title: Improvement of diagnostic approach to Lyme neuroborreliosis in children by using recombinant antigens in detection of intrathecally produced IgM/IgG.
abstract: BACKGROUND
  The purpose of the study was to evaluate new 3rd-generation test kits, EIA Borrelia recombinant IgM and IgG (TestLine, Brno, Czech Republic), in serum and cerebrospinal fluid (CSF) of children with Lyme neuroborreliosis.
  
  
  METHODS
  Comparison of three tests was used: the whole-cell EIA from Borrelia garinii (EIA 1) was compared with the EIA using recombinant antigens (EIA 2) and immunoblot. In total, 364 samples of serum and CSF were examined. Eighty-six paired sera and CSF samples were evaluated in the first group of children with Lyme neuroborreliosis. The second group consisted of 30 children with probable Lyme neuroborreliosis. Sixty-six samples from children with neuroinfections other than borrelial etiology were used as controls.
  
  
  RESULTS
  In the first group of children with proven LNB, EIA 2 gave significantly more positive results for IgG in serum (P = 0.006; OR = 7.5) as in CSF (P < 0.001; OR = 4.5). There was no statistically significant difference in the IgM positivity of serum (P = 0.54; OR = 0.71). EIA 2 determined significantly (P = 0.001; OR = 0.06) less positive results of IgM in CSF in the LNB patients. IgG antibody index (AI) assessed by both methods revealed similar results (P = 0.646; OR = 1.38). Both methods are comparable, but IgM AI assessed by EIA 2 showed significantly less positive results (P < 0.001; OR = 0.04).The differences in the detection of positive IgM/IgG antibodies in serum and CSF did not reach statistical significance either in the groups of children with excluded LNB or in controls.
  
  
  CONCLUSIONS
  EIA 2 showed better results than EIA 1 and western blot for the detection of positive IgG antibodies in serum and CSF. The difference in the calculation of AI IgG by EIA 1 and EIA 2 was not noticeable in the group of LNB patients. Comparing IgG and IgM AIs calculated from both tests, the sensitivity for EIA 2 was 68% for IgG and 26% for IgM. The specificity is 100% for both tests.
authors.forename: L
authors.initials: L
authors.lastname: Krbková
authors.forename: J
authors.initials: J
authors.lastname: Bednářová
authors.forename: Z
authors.initials: Z
authors.lastname: Čermáková
mesh_terms: D000907:Antibodies, Bacterial / Q000134:cerebrospinal fluid*; D000942:Antigens, Bacterial / Q000276:immunology*; D001431:Bacteriological Techniques; D002648:Child; D006801:Humans; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid*; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid*; D020852:Lyme Neuroborreliosis / Q000175:diagnosis*
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Lyme neuroborreliosis - recombinant antigens - specific anti-Borrelia antibody index - serodiagnosis.