Cerebrospinal fluid chemokine CXCL13 in the diagnosis of neuroborreliosis in children

Abstract

Background: The diagnosis of Lyme neuroborreliosis (LNB) requires laboratory confirmation because neurological symptoms indicative of LNB are not specific. Recent studies have suggested that a chemokine, CXCL13, could have an important role in the diagnosis of LNB. The aim of this study was to assess CXCL13 levels in the cerebrospinal fluid (CSF) of children with LNB. Methods: CSF samples were available for 57 children with symptoms indicative of LNB. Based on the presence of anti-flagella antibodies and pleocytosis in CSF, patients were divided into 3 different groups: confirmed LNB (n = 24), possible LNB (n = 16), and non-LNB (n = 17). CXCL13 levels were determined with a commercial kit (Quantikine). Results: All 24 patients with confirmed LNB had elevated CXCL13 levels in CSF. Elevated CXCL13 was also observed in the majority of patients without anti-flagella antibodies in the CSF (possible LNB). Of the 17 non-LNB and 50 control samples, 1 was positive. Conclusions: In LNB, the production of CXCL13 in CSF seems to precede antibody production. Assessment of CSF CXCL13 may improve the diagnostics for children with possible LNB.

Keywords::

• Lyme neuroborreliosis
• cerebrospinal fluid
• children
• CXCL13

Acknowledgements

The authors thank the medical staff at the Paediatric Clinics in Linköping, Norrköping, Jönköping, and Helsinki for including patients and controls in the study. Special thanks to laboratory technician Pirkko Kokkonen in Finland and Mari-Anne Åkeson in Sweden. This work was supported by the National Technology Agency (TEKES), the Biomedicum Helsinki Foundation, Orion-Farmos Research Foundation, Finnish Concordia Found, and Helsinki University Central Hospital Research Funds, Finland, and by the County Council in Östergötland, the Centre for Clinical Research in Dalarna (CKF), the Lions Foundation, the Samaritan Foundation, and the Holmia Foundation, Sweden.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.