In Reply We agree with Lautner and colleagues that, in addition to the ratio of Borrelia burgdorferi antibodies between cerebrospinal fluid (CSF) and serum, tests, such as CSF white blood cell count, can be useful in the assessment of neuroborreliosis. Indeed, CSF analysis is a pivotal tool in making a diagnosis of meningitis. However, whether liberal use of CSF testing to assess for possible neuroborreliosis among patients not suspected to have meningitis would be practiced (given barriers to obtaining samples) or aid in enhancing diagnosis is uncertain.
Melia MT, Lantos PM, Auwaerter PG. Laboratory Testing for Lyme Neuroborreliosis—Reply. JAMA Neurol. 2015;72(1):126. doi:10.1001/jamaneurol.2014.3555