Performance of a point-of-care test in the diagnosis of neuroborreliosis in children with peripheral facial palsy; a diagnostic accuracy study

PURPOSE: Neuroborreliosis is a common cause of peripheral facial palsy (PFP) in children and is traditionally diagnosed with lumbar puncture. While serum Borrelia burgdorferi (Bb) antibodies can reduce the need for lumbar puncture, their use is limited by processing time. Prompt results for Bb antibodies may accelerate clinical decisions. We aimed to evaluate the diagnostic accuracy for neuroborreliosis of a point-of-care lateral flow assay for Bb IgG and IgM in children with PFP.

METHODS: Between October 17, 2019, and November 27, 2023, serum samples from children with PFP were collected across four pediatric departments in Denmark. All samples were tested using the point-of-care test and the results were compared to a conventional Bb IgG chemiluminescence immunoassay (CLIA). Diagnostic performance measures for neuroborreliosis were calculated with the gold standard, based on cerebrospinal fluid cell count and Bb intrathecal antibody test, as reference. The reference data were retrieved from the medical record.

RESULTS: Among 101 children with PFP, 38 had neuroborreliosis and 63 had other conditions. The point-of-care test showed sensitivity of 87% (95% CI: 72-96), specificity of 89% (95% CI: 78-95), positive predictive value of 82% (95% CI: 67-92), and negative predictive value of 92% (95% CI: 81-97). Concordance with conventional CLIA was high (kappa = 0.81).

CONCLUSION: In children with PFP, the novel point-of-care Bb antibody test provides a rapid and reasonably accurate laboratory diagnosis of neuroborreliosis, comparable to the conventional CLIA. Delivery of results within 30 min may facilitate rapid diagnostics for children with PFP.