme neuroborreliosis

Tjernberg, Ivar; Henningsson, Anna J.; Eliasson, Ingvar; Forsberg, Pia; Ernerudh, Jan

doi:10.1016/j.jinf.2010.11.005

Cited by 56 publications

(57 citation statements)

References 33 publications

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“…Cranial nerve involvement was a common and a highly specific finding in children with LM, and few other infectious agents are reported to cause simultaneously CSF pleocytosis and cranial nerve involvement in children 29 36 37. All but three children with FNP were defined as LM, and it is possible that these children had early LM as well since no other aetiological agent was identified 27. Furthermore, headache and/or neck stiffness (meningism) as a single symptom was also specific for children with LM, consistent with the observation in a recent European study 38.…”

Section: Discussionmentioning

confidence: 99%

Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study

et al. 2012

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“…[145][146][147][148][149] CXCL13 was found to be elevated in nearly all patients with early Lyme neuroborreliosis, even before B. burgdorferi antibodies were present. In contrast to B. burgdorferi antibodies, CXCL13 levels fall rapidly after the start of antibiotic therapy.…”

Section: Cxcl13-a Potential Diagnostic Biomarkermentioning

confidence: 96%

Lyme neuroborreliosis—epidemiology, diagnosis and management

Fingerle²,

2015

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Lyme disease, caused by the Borrelia burgdorferi bacterium, is the most common vector-borne disease in the northern hemisphere. The clinical presentation varies with disease stage, and neurological manifestations (often referred to as Lyme neuroborreliosis) are reported in up to 12% of patients with Lyme disease. Most aspects of the epidemiology, clinical manifestation and treatment of Lyme neuroborreliosis are well known and accepted; only the management of so-called chronic Lyme disease is surrounded by considerable controversy. This term is used for disparate patient groups, including those who have untreated late-stage infection (for example, late neuroborreliosis), those with subjective symptoms that persist after treatment (termed 'post-treatment Lyme disease syndrome' [PTLDS]), and those with unexplained subjective complaints that may or may not be accompanied by positive test results for B. burgdorferi infection in serum (here called 'chronic Lyme disease'). The incidence of PTLDS is still a matter of debate, and its pathogenesis is unclear, but there is evidence that these patients do not have ongoing B. burgdorferi infection and, thus, do not benefit from additional antibiotic therapy. Chronic Lyme disease lacks an accepted clinical definition, and most patients who receive this diagnosis have other illnesses. Thus, a careful diagnostic work-up is needed to ensure proper treatment.

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“…It has been shown that CXCL13 is expressed at high levels in cerebrospinal fluid (CSF) from LNB patients, while levels were barely detectable in CSF from subjects with noninflammatory neurological disease. Overall sensitivity for LNB ranged from 96 to 100%, and specificity ranged from 63 to 98% (3,6,11,12). Case reports describing early diagnosis of LNB using CXCL13 levels in CSF have already been published (5, 9).…”

Section: Cxcl13 In Cerebrospinal Fluid (Csf) Could Be An Important Comentioning

confidence: 99%

Discriminating Lyme Neuroborreliosis from Other Neuroinflammatory Diseases by Levels of CXCL13 in Cerebrospinal Fluid

et al. 2011

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CXCL13 in cerebrospinal fluid (CSF) could be an important component for diagnosing Lyme neuroborreliosis (LNB). Levels of intrathecal CXCL13 were determined for 58 LNB patients and 210 controls; sensitivity was 88% and specificity was 89% (cutoff, 250 pg of CXCL13/ml of CSF). Elevated levels of CXCL13 can aid in the diagnosis of LNB, but levels should be interpreted with care.Diagnosing Lyme neuroborreliosis (LNB) is difficult because one of the most specific markers, the antibody index (AI), is negative in 21 to 45% of patients (1). Intrathecal levels of CXCL13 have been suggested to be a potential biomarker for LNB. CXCL13 is produced by antigen-presenting cells and is a selective chemoattractant for B cells and B-helper T cells. It has been shown that CXCL13 is expressed at high levels in cerebrospinal fluid (CSF) from LNB patients, while levels were barely detectable in CSF from subjects with noninflammatory neurological disease. Overall sensitivity for LNB ranged from 96 to 100%, and specificity ranged from 63 to 98% (3,6,11,12). Case reports describing early diagnosis of LNB using CXCL13 levels in CSF have already been published (5, 9).Our aim was to determine the diagnostic potential of levels of intrathecal CXCL13 to distinguish acute and late LNB from other central nervous system diseases in the pediatric and adult population.Patients were identified retrospectively using the OLVG Hospital laboratory information management system. CSF and serum samples from 58 LNB patients before treatment were included. Criteria for diagnosing LNB patients were that their meningitis had no other cause and that they had three of the following four characteristics: positive serology at presentation, pleocytosis, positive AI with an Ideia Lyme neuroborreliosis kit (Oxoid, Cambridge, United Kingdom), and objective neurological complaints with clinical improvement after treatment. From this group, definite LNB patients (n ϭ 45) were those who had a pleocytosis and a positive AI, and probable LNB patients (n ϭ 13) were those who had either pleocytosis (n ϭ 12) or a positive AI (n ϭ 1) (4). Ninety-one percent of the LNB patients presented within 6 months of the start of complaints; the range was 7 days to 48 months. Forty-one percent of LNB patients were children. Most LNB patients presented with a facial nerve paralysis (60%) or meningoradiculitis (26%). Seventeen percent of LNB patients reported experiencing erythema migrans (EM) before or at presentation.As controls, we included 36 patients with Lyme borreliosis that did not meet the criteria for LNB, 93 patients with an infectious cause of meningitis/encephalitis, 62 patients with neurological inflammatory diseases, and 12 patients with noninflammatory neurological complaints. Furthermore, seven HIV patients with no neurological complaints or evidence of an intrathecal infection were tested. For patient characteristics, see Table S1 in the supplemental material.CSF samples were tested with a Quantikine human CXCL13/BLC/BCA-1 immunoassay (R&D Systems, Minneapolis, MN).Resu...

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Diagnostic performance of cerebrospinal fluid chemokine CXCL13 and antibodies to the C6-peptide in Lyme neuroborreliosis

Cited by 56 publications

References 33 publications

Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study

Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study

Lyme neuroborreliosis—epidemiology, diagnosis and management

Discriminating Lyme Neuroborreliosis from Other Neuroinflammatory Diseases by Levels of CXCL13 in Cerebrospinal Fluid

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