Comparison of two methods - Evidence of intrathecal synthesis of specific antiborrelia antibodies and the polymerase chain reaction - in the diagnosis of Lyme Borreliosis
Abstract
In 25 patients with the diagnosis of Lyme neuroborreliosis the intrathecal secretion of specific antiborrelia antibodies was assessed and compared with evidence of Borrelia DNA in cerebrospinal fluid and plasma. Autochthonous production of antiborrelia antibodies was assessed by calculation using the specific antibody index AI Bb and for detection of the DNA of spirochete the authors used the two-stage polymerase chain reaction ("nested" PCR) with three sets of primers: for the plasmid gene coding OspC protein and for chromosomal genes coding 16S rDNA and flagellin.
Specific antiborrelia antibodies in serum were detected in 20 (80%) patients and intrathecal synthesis of specific IgG antibodies was found in 22/(88%) of the examined subjects. DNA spirochetes were detected in cerebrospinal fluid 12x (48%) and in plasma 6x (24%).
At least once DNA of borrelias in some examined biological material was detected in 13 (52%) of the patients. In 3 patients DNA was detected and no specific antibodies were found.
By comparison of results of assessment of autochthonous production of antiborrelia antibodies and PCR it was revealed that the method of calculation of the antibody index was more sensitive (88%) as compared with "direct" evidence of the spirochete in cerebrospinal fluid (48%) and in plasma (24%) before antibiotic therapy. The assembled results showed that the PCR for detection of borrelias can usefully supplement the diagnosis of neuroborreliosis but cannot replace "classical" serology.