Elevated Cerebrospinal Fluid CXCL13 Is a Helpful Marker for the Early Diagnosis of Neuroborreliosis in Children.

Abstract

Background: Lyme neuroborreliosis (LNB) is an early systemic manifestation of Lyme disease in children, but standard diagnostic measures have constraints that limit early LNB diagnosis. Elevated cerebrospinal fluid (CSF) concentrations of the chemokine CXCL13 are considered a useful marker for early LNB diagnosis in adults, however, few studies have evaluated their diagnostic value in children.

Methods: In this retrospective analysis, stored CSF samples of 232 hospitalized pediatric patients tested for LNB with standard serological methods were re-analyzed for CXCL13. CXCL13 levels were compared in children classified as definite, possible or no LNB patients according to European Federation of Neurological Societies guidelines. Specificity and sensitivity of CSF CXCL13 were determined for the diagnosis of early LNB, using previously published cutoff levels for pediatric patients.

Results: CSF CXCL13 levels differed significantly between 25 patients with definite LNB (all >7.8 pg/mL; range: 37.9->500 pg/mL) and 174 patients without LNB [160 (92%) <7.8 pg/mL; 13 (7%) with a range of 7.8-59.3 pg/mL; 1 (1%) with >500 pg/mL and Ureaplasma parvum CNS infection]. Using a cutoff of 55 pg/mL, CSF CXCL13 resulted in a specificity of 98.9% (95% CI: 97.4-100) and sensitivity of 92.0% (95% CI: 81.4-100).

Conclusions: This study confirms the high sensitivity and specificity of CSF CXCL13 for the diagnosis of pediatric LNB using a cutoff value of 55 pg/mL. The use of CSF CXCL13 as an additional diagnostic measure in children with suspected LNB could improve diagnostic specificity and thereby reduce unnecessary antibiotic treatment, especially in the early phases of the disease.