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Borrelia antibodies in children evaluated for Lyme neuroborreliosis.

AbstractBACKGROUND:
We wanted to elucidate the value of Borrelia antibodies in serum and cerebrospinal fluid (CSF) for the diagnosis of Lyme neuroborreliosis (LNB).
MATERIAL AND METHODS:
We analyzed the serological findings, by anti-flagellin assay, in 267 patients with neurological symptoms from the Stockholm area, where Lyme borreliosis is endemic.
RESULTS:
In the 70 children with LNB, intrathecal Borrelia antibody production was diagnostic and found in 50 (71%). Sixteen (23%) showed an elevated antibody titer in serum only, and 4 (7%) had no serologic findings. Borrelia IgG in serum, with or without concomitant IgM, was a specific (98%), but insensitive (43%) marker of infection. Isolated, false-positive serum IgM titers were common and found in 10 of 67 children (15%) with viral meningitis, as well as in 28 of 111 (25%) with various neurological symptoms and normal CSF. The specificity of an isolated Borrelia IgM titer in serum was 81%, and the positive predictive value for Borrelia infection only 50% in our material. On the other hand, absence of antibodies in blood had a negative predictive value of 94%, which increased to 97% if also CSF findings were included.
CONCLUSIONS:
Intrathecal antibody production is strongly supportive of an LNB diagnosis. Conversely, isolated, elevated levels of Borrelia IgM in serum occur in up to one-fourth of children with various neurological complaints, and should be interpreted with caution, especially in nonendemic areas.
AuthorsR Bennet, V Lindgren, B Zweygberg Wirgart
JournalInfection (Infection) Vol. 36 Issue 5 Pg. 463-6 (Oct 2008) ISSN: 0300-8126 [Print] Germany
PMID18791841 (Publication Type: Journal Article)
Chemical References
  • Antibodies, Bacterial
  • Immunoglobulin G
  • Immunoglobulin M
Topics
  • Antibodies, Bacterial (blood, cerebrospinal fluid)
  • Borrelia (immunology)
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Immunoglobulin G (blood, cerebrospinal fluid)
  • Immunoglobulin M (blood, cerebrospinal fluid)
  • Lyme Neuroborreliosis (blood, cerebrospinal fluid, diagnosis, immunology)
  • Male
  • Retrospective Studies
  • Sweden

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