Are There Undiagnosed TBE-, Herpes- or Enteroviral Infections among Children Being Evaluated for Lyme Neuroborreliosis?

Barbro H Skogman,Sirkka Vene,Pia Forsberg,Britt Akerlind

doi:10.4236/ojcd.2014.43020

Abstract

Lyme neuroborreliosis (LNB) in children is a challenging diagnosis based on clinical manifestations and laboratory findings. The aim of this study was to investigate whether herpes simplex virus (HSV) 1 or 2, varicella zoster virus (VZV), enterovirus or tick-borne encephalitis virus (TBEV) could be identified in cerebrospinal fluid (CSF) or serum from children being evaluated for LNB, in order to elucidate whether such infectious diseases may be missed by the clinician. Methods: Ninety-nine pediatric patients (n = 99) were retrospectively included from a previous study on LNB in southeast of Sweden. They had been diagnosed as “Possible LNB” or “Not determined” due to negative Borrelia antibody index in CSF. Routine polymerase chain reaction (PCR) methods were used for detection of herpes viral RNA or enteroviral DNA in CSF. An ELISA assay was used for detection of anti-TBEV antibodies (IgM and IgG) in serum. Results: One patient showed elevated anti-TBEV IgM and IgG antibodies in serum, indicating a current TBE infection. No positive PCR reactions for HSV 1 or 2, VZV or enterovirus were detected in CSF from any of the patients. In conclusion, our results suggest that undiagnosed herpes- or enteroviral infections are unlikely to explain CNS symptoms in children being evaluated for LNB, whereas missed TBE infections may occur. TBEV serology should be included when evaluating children for LNB in TBE endemic areas.

Highlights

The aim of this study was to investigate whether herpes simplex virus (HSV) 1 or 2, varicella zoster virus (VZV), enterovirus or tick-borne encephalitis virus (TBEV) could be identified in cerebrospinal fluid (CSF) or serum from children being evaluated for Lyme Neuroborreliosis (LNB), in order to elucidate whether such infectious diseases may be missed by the clinician
One patient was identified with elevated anti-TBEV IgM and IgG antibody titers in serum, indicating a current tick-borne encephalitis (TBE) infection (Table 2)
In this retrospective study of children being evaluated for LNB, one patient with a highly suspected current TBE infection was identified whereas no indications of HSV 1 or 2, VZV or enteroviral infections were found by polymerase chain reaction (PCR) analyses in CSF

Summary

Introduction

(2014) Are There Undiagnosed TBE-, Herpesor Enteroviral Infections among Children Being Evaluated for Lyme Neuroborreliosis? Neurological signs and symptoms are not specific and the diagnosis Lyme Neuroborreliosis (LNB) needs laboratory confirmation [6] [7]. According to European guidelines, both pleocytosis in CSF (>5 × 106 mononuclear cells /L) and intrathecally produced Borrelia specific antibodies (i.e. positive antibody index, AI) are needed to confirm the LNB diagnosis [7]. Among children with neurological symptoms suggestive for LNB, many cases do not meet these criteria for confirmed LNB [8]-[11]. Patients may receive antibiotic treatment on vague grounds and investigation for other neurotropic agents are seldom performed unless the patient show specific manifestations of viral infection such as skin rash, vesicles, diarrea or distinct signs of viral meningitis/encephalitis

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Conclusion