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Positive intrathecal anti-Borrelia antibody synthesis: what are the implications for clinical practice? Clinical features and outcomes of 138 patients in a French multicenter cohort study

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Abstract

We aimed to describe the clinical characteristics, management, and residual symptoms (RS) in patients with definite and possible Lyme neuroborreliosis (LNB). We conducted a retrospective French multicenter cohort study (2010–2020). Cases of LNB were defined as clinical manifestations attributed to LNB and a positive Borrelia-specific intrathecal antibody index (AI) (“possible” LNB) and with pleocytosis (“definite” LNB). Risk factors of RS were determined using a logistic regression model. We included 138 adult patients with a positive AI. Mean age was 59.5 years (± 14.7). The median duration of symptoms before diagnosis was 1.0 [0.5–4.0] months. The most frequent manifestation was radicular pain (n = 79, 57%). Complete cerebrospinal fluid (CSF) leukocyte analysis was available in 131 patients, of whom 72 (55%) had pleocytosis. Patients with definite LNB had a shorter duration of symptoms (median 1.0 [0.5–2.6] vs. 3.0 [0.6–7.0] months, p < 0.01) and more radicular pain (74% vs 44%, p < 0.01) than patients with possible LNB. At the last visit (median duration of follow-up: 70 [30–175] days), 74/124 patients (59.7%) reported RS, mostly radicular pain (n = 31, 25%). In multivariate analysis, definite LNB (OR = 0.21 [0.05–0.931], p = 0.039) and duration of symptoms less than 3 months (OR = 0.04 [0.01–0.37], p = 0.005) were protective factors against RS at last follow-up. Our study highlights the challenges of LNB management, especially for patients with a positive AI without pleocytosis, questioning whether LB is still ongoing or not. Early diagnosis and treatment are important to improve outcomes and to lower potential RS.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Code availability

SPSS 22.0 (IBM, Armonk, NY, USA).

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Authors and Affiliations

  1. Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France

    Pauline Naudion, Catherine Chirouze & Kevin Bouiller

  2. Department of Infectious Diseases, Tick-Borne Diseases Reference Center, Paris and Northern Region, General Hospital of Villeneuve-Saint-Georges, 40 Allée de La Source, 94 190, Villeneuve-Saint-Georges, France

    Alice Raffetin

  3. Research Unity of EpiMAI (USC Anses), Ecole Nationale Vétérinaire de Maisons-Alfort, Maisons-Alfort, France

    Alice Raffetin

  4. European Study Group for Lyme Borreliosis (ESGBOR), Basel, Switzerland

    Alice Raffetin & Kevin Bouiller

  5. EA 7380 Dynamyc, Université Paris-Est Créteil, Ecole Nationale Vétérinaire d’Alfort, USC Anses, Créteil, France

    Alice Raffetin

  6. Department of Infectious Diseases, General Hospital of Nord Franche-Comté, Belfort, France

    Souheil Zayet & Timothée Klopfenstein

  7. Department of Infectious Diseases, University Hospital of Nancy, Nancy, France

    Elisabeth Baux

  8. Department of Infectious Diseases, General Hospital of Colmar, Colmar, France

    Martin Martinot

  9. Department of Infectious Diseases, University Hospital of Dijon, Dijon, France

    Lionel Piroth

  10. Department of Infectious Diseases, University Hospital of Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France

    Eric Caumes

  11. Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique, Paris, France

    Eric Caumes

  12. UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000, Besançon, France

    Catherine Chirouze & Kevin Bouiller

Authors
  1. Pauline Naudion
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  2. Alice Raffetin
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  8. Eric Caumes
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  9. Catherine Chirouze
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  10. Kevin Bouiller
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Contributions

PN: investigation, writing—original draft preparation; AR: conceptualization, investigation, writing – original draft preparation, resources; SZ: investigation, resources, writing—reviewing and editing; TK: resources, writing—reviewing and editing; EB: resources, writing—reviewing and editing; MM: resources, writing—reviewing and editing; LP: resources, writing—reviewing and editing; EC: resources, writing—reviewing and editing; CC: conceptualization, resources, writing—reviewing and editing; KB: conceptualization, resources, supervision, formal analysis, writing—reviewing and editing.

Corresponding authors

Correspondence to Alice Raffetin or Kevin Bouiller.

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This is an observational study. The University of Besancon Research Ethics Committee has confirmed that no ethical approval is required.

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Informed consent was collected from all patients in conformity with the French national ethical guidelines.

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Not applicable.

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The authors declare no competing interests.

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Pauline Naudion and Alice Raffetin participated equally in this work as first co-authors.

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Naudion, P., Raffetin, A., Zayet, S. et al. Positive intrathecal anti-Borrelia antibody synthesis: what are the implications for clinical practice? Clinical features and outcomes of 138 patients in a French multicenter cohort study. Eur J Clin Microbiol Infect Dis 42, 441–452 (2023). https://doi.org/10.1007/s10096-023-04574-0

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