CXCL13 may improve diagnosis in early neuroborreliosis with atypical laboratory findings

BMC Infectious Diseases

Winfried V Kern²  Johannes Hübner²  Christiane Klier³  Volker Fingerle³  Simone Meier¹  Johannes P Borde⁴ 

[1]Universitätsklinik Freiburg i.Br., Neurologische Klinik, Hugstetter Str. 55, 79106, Freiburg i.Br, Germany

[2]Universitätsklinik Freiburg i.Br., Medizinische Klinik II / Sektion Klinische Infektiologie, Hugstetter Str. 55, 79106, Freiburg i.Br, Germany

[3]Nationales Referenzzentrum für Borrelien, Veterinärstraße 2, 85764, Oberschleißheim, Germany

[4]Ortenauklinikum Offenburg-Gengenbach, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Ebertplatz 12, 77654, Offenburg, Germany

关键词: OspA-type;    B. garinii;    Borrelia burgdorferi;    Neuroborreliosis;    CXCL13;   

Others  :  1158725
DOI  :  10.1186/1471-2334-12-344

 received in 2012-05-13, accepted in 2012-12-07,  发布年份 2012

【 摘 要 】

Background

Current guidelines regarding Lyme neuroborreliosis [LNB] require the presence of intrathecal Borrelia burgdorferi-specific antibody production for the definite diagnosis of LNB. However, about 20% of early stage infections present without an elevated antibody index. Moreover, intrathecal B. burgdorferi specific antibody synthesis may persist long after successful therapy of LNB. Recently published data indicate that CXCL13 seems to be a promising diagnostic tool for early stage LNB. In addition, CXCL13 might be suitable for treatment monitoring.

Case presentation

We report on a 39-year-old male patient from southern Germany, who has been suffering from subfebrile body temperatures and meningeal headache for six weeks. On the second day after hospital admission he developed peripheral palsy of the VII. cranial nerve. Cerebrospinal fluid (CSF) analysis showed granulocytic pleocytosis, elevated total protein and blood-CSF barrier dysfunction. Differential diagnostics for granulocytic pleocytosis were unremarkable. Only a second lumbar puncture, on day 6 after admission, revealed a lymphocytic pleocytosis. Serologic testing pointed to clear intrathecal Borrelia specific IgG antibody production. Interestingly, no anti-OspC antibodies were detectable. DNA of the rare Borrelia garinii OspA-type 7 could be amplified from the first CSF sample. The monitoring of CXCL13 in all CSF samples documented a fast decrease from 5000 pg/ml to 450 pg/ml after appropriate antibiotic treatment.

Conclusion

CXCL13 is a novel biomarker with high sensitivity and specificity for acute LNB. Our data show, that CXCL13 might be helpful in unclear cases and support the presumption that it might be a valuable tool for treatment monitoring. Anti-OspC antibody negativity is a rare observation, given the need of OspC for infection of the human hosts. Most likely this is due to a lack of sensitivity of OspC immunoblots that are unable to detect rare OspC variants.

【 授权许可】

   
2012 Borde et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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