Presence of BB-specific
antibodies in the cerebrospinal fluid (CSF) with evidence of their intrathecal production in conjunction with the white cell count in the CSF and typical clinical symptoms is the traditional diagnostic gold standard of
Lyme neuroborreliosis (LNB). Few data are available on the CSF
lactate concentration in European adults with the diagnosis of acute LNB. The objective of the study was to investigate the CSF changes during acute LNB. Routine CSF parameters [leukocyte count,
protein,
lactate and
albumin concentrations, CSF/serum quotients of
albumin (Q(Alb)),
IgG,
IgA and
IgM, and
oligoclonal IgG bands] and the Borrelia burgdorferi (BB)-specific antibody index were retrospectively studied in relation to the clinical presentation in patients diagnosed with acute LNB. A total of 118 patients with LNB were categorized into the following groups according to their symptoms at presentation; group 1:
polyradiculoneuritis (Bannwarth's syndrome), group 2: isolated
facial palsy and group 3: predominantly meningitic course of the disease. In addition to the CSF of patients with acute LNB, CSF of 19 patients with
viral meningitis (VM) and 3 with neurolues (NL) were analyzed. There were 97 patients classified with definite LNB, and 21 as probable LNB. Neck stiffness and
fever were reported by 15.3% of patients. Most of these patients were younger than 50 years.
Polyradiculoneuritis was frequently found in patients older than 50 years. Lymphopleocytosis was found in all patients. Only 5 patients had a CSF
lactate ≥3.5 mmol/l, and the mean CSF
lactate level was not elevated (2.1 ± 0.6 mmol/l). The patients with definite LNB had significantly higher
lactate levels than patients with probable LNB. Elevated
lactate levels were accompanied by
fever and
headache. In the Reiber nomograms, intrathecal
immunoglobulin synthesis was found for
IgM in 70.2% followed by
IgG in 19.5%. Isoelectric focussing detected an intrathecal
IgG synthesis in 83 patients (70.3%). Elevated BB AIs in the CSF were found in 97 patients (82.2%). Patients with VM showed lower CSF
protein concentration and CSF/serum quotients of
albumin than LNB patients. In acute LNB, all patients had elevated cerebrospinal fluid (CSF) leukocyte counts. In contrast to
infections by other bacteria, CSF
lactate was lower than 3.5 mmol/l in all but 5 patients. The CSF findings did not differ between
polyradiculoneuritis,
facial palsy, and
meningitis. The CSF in LNB patients strongly differed from CSF in VM patients with respect to
protein concentration and the CSF/
serum albumin quotient.