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Clinical, diagnostic and immunological characteristics of patients with possible neuroborreliosis without intrathecal Ig-synthesis against Borrelia antigen in the cerebrospinal fluid
Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
Kalmar Hospital.
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2011 (English)In: Neurology International, ISSN 2035-8385, E-ISSN 2035-8377, Vol. 3, no 1, e2Article in journal (Refereed) Published
Abstract [en]

The diagnosis of neuroborreliosis is not always straightforward. Intrathecal immunoglobulin (Ig) synthesis against Borrelia antigen may not be detected, at least early in the disease course. Also other neurological and infectious diagnoses have to be considered. We have studied patients with clinical possible neuroborreliosis without intrathecal Ig synthesis against Borrelia antigen in the cerebrospinal fluid (CSF) (n=17). Diagnosis was based on typical clinical history and at least one of the following findings; mononuclear leucocytosis in the CSF (n=4); typical erythema migrans >5 cm in diameter in relation to debut of symptoms (n=8); prompt clinical response to antibiotic teratment (n=14). Also other possible diagnoses had to be excluded. Seventeen patients first investigated because of suspected neuroborreliosis but later confirmed with other diagnoses were used as controls. All patients had a lumbar puncture. Borrelia specific IFN-γ and IL-4 secretion was investigated in peripheral blood (PBL) and CSF with an ELISPOT assay. Polymerase chain reaction (PCR) was used to reveal any Borrelia antigen in the CSF. Six of 17 patients with possible neuroborreliosis showed high IFN-g secretion in peripheral blood, otherwise we found no statistically significant differences between the groups. PCR did not reveal any Borrelia antigen in CSF. The diagnosis and treatment of possible but not confirmed neuroborreliosis is a clinical challenge. The clinical response to treatment may be the best option in these cases.

Place, publisher, year, edition, pages
Pavia: Page One Publishing Pte Ltd, 2011. Vol. 3, no 1, e2
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Medical and Health Sciences
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URN: urn:nbn:se:liu:diva-75351DOI: 10.4081/ni.2011.e2OAI: oai:DiVA.org:liu-75351DiVA: diva2:506071
Available from: 2012-02-27 Created: 2012-02-27 Last updated: 2017-12-07Bibliographically approved

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Vrethem, MagnusWidhe, MonaErnerudh, JanForsberg, Pia

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NeurologyFaculty of Health SciencesDepartment of NeurologyClinical ImmunologyDepartment of Clinical Immunology and Transfusion MedicineInfectious DiseasesDepartment of Infectious Diseases
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