Abstract
BackgroundThe chemokine CXCL13 has been discussed as a diagnostic parameter with high specificity for Lyme neuroborreliosis (LNB) and as a marker of disease activity. Neurosyphilis and LNB share similar characteristics. We investigated retrospectively CXCL13 levels in the cerebrospinal fluid (CSF) of patients with neurosyphilis at initial diagnosis and during treatment.ResultsFive patients with neurosyphilis were identified retrospectively using an electronic database in a tertiary care hospital from 2005 to 2012. CXCL13 levels were measured using an ELISA. Five patients with definite LNB and 10 patients with multiple sclerosis (MS) served as controls. Median CXCL13 levels at baseline were 972 pg/mL for neurosyphilis patients, 8,000 pg/mL for LNB patients, and 7.8 pg/mL for MS patients. Patients with LNB and neurosyphilis showed significantly higher CXCL13 levels in their CSF compared to MS patients (p < 0.05, p < 0.001, respectively). CXCL13 levels in the CSF declined during treatment.ConclusionCXCL13 levels in the CSF of patients with neurosyphilis can be as high as in patients with LNB, exceeding the proposed threshold of 250 pg/mL for the diagnosis of LNB. Patients with encephalitic/myelitic syndromes appear to have especially high levels of CXCL13. Clinicians should be aware that high levels of CXCL13 are not found exclusively in LNB but also in other infectious diseases of the CNS.
Highlights
The chemokine CXCL13 has been discussed as a diagnostic parameter with high specificity for Lyme neuroborreliosis (LNB) and as a marker of disease activity
WBC white blood cell, QAlb albumin cerebrospinal fluid (CSF)–serum quotient, n.a. not available, ref reference values. This is the first controlled study reporting on CXCL13 levels in CSF from patients diagnosed with neurosyphilis but without confounding co-infections at the time of the first diagnosis and during the course of treatment
Our main finding is that CXCL13 levels are substantially elevated in CSF from patients with untreated neurosyphilis and can surge as high as previously reported for patients with LNB [13]
Summary
The chemokine CXCL13 has been discussed as a diagnostic parameter with high specificity for Lyme neuroborreliosis (LNB) and as a marker of disease activity. We investigated retrospectively CXCL13 levels in the cerebrospinal fluid (CSF) of patients with neurosyphilis at initial diag‐ nosis and during treatment. Syphilis is a sexually transmitted spirochetal disease caused by Treponema pallidum subspecies pallidum. The chemokine CXCL13 is produced by antigen-presenting cells and is thought to play a role in attracting B cells and B-helper T cells into the cerebrospinal fluid (CSF) in neuroinfectious. There is no generally accepted cut-off for diagnosing LNB on the basis of CXCL13 levels in CSF. As neurosyphilis shares some similarities with LNB (e.g., spirochetal origin, subacute course, and similar CSF changes), we aimed to measure CXCL13 levels in the CSF of patients with clinically and serologically definite neurosyphilis before and during antibiotic treatment and compared the results with those of patients with definite LNB and MS
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