Diagnosis, Treatment and Prevention of Pediatric Lyme disease

Abstract

Lyme disease remains a significant public health challenge in the United States, particularly in the Northeast and Midwest regions, and is likely to increase in the coming years with population growth to suburban areas and warmer weather. Lyme disease is a bacterial infection caused by the spirochete, Borrelia burgdorferi, that is transmitted to humans through deer ticks. The presentation of Lyme disease can involve multiple systems with dermatologic, neurologic, rheumatologic, and cardiac symptoms commonly described. However, there is substantial variation in the presentation of Lyme disease, creating a challenge to diagnosis and treatment. The standard treatment for Lyme disease is administration of antibacterial agents. Although the majority of pediatric patients achieve symptom resolution with treatment, a subset continues to experience fatigue, pain, and psychological disturbances known as post-treatment Lyme disease syndrome. Prevention of Lyme disease largely relies on behavioral measures such as wearing long sleeves and pants and checking for ticks given the absence of an effective vaccine. Prophylactic antibiotic treatment is also highly effective for children who have experienced a Ixodes tick bite, occurring in an endemic region with tick attachment for at least 36 hours. Although Lyme disease disproportionately impacts children, the existing literature primarily focuses on its presentation in adults. In this review, we summarize the latest literature surrounding the diagnosis, treatment, and prevention of Lyme disease with a specific emphasis on pediatric populations and the recent advancements in vaccine development.