Neuroborreliosis

Borreliosis is a disease that frequently and typically affects both the central and peripheral nervous systems (Table 13 for a historical overview, see Table 14). Owing to the frequent occurrence in our area, it is possible to observe highly variable clinical manifestations as well as different types of pathological appearances in cerebrospinal fluid. Current methods used in neuroborreliosis diagnosis include the evaluation of specific antibodies IgM, IgG detected by ELISA, Western blot, and PCR. 

1883 Acrodermatitis chronica atroficans (ACA) Described by Buchwald in Europe 

1922 Description of neurological syndromes Garin, Bujadoux, and Bannwarth 

The concentration of total protein is a problematic parameter it may vary from normal to slightly increased levels up to a very significant increase, especially in polyradiculoneuritic syndromes caused by neuroborreliosis. 

It is often observed that the concentration of some other protein markers in cerebrospinal fluid is increased. In this respect, it is worth mentioning the increase in some acute-phase proteins, including transferrin, haptoglobin, and orosmucoid. Very frequently an increased concentration of the C3 component is observed in cerebrospinal fluid. Increased concentrations of apolipoproteins in cerebrospinal fluid are frequently seen as well, especially Apo A-I and, less distinctly, Apo B. Although these findings are common, they are also rather nonspecific, suggesting only that the destruction of tissue is present—in this case, the destruction of the central and peripheral myelin. 

---

Neuroborreliosis—especially in the initial stages, the numerical proportion of neutrophils is higher in the chronic stage, the cytological differentiation from multiple sclerosis is practically impossible. 

Examination of the most frequent complex of abnormal CSF parameters may be defined as in Table 7. According to this study, we concluded that generally the inflammatory changes are not so evident as in, say, neuroborreliosis (S8) (see Tables 8-12). 

Changes of immunoglobulin concentrations in cerebrospinal fluid are very common. In neuroborreliosis the increase occurs very frequently in the IgM class, for which it is possible (using Reiber s formula) to demonstrate the presence of intrathecal synthesis. 

Polyradiculoneuritis Guillain-Barre—the manifestation of monocytous oligocytosis is present and is practically indistinguishable from certain forms of neu-roborreliosis the syndrome of proteinocytological dissociation is also present, and it is usually distinctly expressed. The best differentiation can be obtained by the presence of an antibody response in cerebrospinal fluid in neuroborreliosis. 

We investigated 53 samples of cerebrospinal fluid (CSF) in patients with neuroborreliosis. The clinical diagnosis of neuroborreliosis was confirmed by positive antibody titers and intrathecal synthesis of immunoglobulins in CSF examined in the IgM and IgG classes by the EFISA method or Western blot or confirmed by direct detection by PCR. 

Neuroborreliosis (A= 53) Intrathecal Synthesis of Immunoglobulins according to Reiber s Formula (S9)... 

B2. Bedn ova, J., and Stourac, R, Intrathecal synthesis of specific antiborrelia IgG antibodies and its significance in diagnosis of neuroborreliosis. Klin. Biochem. Metab. 8(29), 219-223 (2000). 

Sobek, O., Adam, R, Zeman, D., Kelbich, R, etal., Parameters of cerebrospinal fluid in patients with neuroborreliosis. Clin. Biochem. Metab. 6(27), 229-234 (1998). 

There are many examples of CNS diseases where a combination of more than one CSF parameter significantly improves the accuracy of the diagnosis. Neuro-inflammatory diseases, like neuroborreliosis (Tumani et al., 1995) or multiple sclerosis (Reiber et al., 1998) are representative examples. Similarly, studies have been reported showing increased sensitivity and specificity of a combination of CSF parameters in early and differential diagnoses of AD. 

Cadavid D, Barbour AG. Neuroborreliosis during relapsing fever Review of the clinical manifestations, pathology, and treatment of infections in humans and experimental animals. Clin Infect Dis. 1998 26 151-164. 

---