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Diagnostic performance of cerebrospinal fluid free light chains in Lyme neuroborreliosis: a pilot study
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Kalmar County, Kalmar, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Kalmar County, Kalmar, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Microbiology. Region Jönköping County, Jönköping, Sweden.
2019 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 57, no 12, p. 2008-2018Article in journal (Refereed) Published
Abstract [en]

Background

The aim of this study was to evaluate the diagnostic performance of cerebrospinal fluid (CSF) free light chains (FLCs) in the diagnosis of Lyme neuroborreliosis (LNB).

Methods

Serum and CSF levels of κ- and λ-FLC, albumin and total concentration of immunoglobulin M (IgM) were determined together with CSF chemokine CXCL13 in 23 patients with definite LNB, 35 inflammatory neurological disease control (INDC) and 18 non-inflammatory control (NIC) patients. Indices and intrathecal fractions (IFs) of FLC and IgM were calculated.

Results

Significant differences in FLC indices and IFs were found between the LNB group and both control groups, p ≤ 0.007. Sensitivity of intrathecal κ- and λ-FLC synthesis reached 78%–87% in LNB patients with a specificity of 94%–100% in NIC patients, whereas specificity in INDC patients was 69%. The corresponding frequencies of positive results for IF and index of IgM and CSF CXCL13 in these three diagnostic groups were 74%–96% in LNB patients, 0% in NIC patients and 3%–6% in INDC patients at the chosen cut-off levels.

Conclusions

The findings of this study show a moderate to high sensitivity of CSF κ- and λ-FLC in LNB patients with a high specificity in NIC patients. However, overlap in CSF κ- and λ-FLC levels between LNB and INDC patients calls for caution in the interpretation and limits the diagnostic usefulness in the LNB diagnosis. CSF CXCL13 appears to be the most valuable additional biomarker of LNB aside from routine parameters such as CSF pleocytosis and anti-Borrelia antibody index.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019. Vol. 57, no 12, p. 2008-2018
Keywords [en]
Lyme neuroborreliosis, cerebrospinal fluid, diagnosis, free light chain
National Category
Clinical Laboratory Medicine
Identifiers
URN: urn:nbn:se:liu:diva-161102DOI: 10.1515/cclm-2019-0315ISI: 000496153900033PubMedID: 31199760Scopus ID: 2-s2.0-85067499255OAI: oai:DiVA.org:liu-161102DiVA, id: diva2:1362956
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS)

Available from: 2019-10-22 Created: 2019-10-22 Last updated: 2019-12-09Bibliographically approved

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Tjernberg, IvarHenningsson, Anna J.

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Tjernberg, IvarJohansson, MarcusHenningsson, Anna J.
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Division of Microbiology, Infection and InflammationFaculty of Medicine and Health SciencesDivision of Neuro and Inflammation ScienceDepartment of Clinical Microbiology
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Clinical Chemistry and Laboratory Medicine
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