Nora Wutte1, Juan Archelos2, Brian A Crowe3, Werner Zenz4, Elisabeth Daghofer5, Franz Fazekas6, Elisabeth Aberer7. 1. Department of Dermatology and Venerology, Division of Environmental Dermatology and Venerology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria. Electronic address: Nora.wutte@medunigraz.at. 2. Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbrugger Platz 22, A-8036 Graz, Austria. Electronic address: juan.archelos@medunigraz.at. 3. Vaccines R&D, Baxter Bioscience, Orth an der Donau, Austria. 4. Department of General Pediatrics, Medical University of Graz, Auenbrugger Platz 34/2, A-8036 Graz, Austria. Electronic address: Werner.zenz@medunigraz.at. 5. Institute for Hygiene and Microbiology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria. 6. Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbrugger Platz 22, A-8036 Graz, Austria. Electronic address: franz.fazekas@medunigraz.at. 7. Department of Dermatology and Venerology, Division of Environmental Dermatology and Venerology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria. Electronic address: Elisabeth.aberer@medunigraz.at.
Abstract
PURPOSE: To compare Borrelia-specific intrathecal antibodies by two different ELISAs, an immunoblot (IB) and CXCL13. METHODS: Twenty-seven adults and 23 children with clinical symptoms compatible with NB were tested for Borrelia-specific intrathecal antibodies by flagellum ELISA-AI (flELISA), a recombinant ELISA-AI (rELISA) and by IB. Patients were classified according to the European Federation of Neurological Societies (EFNS) criteria as definite NB, possible NB, or non-NB. CSF CXCL13 levels were measured by ELISA. RESULTS: Among 50 patients, definite NB was diagnosed with the rELISA-AI in 29 (58%) patients, confirmed by IB in 19/29 patients, with flELISA-AI in 17 (34%) patients, confirmed by IB in 15/17 patients, and with IB in 20 (40%) patients. CXCL13 was positive in 22 (44%) patients. In 4 of 8 patients with negative AI, IB showed many detectable bands both in the CSF and serum. CONCLUSIONS: The diagnosis of NB strongly relies on the used test method. The rELISA-AI test appears to be the most sensitive while the flELISA-AI is the least sensitive. However when the ELISA-AIs were confirmed by IB, different patients were identified as NB, while only 26% were identified by all performed test methods. There is a demand for standardized test methods with well-defined sensitivity and specificity to establish validated diagnostic criteria for NB including the use of the IB assay and CXCL13 as an additional non-Borrelia specific determinant in early NB.
PURPOSE: To compare Borrelia-specific intrathecal antibodies by two different ELISAs, an immunoblot (IB) and CXCL13. METHODS: Twenty-seven adults and 23 children with clinical symptoms compatible with NB were tested for Borrelia-specific intrathecal antibodies by flagellum ELISA-AI (flELISA), a recombinant ELISA-AI (rELISA) and by IB. Patients were classified according to the European Federation of Neurological Societies (EFNS) criteria as definite NB, possible NB, or non-NB. CSF CXCL13 levels were measured by ELISA. RESULTS: Among 50 patients, definite NB was diagnosed with the rELISA-AI in 29 (58%) patients, confirmed by IB in 19/29 patients, with flELISA-AI in 17 (34%) patients, confirmed by IB in 15/17 patients, and with IB in 20 (40%) patients. CXCL13 was positive in 22 (44%) patients. In 4 of 8 patients with negative AI, IB showed many detectable bands both in the CSF and serum. CONCLUSIONS: The diagnosis of NB strongly relies on the used test method. The rELISA-AI test appears to be the most sensitive while the flELISA-AI is the least sensitive. However when the ELISA-AIs were confirmed by IB, different patients were identified as NB, while only 26% were identified by all performed test methods. There is a demand for standardized test methods with well-defined sensitivity and specificity to establish validated diagnostic criteria for NB including the use of the IB assay and CXCL13 as an additional non-Borrelia specific determinant in early NB.
Authors: Tamara van Gorkom; Willem Voet; Gijs H J van Arkel; Michiel Heron; B J A Hoeve-Bakker; Daan W Notermans; Steven F T Thijsen; Kristin Kremer Journal: Microbiol Spectr Date: 2022-06-21