ANALYSIS OF THE INTRATHECAL IMMUNE-RESPONSE IN NEUROBORRELIOSIS TO A SONICATE ANTIGEN AND 3 RECOMBINANT ANTIGENS OF BORRELIA-BURGDORFERI SENSU-STRICTO

The intrathecal synthesis of borrelial-specific IgM- and IgG-antibodie s was studied in 67 patients with neuroborreliosis and in 14 patients with neurosyphilis (controls). Antibody concentrations in serum and in the cerebrospinal fluid were determined by an enzyme immunoassay (EIA ) using, as antigens, a sonicate of Borrelia burgdorferi, the recombin ant 14 kDa flagellin fragment, the outer surface protein C (22 kDa), a nd the high molecular mass protein p83 (83 kDa). In the sonicate EIA, IgG- and/or IgM-antibodies to Borrelia burgdorferi in serum were detec ted in all patients with neuroborreliosis and in 71% of patients with neurosyphilis. Intrathecal synthesis of borrelial-specific IgG- and/or IgM-antibodies was demonstrated in 82% of patients with neuroborrelio sis and in 71% of patients with neurosyphilis. Immunoglobulin G- and/o r IgM-antibodies in serum against any of the recombinant antigens were detected in 92% of patients with neuroborreliosis and in none of thos e with neurosyphilis. Intrathecal synthesis of IgG- and/or IgM-antibod ies to individual recombinant antigens was demonstrated in 67% of pati ents with neuroborreliosis and in none of those with neurosyphilis. Th e sensitivity of the recombinant antigens in serum was almost equal to that of the sonicate EIA, whereas the recombinant antigens were clear ly less sensitive in the estimation of the intrathecal specific immune response. It was concluded that in suspected cases of neuroborreliosi s, the estimation of high specific antibodies in the recombinant EIA w ill be helpful in confirming the diagnosis.