High sensitivity and specificity of the C6-peptide ELISA on cerebrospinal fluid in Lyme neuroborreliosis patients

Burgel, N.D. van; Brandenburg, A. H.; Gerritsen, H.J.; Kroes, Aloys C.M.; Dam, Alje P. van

doi:10.1111/j.1469-0691.2011.03459.x

Cited by 22 publications

(11 citation statements)

References 27 publications

(29 reference statements)

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“…For example, increased concentrations of CXCL13 (a chemoattractant for B cells) in CSF have been proposed as a biomarker for Lyme neuroborreliosis. Although European patients with Bannwarth syndrome typically have high levels of CXCL13 in CSF, which correlates with intrathecal antibody production against Lyme borrelia 191,192 , numerous other conditions can also cause increased levels of CXCL13, including neurosyphilis, HIV infection, CNS lymphoma and multiple sclerosis 192–194 . Thus, for use as a diagnostic test for Lyme neuroborreliosis, the cut-off concentration of CXCL13 becomes crucially important and needs definition.…”

Section: Discussionmentioning

confidence: 99%

Lyme borreliosis

Steere

Strle

Wormser

et al. 2016

Nat Rev Dis Primers

645

697

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Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. Infection usually begins with an expanding skin lesion, known as erythema migrans (referred to as stage 1), which, if untreated, can be followed by early disseminated infection, particularly neurological abnormalities (stage 2), and by late infection, especially arthritis in North America or acrodermatitis chronica atrophicans in Europe (stage 3). However, the disease can present with any of these manifestations. During infection, the bacteria migrate through the host tissues, adhere to certain cells and can evade immune clearance. Yet, these organisms are eventually killed by both innate and adaptive immune responses and most inflammatory manifestations of the infection resolve. Except for patients with erythema migrans, Lyme borreliosis is diagnosed based on a characteristic clinical constellation of signs and symptoms with serological confirmation of infection. All manifestations of the infection can usually be treated with appropriate antibiotic regimens, but the disease can be followed by post-infectious sequelae in some patients. Prevention of Lyme borreliosis primarily involves the avoidance of tick bites by personal protective measures.

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Section: Discussionmentioning

confidence: 99%

Lyme borreliosis

Steere

Strle

Wormser

et al. 2016

Nat Rev Dis Primers

645

697

View full text Add to dashboard Cite

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“…In retrospect, a brain biopsy might have delivered an earlier diagnosis, but the patient refused. There are scarce reports on seronegative patients who do indeed have intrathecal antibody production, so we cannot fully exclude the presence of Borrelia antibodies in this patient [ 12 , 13 ]. However, given the near-absence of B-cells in CSF, the lack of serum antibodies and the progressive meningo-encephalitic disease progress over months, we hypothesize that intrathecal antibodies were absent.…”

Section: Discussionmentioning

confidence: 98%

Case report: persistently seronegative neuroborreliosis in an immunocompromised patient

et al. 2018

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BackgroundInfection with Borrelia burgdorferi sensu lato complex (B. b. sl) spirochetes can cause Lyme borreliosis, manifesting as localized infection (e.g. erythema migrans) or disseminated disease (e.g. Lyme neuroborreliosis). Generally, patients with disseminated Lyme borreliosis will produce an antibody response several weeks post-infection. So far, no case of neuroborreliosis has been described with persistently negative serology one month after infection.Case presentationWe present a patient with a history of Mantle cell lymphoma and treatment with R-CHOP (rituximab, doxorubicine, vincristine, cyclofosfamide, prednisone), with a meningo-encephalitis, who was treated for a suspected lymphoma relapse. However, no malignant cells or other signs of malignancy were found, and microbial tests did not reveal any clues, including Borrelia serology. He did not recall being bitten by ticks, and a Borrelia PCR on CSF was negative. After spontaneous improvement of symptoms, he was discharged without definite diagnosis. Several weeks later, he was readmitted with a relapse of symptoms of meningo-encephalitis. This time however, a Borrelia PCR on CSF was positive, confirmed by two independent laboratories, and the patient received ceftriaxone upon which he partially recovered. Interestingly, during the diagnostic process of this exceptionally difficult case, a variety of different serological assays for Borrelia antibodies remained negative. Only P41 (flagellin) IgG was detected by blot and the Liaison IgG became equivocal 2 months after initial testing.ConclusionsTo the best of our knowledge this is the first case of neuroborreliosis that is seronegative on repeated sera and multiple test modalities. This unique case demonstrates the difficulty to diagnose neuroborreliosis in severely immunocompromised patients. In this case, a delay in diagnosis was caused by broad differential diagnosis, an absent known history of tick bites, negative serology and the low sensitivity of PCR on CSF. Therefore, awareness of the diagnostic limitations to detect Borrelia infection in this specific patient category is warranted.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3273-8) contains supplementary material, which is available to authorized users.

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“…Similarly, our retrospective chart review of patients in a communitybased setting also found a majority (61 %) of those presenting with neurologic symptoms or arthritis were male (Aucott et al 2012). In the European setting, a male predominance for late-stage arthritis and neurologic complications has also been noted in clinic or referral-based patient samples (Renaud et al 2004;van Burgel et al 2011). For example, a recent analysis of chart reviews from a university medical center in Slovenia from 1990 to 2012 found that there was a male predominance among patients with Lyme arthritis and among those with neuroborreliosis .…”

Section: Late Lyme Diseasementioning

confidence: 98%

Sex and Gender Differences in Infection and Treatments for Infectious Diseases

Klein

Roberts

2015

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This book provides an overview of the underlying sex-based and hormone-based differences in immunity, wound healing and pharmacokinetics, while also exploring how pregnancy affects immunity. The second part of the book shows, for the first time in a single volume, the growing number of infectious diseases for which sex and gender differences are noted, identifies common as well as distinct mechanisms mediating these differences and illustrates how responses to treatments might differ between the sexes. The awareness that males and females differ in their response to specific pathogens as well as to treatments for infectious diseases may yield sex-specific personalized treatments. This book will be of interest to basic scientists and clinicians in the fields of microbiology, immunology and pharmacology. Individuals working in academia, government and industry will also benefit from the information presented

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High sensitivity and specificity of the C6-peptide ELISA on cerebrospinal fluid in Lyme neuroborreliosis patients

Cited by 22 publications

References 27 publications

Lyme borreliosis

Lyme borreliosis

Case report: persistently seronegative neuroborreliosis in an immunocompromised patient

Sex and Gender Differences in Infection and Treatments for Infectious Diseases

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