Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation

Mojca Rožič ,Andra Leskovec,Eva Ružić‐Sabljić ,Maja Arnež

doi:10.11648/j.ajp.20190504.24

Abstract

We evaluate the incidence of Lyme meningitis (LM) in children with acute serous meningitis and compare demographic, clinical and laboratory findings in children with LM and non-LM. During 2004-2005, 122 children fulfilled the inclusion criteria for this prospective clinical study (age < 15 years, meningitis, without typical clinical sign for Lyme borreliosis on admission). Antibodies to B. burgdorferi sensu lato were determined in blood and cerebrospinal fluid (CSF) and isolation of B. burgdorferi sensu lato was performed. LM was confirmed by isolation of B. burgdorferi sensu lato from blood and/or CSF and/or seroconversion to borrelial antigens and/or demonstration of borrelial intrathecal antibody production and/or history of erythema migrans. LM was probable in patients with positive but unchanging borrelial serum antibody titers. LM (83% confirmed, 17% probable) was established in 41 (34%) patients. Demographic, clinical and neurologic findings were comparable between the two groups. Fever and peripheral leukocytosis were more common in non-LM and inappetence and lymphocytic pleocytosis in LM. Borrelial serum IgM and/or IgG was found in 25%, seroconversion in 39%, IgG intrathecal antibody production in 5% and isolation of B. burgdorferi sensu lato from CSF and blood in 41% and 22% of patients, respectively. LM was found in 34% of children with acute serous meningitis. It is impossible to distinguish LM from non-LM only from medical history, clinical examination and basic blood and CSF investigations. For this reason, other signs of Lyme borreliosis and microbiological studies on Lyme borreliosis are compulsory.

Highlights

Lyme borreliosis (LB) is a tick-borne infectious disease caused by Borrelia burgdorferi sensu lato
In the present study we were interested in the incidence of Lyme meningitis (LM) in Slovenian children with acute serous meningitis without erythema migrans (EM) or other highly suggestive clinical sign of LB
Antibiotics are indicated in children for LM but not when causes of acute serous meningitis are viral

Summary

Introduction

Lyme borreliosis (LB) is a tick-borne infectious disease caused by Borrelia burgdorferi sensu lato. In USA, the only species known to cause LB is B. burgdorferi sensu stricto (B. burgdorferi) while in Europe at least five species can cause human disease from which B. afzelii and B. garinii are predominant. B. afzelii is mostly associated with a skin lesion known as erythema migrans (EM), which is pathognomonic clinical sign of LB, while B. garinii seems to be most neurotropic [1,2,3]. Acute serous meningitis is a part of early, disseminated stage of the disease [4, 5]. Differentiating Lyme meningitis (LM) from other forms of acute serous meningitis in children is a common diagnostic dilemma in LB endemic regions [6,7,8,9]. Parenteral antibiotics are indicated in children for LM but not when causes of acute serous meningitis are viral [11]

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Conclusion