Optimised Diagnosis of Neuroborreliosis. Signalling Protein as a Biomarker.

A newly defined threshold for the concentration of the cytokine CXCL13 may improve the diagnosis of neuroborreliosis. The clinical diagnosis of this disease, which is caused by infections from tick bites, is still difficult and often occurs long after infection. CXCL13 now makes it possible to diagnose neuroborreliosis more quickly and start treatment earlier. In the study conducted by the Karl Landsteiner University of Health Sciences (KL Krems), a concentration of CXCL13 in the cerebrospinal fluid of > 271 pg/ml was identified with a very high statistical certainty as the threshold value for a better diagnosis of neuroborreliosis.

Lyme disease is caused by infection with the bacterium Borrelia burgdoferi, with tick bites being the most common mode of transmission. In about 15% of cases, the infection spreads to the nervous system and causes a condition called neuroborreliosis. This causes symptoms ranging from headaches and dizziness to facial paralysis and epilepsy. Diagnosis is difficult and involves several methods. These include identifying neurological abnormalities, measuring the proliferation of white blood cells in the cerebrospinal fluid (CSF) and detecting specific antibodies in the CSF. However, all of these methods are relatively non-specific, complex and time-consuming. CXCL13, a signalling protein that is produced immediately after infection with B. burgdorferi and triggers an immune response, could provide a more accurate diagnosis – if it were known at what concentration a clear statement could be made. A team from Krems has now found this threshold.

Our measurements of the concentration of CXCL13 in the CFS showed a clear difference between people with neuroborreliosis and those in whom this infection was not clinically detectable. In the group of people affected by CFS, the average value was 8,273 picograms per millilitre – while in those who were not affected, this value was 45.

Dr Christoph Waiß from the Division of Neurology at St. Pölten University Hospital (a teaching and research siteof KL Krems)

For Dr Waiß, the high significance of CXCL13 levels in CSF and the readily available test to measure the concentration lead to a clear clinical benefit of the study, now published in the Journal of Central Nervous System Disease.

The concentration of CXCL13 is an excellent biomarker that can support the diagnosis of neuroborreliosis shortly after infection, especially in equivocal cases. Together with the colleagues involved in this study, I believe that this biomarker should be included in the routine diagnosis of neuroborreliosis.

Dr Christoph Waiß