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The chemokine CXCL13 is elevated in the cerebrospinal fluid of patients with neurosyphilis.

Dersch R, Hottenrott T, Senel M, Lehmensiek V, Tumani H, Rauer S, Stich O - Fluids Barriers CNS (2015)

Bottom Line: CXCL13 levels in the CSF declined during treatment.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. rick.dersch@uniklinik-freiburg.de.

ABSTRACT

Background: The 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.

Results: Five 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.

Conclusion: CXCL13 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.

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Related in: MedlinePlus

a CXCL13 levels in CSF at baseline in patients with neurosyphilis (n = 5), neuroborreliosis (n = 5, LNB), and multiple sclerosis (n = 10, MS). The box includes all values from the first (25%) to the third quartile (75%) while the band inside the box corresponds to the median. The ends of the whiskers represent the range. b CXCL13 levels (left ordinate) and WBC count (right ordinate) in the CSF of neurosyphilis patients during the course of disease. Circles represent the mean, and whiskers represent the standard errors. Correlation with Spearman‘s rank correlation: r = 1.00; p = 0.33.
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Fig1: a CXCL13 levels in CSF at baseline in patients with neurosyphilis (n = 5), neuroborreliosis (n = 5, LNB), and multiple sclerosis (n = 10, MS). The box includes all values from the first (25%) to the third quartile (75%) while the band inside the box corresponds to the median. The ends of the whiskers represent the range. b CXCL13 levels (left ordinate) and WBC count (right ordinate) in the CSF of neurosyphilis patients during the course of disease. Circles represent the mean, and whiskers represent the standard errors. Correlation with Spearman‘s rank correlation: r = 1.00; p = 0.33.

Mentions: There was a non-significant trend toward higher baseline values of CXCL13 in patients with LNB compared to neurosyphilis (Figure 1a). However, the difference in the mean baseline CXCL13 levels was statistically significant for both neurosyphilis and LNB compared to MS (Figure 1a, p < 0.05, p < 0.001, respectively). During the course of treatment, CXCL13 levels rapidly declined in neurosyphilis patients, paralleling the course of WBCs in the CSF (Figure 1b).Figure 1


The chemokine CXCL13 is elevated in the cerebrospinal fluid of patients with neurosyphilis.

Dersch R, Hottenrott T, Senel M, Lehmensiek V, Tumani H, Rauer S, Stich O - Fluids Barriers CNS (2015)

a CXCL13 levels in CSF at baseline in patients with neurosyphilis (n = 5), neuroborreliosis (n = 5, LNB), and multiple sclerosis (n = 10, MS). The box includes all values from the first (25%) to the third quartile (75%) while the band inside the box corresponds to the median. The ends of the whiskers represent the range. b CXCL13 levels (left ordinate) and WBC count (right ordinate) in the CSF of neurosyphilis patients during the course of disease. Circles represent the mean, and whiskers represent the standard errors. Correlation with Spearman‘s rank correlation: r = 1.00; p = 0.33.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489031&req=5

Fig1: a CXCL13 levels in CSF at baseline in patients with neurosyphilis (n = 5), neuroborreliosis (n = 5, LNB), and multiple sclerosis (n = 10, MS). The box includes all values from the first (25%) to the third quartile (75%) while the band inside the box corresponds to the median. The ends of the whiskers represent the range. b CXCL13 levels (left ordinate) and WBC count (right ordinate) in the CSF of neurosyphilis patients during the course of disease. Circles represent the mean, and whiskers represent the standard errors. Correlation with Spearman‘s rank correlation: r = 1.00; p = 0.33.
Mentions: There was a non-significant trend toward higher baseline values of CXCL13 in patients with LNB compared to neurosyphilis (Figure 1a). However, the difference in the mean baseline CXCL13 levels was statistically significant for both neurosyphilis and LNB compared to MS (Figure 1a, p < 0.05, p < 0.001, respectively). During the course of treatment, CXCL13 levels rapidly declined in neurosyphilis patients, paralleling the course of WBCs in the CSF (Figure 1b).Figure 1

Bottom Line: CXCL13 levels in the CSF declined during treatment.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. rick.dersch@uniklinik-freiburg.de.

ABSTRACT

Background: The 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.

Results: Five 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.

Conclusion: CXCL13 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.

Show MeSH
Related in: MedlinePlus