No correlation between symptom duration and intrathecal production of IgM and/or IgG antibodies in Lyme neuroborreliosis – a retrospective cohort study in Denmark

Ingrid Krogen*, Sigurdur Skarphédinsson, Thøger Gorm Jensen, Fredrikke Christie Knudtzen

*Corresponding author for this work

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Abstract

Objectives: In Europe, a definite diagnosis of Lyme neuroborreliosis (LNB) requires intrathecally produced Borrelia-specific antibodies. We aimed to examine if the time from symptom debut to lumbar puncture (LP) correlated with findings of intrathecal production of Borrelia-specific IgM and/or IgG antibodies in LNB Methods: A retrospective study of 544 patients with a positive Borrelia burgdorferi antibody index (Bb-AI) analysed at the Department of Clinical Microbiology, Odense University Hospital, Denmark, between 01.01.1995 and 31.12.2020 Results: The delay from symptom onset to LP for patients with positive Bb-AI IgM was 30 days (IQR 14–95 days), IgG 24 days (IQR 11–62), IgM+IgG 24 days (IQR 14–48), P = 0.098. Ninety-three patients had a second LP after median 125 days (IQR 28–432) and 25 had a third LP after median 282 days (IQR 64–539). Most patients (66.7%) did not convert from their initial intrathecal antibody finding. The prevalence of different clinical manifestations differed significantly between the three Bb-AI groups. Conclusions: Intrathecal Borrelia-specific antibody production did not follow the typical immune response of initial IgM production followed by IgG production. Diagnosis of LNB stage should not be based on the type of antibodies found in the cerebrospinal fluid.

Original languageEnglish
JournalJournal of Infection
Volume85
Issue number5
Pages (from-to)507-512
ISSN0163-4453
DOIs
Publication statusPublished - Nov 2022

Keywords

  • Borrelia burgdorferi sensu lato
  • Cerebrospinal fluid
  • Intrathecal borrelia burgdorferi antibody index
  • Lyme neuroborreliosis

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