The intrathecal synthesis of IgM and IgG antibodies to sonicate, to recombinant flagellin (41 kDa) and to a tryptic peptide of the flagellin (14-kDa fragment) was determined by ELISA in paired cerebrospinal fluid (CSF) and serum samples from 35 patients with Lyme neuroborreliosis (LNB) and in 10 patients with neurosyphilis. The antibody index (AI = QQ) was calculated from the ratio between CSF/serum quotients for specific antibodies (Q) and total immunoglobulins (Q). For the examination of IgG antibodies, the sonicate ELISA was performed with and without pre-absorption with . Of 35 patients with LNB, 31 had intrathecal IgG response to demonstrated by sonicate ELISA (24 after absorption of cross-reactive anti-bodies), 29 had a response demonstrated by flagellin ELISA and 21 of 35 by 14-kDa ELISA. In patients with neurosyphilis the AI (IgG) was elevated in the sonicate ELISA in 7 of 10 samples (none of 10 after absorption of cross-reactive antibodies), in the flagellin ELISA in 5 of 10 samples and in the 14-kDa ELISA in none of 10 samples. Intrathecal synthesis of IgM antibodies to was demonstrated in patients with neuroborreliosis by sonicate ELISA in 20 of 35 samples, by flagellin ELISA in 16 of 35 samples and by 14-kDa ELISA in 9 of 35 samples. No intrathecal synthesis of -specific IgM could be detected by any assay in patients with neurosyphilis. The highest specificity and sensitivity was achieved with findings from IgG and IgM AI determinations in 14-kDa and sonicate ELISA (after pre-absorption with ) providing positive results in 32 (91·4%) of 35 patients.


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