Issakainen J, Gnehm H E, Lucchini G M, Zbinden R
Children's Hospital, Kantonsspital Aarau.
Klin Padiatr. 1996 May-Jun;208(3):106-9. doi: 10.1055/s-2008-1046456.
Due to the wide spectrum of clinical manifestations of Lyme neuroborreliosis laboratory investigations are necessary to confirm the diagnosis. Serum and CSF antibodies against Borrelia burgdorferi (Bb) as well as mononuclear CSF pleocytosis are usually present in patients with suspected neuroborreliosis. In some cases, however, the results may be conflicting, causing difficulty for the clinician in making a therapeutic decision. We therefore analysed the value of clinical symptoms, the presence of intrathecal antibody production against Bb with a modified IFA and a capture ELISA test, and the presence of Bb in the CSF with PCR testing in eleven children with suspected neuroborreliosis. In six of eight children with probable neuroborreliosis we could demonstrate intrathecal antibody production against Bb. In only one of these cases could Bb be detected in the CSF with the PCR assay. In two children the clinical manifestations consisting of erythema chronicum migrans and facial palsy, the presence of mononuclear CSF pleocytosis, and the presence of Bb specific antibodies in serum supported the diagnosis of neuroborreliosis, despite the absence of intrathecal specific antibodies. Three additional children with possible neuroborreliosis based on the occurrence of nonspecific clinical symptoms along with high serum antibody titers to Bb were included in the study. Intrathecal antibodies against Bb could not be detected and the PCR result was negative; therefore the diagnosis of neuroborreliosis was not substantiated in these three patients. We conclude that in addition to clinical symptoms, serological evidence and CSF findings suggestive of neuroborreliosis, the demonstration of intrathecal specific antibody synthesis against Bb may be helpful in establishing a definitive diagnosis of neuroborreliosis. The absence of CSF antibodies, however, does not necessarily indicate a lack of CNS involvement, especially if the examination is performed early in the course of disease. PCR testing in CSF is not suitable for routine application in the diagnosis of Lyme neuroborreliosis.
由于莱姆病神经螺旋体病临床表现多样，因此需要进行实验室检查以确诊。疑似神经螺旋体病患者通常存在抗伯氏疏螺旋体（Bb）的血清和脑脊液抗体以及脑脊液单核细胞增多。然而，在某些情况下，结果可能相互矛盾，给临床医生做出治疗决策带来困难。因此，我们分析了临床症状的价值、用改良免疫荧光法（IFA）和捕获酶联免疫吸附测定（ELISA）检测脑脊液中针对Bb的鞘内抗体产生情况，以及用聚合酶链反应（PCR）检测11例疑似神经螺旋体病儿童脑脊液中Bb的情况。在8例可能患有神经螺旋体病的儿童中，有6例可证明存在针对Bb的鞘内抗体产生。在这些病例中，只有1例通过PCR检测在脑脊液中检测到Bb。另外2例儿童有慢性游走性红斑和面瘫的临床表现、脑脊液单核细胞增多以及血清中存在Bb特异性抗体，尽管缺乏鞘内特异性抗体，但这些支持了神经螺旋体病的诊断。另外3例基于出现非特异性临床症状以及血清中针对Bb的抗体滴度高而可能患有神经螺旋体病的儿童也纳入了研究。未检测到针对Bb的鞘内抗体，PCR结果为阴性；因此，这3例患者的神经螺旋体病诊断未得到证实。我们得出结论，除了临床症状、提示神经螺旋体病的血清学证据和脑脊液检查结果外，证明存在针对Bb的鞘内特异性抗体合成可能有助于确立神经螺旋体病的明确诊断。然而，脑脊液抗体的缺乏并不一定表明中枢神经系统未受累，尤其是在疾病早期进行检查时。脑脊液PCR检测不适用于莱姆病神经螺旋体病诊断的常规应用。
