DETECTION OF BORRELIA-BURGDORFERI BY NESTED POLYMERASE CHAIN-REACTIONIN CEREBROSPINAL-FLUID AND URINE OF CHILDREN WITH NEUROBORRELIOSIS

Diagnosis of neuroborreliosis is often difficult since history and cli nical presentation may be non-specific and serological tests may initi ally be negative. We therefore tested the polymerase chain reaction (P CR) for the detection of borrelial sequences in CSF and urine samples of consecutive children with neuroborreliosis seen in a single summer season. Four of eight children were negative in serum for antibodies t o Borrelia burgdorferi. Two of eight children were PCR-positive in CSF and one other child was positive in urine. In two out of four childre n PCR was the only laboratory test confirming the clinical diagnosis. All children recovered after treatment with third generation cephalosp orins. When seven of eight children were re-examined 6 months later al l were healthy and antibodies to B. burgdorferi were detected in their serum. PCR may assist the paediatrician in establishing a diagnosis o f neuroborreliosis; however, a negative result does not rule out neuro borreliosis. PCR is an adjunct, but no substitute for clinical judgeme nt and serology.