title: Laboratory diagnosis of Lyme neuroborreliosis is influenced by the test used: comparison of two ELISAs, immunoblot and CXCL13 testing.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Nora
authors.initials: N
authors.lastname: Wutte
authors.affiliation: Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbrugger Platz 22, A-8036 Graz, Austria. Electronic address: juan.archelos@medunigraz.at.
authors.forename: Juan
authors.initials: J
authors.lastname: Archelos
authors.affiliation: Vaccines R&D, Baxter Bioscience, Orth an der Donau, Austria.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Crowe
authors.affiliation: Department of General Pediatrics, Medical University of Graz, Auenbrugger Platz 34/2, A-8036 Graz, Austria. Electronic address: Werner.zenz@medunigraz.at.
authors.forename: Werner
authors.initials: W
authors.lastname: Zenz
authors.affiliation: Institute for Hygiene and Microbiology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Daghofer
authors.affiliation: Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbrugger Platz 22, A-8036 Graz, Austria. Electronic address: franz.fazekas@medunigraz.at.
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.affiliation: 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.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Aberer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D025065:Borrelia burgdorferi / Q000276:immunology*; D054382:Chemokine CXCL13 / Q000134:cerebrospinal fluid*; D002648:Child; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: C110663:CXCL13 protein, human; D054382:Chemokine CXCL13
keywords: CXCL13; Diagnosis; ELISA; Immunoblot; Neuroborreliosis