Lyme neuroborreliosis (LNB): New cerebrospinal fluid (CSF) biomarkers

CXCL131

•Single-centre, retrospective analysis: N=366 CSF samples:

•CXCL13: useful tool for follow-up of LNB pts after antibiotic Tx:

1Hytönen J. ECCMID 2014 abs. eP0752Gyllemark P. ECCMID 2014 abs. eP074

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Data from poster

*Tick-borne encephalitis (N=10), CNS varicella zoster infection (N=19), CNS herpes simplex infection (N=14), CNS HHV6 infection (N=3), CNS enterovirus infection (N=8); AI: Borrelia-specific antibody index; MS: multiple sclerosis; NI: neuroinflammatory; NS: not significant; ref.: reference; Tx: treatment

Lyme neuroborreliosis (LNB): New cerebrospinal fluid (CSF) biomarkers

IL-17A2

•Single-centre retrospective analysis (2007-2009): N=178 suspected LNB pts

•Pts with definite LNB: If duration of symptoms >3 mo after Tx: CSF IL-17A levels significantly higher than if recovery within 3 mo after Tx (P=0.015)

CXCL13 and IL-17A are promising CSF biomarkers of LNB disease activity; CXCL13 may also be useful for monitoring Tx response

1Hytönen J. ECCMID 2014 abs. eP0752Gyllemark P. ECCMID 2014 abs. eP074

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Data from poster

Incidence and clinical characteristics of Group A streptococcal meningitis (GASM) in adults

• Prospective, nationwide cohort study (the Netherlands; 2006-2013):

– Inclusion criteria: ≥16 yr; positive cerebrospinal fluid (CSF) culture OR positive blood culture + ≥1 individual predictor of bacterial meningitis + clinical presentation compatible with bacterial meningitis

– Exclusion criteria: nosocomial meningitis

• 2.0% (27/1,322) of community-acquired bacterial meningitis episodes were GASM

Lucas MJ. ECCMID 2014 abs. P1453

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Data from poster

Incidence and clinical characteristics of Group A streptococcal meningitis (GASM) in adults

GASM is often preceded by otitis or sinusitis. It has high mortality and morbidity rates, and a high subdural empyema risk

Lucas MJ. ECCMID 2014 abs. P1453

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Data from poster

Meningococcal multi-component vaccine (4CMenB): predicted strain coverage in Europe

• 4CMenB (Bexsero®): novel multi-component protein-based vaccine against capsular group B meningococci (MenB): 4 major components:

– Factor-H-binding protein: fHbp

– Neisserial heparin binding antigen: NHBA

– Neisserial adhesin A: NadA

– Outer-membrane vesicles derived from strain NZ98/254

• Large-scale epidemiological survey (2007-2008): N=1,052 invasive MenB strains from England + Wales, France, Germany, Italy, Norway

• Meningococcal antigen typing system (MATS)*

→ results linked to multilocus sequence typing and antigen sequence data

Vogel U et al. Lancet Infect Dis 2013;13:416-25

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*Donnelly J et al. Proc Natl Acad Sci USA 2010;107:19490-5

Meningococcal multi-component vaccine (4CMenB): predicted strain coverage in Europe

• Predicted strain coverage (MATS): 78% (95% CI: 63-90)

• 50% of strains/64% of covered strains could be targeted by bactericidal antibodies against ≥1 vaccine antigen

• Does generalisation of coverage apply to the rest of Europe?

A multi-component vaccine may protect against a substantial proportion of invasive MenB strains isolated in Europe

Vogel U et al. Lancet Infect Dis 2013;13:416-25

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Relapsing post-herpes simplex virus (HSV) encephalitis (post-HSE): role in brain autoimmunity

Single-centre study (2012-2013, Spain): 2 parts:

1. Prospective case study: N=5 pts with relapsing post-HSE

Armangue T et al. Ann Neurol 2014;75:317-23

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Abs: antibodies; Acyc: acyclovir; CycP: monthly intravenous cyclophosphamide; IVIg: intravenous immunoglobulins; IVMP: intravenous methylprednisolone; NA: not available; NMDAR: N-methyl-D-aspartate receptor; Ritux: rituximab

Relapsing post-herpes simplex virus (HSV) encephalitis (post-HSE): role in brain autoimmunity

2. Retrospective study: N=34 pts with definite or probable HSE

•Frequency of autoAbs ↑ over time in serum (P=0.004) and CSF (P=0.04)

As NMDAR Abs appear between HSE and onset of relapsing post-HSE symptoms, HSE may trigger NMDA Abs and potentially other

cell-surface/synaptic autoimmunity

Armangue T et al. Ann Neurol 2014;75:317-23

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