ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Serum Borrelia IgG as a rule-out test in suspected lyme neuroborreliosis: a large retrospective cohort study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesIn Europe, the diagnosis of Lyme neuroborreliosis (NB) relies on intrathecal Borrelia burgdorferi sensu lato (Bbsl) antibody production, but this test has limited sensitivity in early disease and requires lumbar puncture (LP). We therefore evaluated the diagnostic performance of the quantitative LIAISON
methodsWe retrospectively analyzed 3,841 patients who underwent intrathecal Bbsl antibody testing in the Capital Region of Denmark (2016-2024). NB cases were defined by European criteria and matched to non-NB controls. We assessed sensitivity, specificity, predictive values, area under the curve (AUC), and accuracy of Bbsl IgG across age groups, symptom durations, and clinical scenarios, and used logistic regression to model NB probability from serum IgG titers.
resultsWe included 392 NB patients and 2,681 non-NB controls, all with available serum Bbsl IgG LIAISON
interpretationTaken together, our findings support a re-evaluation of the diagnostic sequence in suspected NB, although prospective external validation is required. A negative quantitative VlsE-based serum Bbsl IgG result after ≥ 2 weeks of symptoms was associated with a very low probability of NB in this selected cohort, supporting its potential use as a rule-out tool to guide LP decisions.
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