Intrathecal Production of Specific Antibodies Against Borrelia Burgdorferi in Patients with Lymphocytic Meningoradiculitis (Bannwarth's Syndrome)

Central nervous system infection with Borrelia burgdorferi, the causative agent of Lyme disease in the USA, manifests itself most frequently in Europe as lymphocytic meningoradiculitis (Bannwarth's syndrome). We examined 12 patients with lymphocytic meningoradiculitis with cerebrospinal fluid (CSF) antibodies against B. burgdorferi to establish whether these antibodies were produced intrathecally or were serum derived. By comparison of titers of antibody to B. burgdorferi with total IgG and antibodies against tetanus toxoid in CSF and serum, we demonstrated intrathecal production of antibodies to B. burgdorferi in 11 patients. Reactions of IgG antibodies in CSF with a panel of borrelial proteins (molecular weights, 22k, 23k, 39k, 41k, 42k, 48k, 60k, 66k, and 75k) were stronger than those of the serum antibodies; patterns of reactivity varied considerably between patients. However, CSF reactions (in comparison to serum reactions) to the 41k protein were stronger in all patients. Examination of CSF for intrathecal production of antibodies to B. burgdorferi is helpful in diagnosing neurological manifestations caused by B. burgdorferi infections.