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J Clin Microbiol. 2018 Apr 25;56(5). pii: e01868-17. doi: 10.1128/JCM.01868-17. Print 2018 May.

Direct Molecular Detection and Genotyping of Borrelia burgdorferi Sensu Lato in Cerebrospinal Fluid of Children with Lyme Neuroborreliosis.

Author information

1
Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway bjorn.barstad@sus.no.
2
Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway.
3
Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.
4
Department of Pediatrics, Hospital of Southern Norway Trust, Kristiansand, Norway.
5
Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
6
Department of Pediatrics, Haugesund Hospital, Haugesund, Norway.
7
Department of Pediatrics, Hospital of Southern Norway Trust, Arendal, Norway.
8
Department of Clinical Science, University of Bergen, Bergen, Norway.

Abstract

The current diagnostic marker of Lyme neuroborreliosis (LNB), the Borrelia burgdorferisensu lato antibody index (AI) in the cerebrospinal fluid (CSF), has insufficient sensitivity in the early phase of LNB. We aimed to elucidate the diagnostic value of PCR for B. burgdorferisensu lato in CSF from children with symptoms suggestive of LNB and to explore B. burgdorferisensu lato genotypes associated with LNB in children. Children were prospectively included in predefined groups with a high or low likelihood of LNB based on diagnostic guidelines (LNB symptoms, CSF pleocytosis, and B. burgdorferisensu lato antibodies) or the detection of other causative agents. CSF samples were analyzed by two B. burgdorferisensu lato-specific real-time PCR assays and, if B. burgdorferisensu lato DNA was detected, were further analyzed by five singleplex real-time PCR assays for genotype determination. For children diagnosed as LNB patients (58 confirmed and 18 probable) (n = 76) or non-LNB controls (n = 28), the sensitivity and specificity of PCR for B. burgdorferisensu lato in CSF were 46% and 100%, respectively. B. burgdorferisensu lato DNA was detected in 26/58 (45%) children with AI-positive LNB and in 7/12 (58%) children with AI-negative LNB and symptoms of short duration. Among 36 children with detectable B. burgdorferisensu lato DNA, genotyping indicated Borrelia garinii (n = 27) and non-B. garinii (n = 1) genotypes, while 8 samples remained untyped. Children with LNB caused by B. garinii did not have a distinct clinical picture. The rate of detection of B. burgdorferisensu lato DNA in the CSF of children with LNB was higher than that reported previously. PCR for B. burgdorferisensu lato could be a useful supplemental diagnostic tool in unconfirmed LNB cases with symptoms of short duration. B. garinii was the predominant genotype in children with LNB.

KEYWORDS:

Borrelia burgdorferi; Lyme disease; PCR; cerebrospinal fluid; children; genotypic identification; neuroborreliosis; polymerases

PMID:
29467195
PMCID:
PMC5925720
DOI:
10.1128/JCM.01868-17
[Indexed for MEDLINE]
Free PMC Article

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