The B-lymphocyte chemokine CXCL13 in the cerebrospinal fluid of children with Lyme neuroborreliosis: associations with clinical and laboratory variables

Abstract

Background: The B-lymphocyte chemokine CXCL13 is increasingly considered as a useful early phase diagnostic marker of Lyme neuroborreliosis (LNB). However, the large variation in level of CXCL13 in the cerebrospinal fluid (CSF) observed in LNB patients is still unexplained. We aimed to identify factors associated with the level of CXCL13 in children with LNB, possibly improving the interpretation of CXCL13 as a diagnostic marker of LNB.

Methods: Children with confirmed and probable LNB were included in a prospective study on CXCL13 in CSF as a diagnostic marker of LNB. The variables age, sex, facial nerve palsy, generalized inflammation symptoms (fever, headache, neck-stiffness and/or fatigue), duration of symptoms, Borrelia antibodies in CSF, Borrelia antibody index (AI), CSF white blood cells (WBC), CSF protein and detection of the genospecies Borrelia garinii by PCR were included in simple and multivariable regression analyses to study the associations with the CXCL13 level.

Results: We included 53 children with confirmed and 17 children with probable LNB. CXCL13 levels in CSF were positively associated with WBC, protein and Borrelia antibodies in CSF in both simple and multivariable analyses. We did not find any associations between CXCL13 and age, sex, clinical symptoms, duration of symptoms, AI or the detection of Borrelia garinii.

Conclusions: High levels of CSF CXCL13 are present in the early phase of LNB and correlate with the level of CSF WBC and protein. Our results indicate that CSF CXCL13 in children evaluated for LNB can be interpreted independently of clinical features or duration of symptoms.

Keywords:

• Lyme neuroborreliosis
• CXCL13
• children
• clinical variables
• laboratory variables
• diagnosis

View addendum:

Diagnosis of Lyme neuroborreliosis

Acknowledgements

The authors thank Sivagowri Kasinathan (Department of Immunology and Transfusion Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway) for performing the CXCL13 analysis; Maryam Saeed, Ilka Huber and Grete Vigemyr for inclusion of patients at the local Departments of Pediatric and Adolescent Medicine (Hospital of Southern Norway Trust, Kristiansand, Hospital of Southern Norway Trust, Arendal and Haugesund Hospital, respectively); Hanne Quarsten (Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway) for performing Borrelia genospecies analyses; the staff at the pediatric wards at the participating hospitals for the recruitment of patients, and finally, the participating children and their parents.

Ethical approval

The study was approved by the Regional Committee for Medical Health and Research Ethics in Western Norway.

Informed consent

For each child, one of the parents provided written informed consent to participate.

Disclosure statement

The authors declare that they have no competing interests.

Additional information

Funding

This research has received a grant from Stavanger University Hospital and the EU-Interreg ÖKS Project ScandTick Innovation for laboratory analyses and from the Western Norway Health Authority (reference number: 912017) for a scholarship (corresponding author). The funders had no role in the study design, data collection and interpretation, and the decision to submit the work for publication.