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Two-tiered serology in patients with Lyme neuroborreliosis

By
Tatjana Roganović ,
Tatjana Roganović
Contact Tatjana Roganović

Infectious Diseases Clinic, University clinical center of Republika Srpska, Banja Luka, Bosnia and Herzegovina

Miloš Korać ,
Miloš Korać

Klinički centar Srbije, Belgrade, Serbia

Borut Bosančić ,
Borut Bosančić

Faculty of Agriculture, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Višnja Mrdjen ,
Višnja Mrdjen

Infectious Diseases Clinic, University clinical center of Republika Srpska, Banja Luka, Bosnia and Herzegovina

Ljiljana Božić ,
Ljiljana Božić

Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Andjela Bojanić
Andjela Bojanić

Faculty of Medicine , University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Editor: Siniša Ristić

Abstract

Introduction. Lyme borreliosis is a multisystem infectious disease caused by Borrelia burgdorferi sensu lato complex. It is transmitted by Ixodes ticks. Apart from erythema migrans, other manifestations require laboratory confirmation. The aim of our study was to analyze the results of Two-Tiered Testing in patients with possible Lyme neuroborreliosis (LNB).

Method. We conducted a prospective diagnostic study at the University Clinical Centre of Republic of Srpska from October 2017 to October 2021. The study included 51 patients exam ined and treated under suspicion of Lyme neuroborreliosis (LNB). We used Two-Tiered Testing through ELISA anti-Borrelia IgM/IgG and confirmatory Immunoblot anti-Borrelia test IgM/ IgG.

Results. ELISA anti-Borrelia IgM in serum was positive in 25.5% patients and IgG in 76.47%, while in cerebrospinal fluid (CSF) IgM was positive in 13.7% patients and IgG in 39.2%. Immuno blot test of anti-Borrelia IgM in serum was at the borderline in 7.84% patients, positive in 6.17% and no data for 35.29%, while IgG was positive in 54.9% of patients and no data for 37.25%. A strong correlation between results of ELISA anti-Borrelia IgM in serum and CSF was observed (ρ=0.802, p<0.001) and also between ELISA anti-Borrelia IgG and Immunoblot IgG in serum (ρ=0.787, p<0.001).

Conclusion. Two-Tiered Testing is very important in patients with possible LNB. False positive and false negative results are possible and test should be interpreted with caution and in correlation with the clinical manifestation and other avail able tests. More work needs to be done to develop new reli able diagnostic test for LNB, such as detection of CXCL13 in CSF, titrate the interleukin-6 (IL-6) in addition to the CXCL13 chemokine.

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