Treib J, Woessner R, Dobler G, Fernandez A, Holzer G, Schimrigk K
Department of Neurology, University of the Saarland, Homburg, Germany.
Acta Virol. 1997 Feb;41(1):27-30.
The production of intrathecal antibodies is considered a highly specific marker for an infection of the central nervous system (CNS), e.g. borreliosis or tick-borne encephalitis (TBE). To investigate the validity of this assumption, we examined records of patients who had been hospitalized between 1989 and 1995, who were tested for borreliosis (n = 8003) and TBE (n = 904) and whose cerebrospinal fluid (CSF) had subsequently tested positive for intrathecal production of antibodies. The time period between the beginning of the symptoms and the time of the CSF examination ranged from one day to six weeks. Seventy-seven patients showed a production of intrathecal antibodies against Borrelia burgdorferi. Three of these patients were false positives with no history and no clinical signs of neuroborreliosis. In two cases, this was due to a non-specific cross-reaction caused by a preceding infection with syphilis. The third false positive was possibly caused by an earlier administration of immunoglobulins. Three patients showed a production of intrathecal antibodies against TBE virus. Two of these patients were false positives. In one case, we suspect that the production of intrathecal antibodies was caused by a non-specific immune reaction during an acute neuroborreliosis. One year earlier, the patient had contact with TBE virus through a vaccination against TBE. The cause of the second false positive is unclear, the clinical findings, acute encephalitis and the serological analysis suggest a cross-reaction with a virus similar to TBE. A specific intrathecal production of antibodies is not a proof for an infection of the CNS. In unclear cases, one should carry out a Western blot analysis or, if one suspects a case of TBE, a neutralization test.
鞘内抗体的产生被认为是中枢神经系统（CNS）感染的高度特异性标志物，例如莱姆病或蜱传脑炎（TBE）。为了研究这一假设的有效性，我们检查了1989年至1995年间住院患者的记录，这些患者接受了莱姆病（n = 8003）和TBE（n = 904）检测，其脑脊液（CSF）随后检测出鞘内抗体产生呈阳性。症状开始至CSF检查的时间段为1天至6周。77例患者显示出针对伯氏疏螺旋体的鞘内抗体产生。其中3例患者为假阳性，无神经莱姆病病史和临床体征。在2例中，这是由于先前梅毒感染引起的非特异性交叉反应所致。第三例假阳性可能是由于早期给予免疫球蛋白所致。3例患者显示出针对TBE病毒的鞘内抗体产生。其中2例患者为假阳性。在1例中，我们怀疑鞘内抗体的产生是由急性神经莱姆病期间的非特异性免疫反应引起的。1年前，该患者通过接种TBE疫苗接触过TBE病毒。第二例假阳性的原因尚不清楚，临床发现、急性脑炎和血清学分析提示与一种类似于TBE的病毒发生交叉反应。鞘内特异性抗体产生并不能证明CNS感染。在不明确的病例中，应进行蛋白质印迹分析，或者，如果怀疑是TBE病例，则应进行中和试验。
