Remy MM, et al. – This study was designed not only to assess the clinical relevance of measuring CXCL13 in the cerebrospinal fluid (CSF) of children with suspected Lyme neuroborreliosis (LNB) but also to determine a CXCL13 cut-off concentration that would discriminate between LNB and other central nervous system (CNS) infections. It was found that CSF CXCL13 was highly elevated in children during early LNB as previously shown in adults. The findings suggested that CXCL13 was a highly sensitive and specific marker that helps to distinguish LNB from other CNS affections in children.

Methods

• It was a single-center retrospective case-control study.
• A diagnostic-approved ELISA was used to measure CXCL13 concentrations in the CSF of one hundred eighty-five children with LNB suspicion at presentation.
• After that, patients were classified into definite LNB (cases), non-LNB (controls with other CNS affections), and possible LNB.
• Finally, a receiver-operating characteristic curve was generated by comparison of cases and controls.

Results

• The study results showed that CXCL13 was significantly elevated in the CSF of fifty-three children with definite LNB (median 774.7 pg/ml) compared to 91 control patients (median 4.5 pg/ml, p < 0.001).
• It was noted that a cut-off of 55 pg/ml resulted in a sensitivity of 96.7% and a specificity of 98.1% for the diagnosis of definite LNB and the test displayed a diagnostic odds ratio of 1525.3.
• In addition, elevated CSF CXCL13 levels were detected in 3 controls with viral meningitis (enterovirus n = 1, varicella-zoster virus n = 2) while other CNS affections such as idiopathic facial palsy did not lead to CXCL13 elevation.
• According to the findings obtained, of the forty-one patients with possible LNB, 27% had CXCL13 values above the cut-off of 55 pg/ml (median 16.7 pg/ml).