Lyme Disease In Children Research Articles

Seroprevalence of Lyme Disease in Children With Facial Nerve Palsy.

This retrospective chart review examined children with documented Lyme disease serology in New Jersey aged <21 years presenting with facial nerve palsy. The presence of symptoms including tick bite, fever, headache, and arthritis was recorded. Data were categorized based on demographic factors, and multivariate regression was employed. We enrolled 122 children, 54% female (mean age of 11.4 ± 5.1 years); 22.1% had Lyme disease. Fever was a significant predictor of Lyme disease (P = .01), confirmed by multivariate regression (odds ratio [OR] = 16.11, 95% confidence interval [CI] = 2.04, 366.14), as was male gender (P = .01, OR = 3.68, 95% CI = 1.21, 12.89). This association held especially true in Lyme-endemic regions (prevalence ≥ 0.35). The combination of headache with fever was also significantly predictive (P = .01). We found no significant predictive value in the remaining symptoms. These findings suggest that clinical predictors may be useful in diagnosing Lyme disease and initiating early empiric treatment.

Retrospective validation of a rapid Lyme fluorescent immunoassay in differentiating Lyme arthritis from other musculoskeletal presentations in children in a Lyme-endemic region.

Lyme arthritis is a common manifestation of Lyme disease in children, with clinical features overlapping with other causes of acute and chronic joint pain/swelling in children. We have demonstrated that the Sofia IgG is a reliable test to rule in and rule out the diagnosis of Lyme arthritis in children with musculoskeletal presentations in a Lyme-endemic region. When used in conjunction with clinical and laboratory variables routinely considered when differentiating Lyme arthritis from other diagnoses, the Sofia IgG has the potential to fill an important gap in care, especially when acute decision-making is necessary. The Sofia IgG should be included in prospective research studies examining clinical prediction tools to identify children at low risk of septic arthritis.

BORRELIAL LYMPHOCYTOMA IN A CHILD. CLINICAL CASE

Lyme borreliosis is a multisystem infectious disease caused by bacteria of the Borrelia burgdorferi sensu lato complex.The course of the disease is characterized by three stages: early localized, early disseminated and late disseminated. One of the rare forms of the early disseminated stage of Lyme disease in children is lymphocytoma.We present a clinical case of borrelial lymphocytoma caused by a combination of three types of Borrelia (Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii) in a 6-year-old girl. The disease manifested as multiple migratory erythema on the child's face, mistaken for allergic dermatitis. According to the parents, the child had no history of tick bites. The diagnosis was confirmed by the ELISA method and immunoblot analysis. The patient was prescribed a 21-day course of doxycycline at 50 mg twice daily. Three weeks after the initiation of antibiotic therapy, complete regression of the lymphocytoma was observed. The purpose of the study is to draw the attention of doctors of various specialties to rare forms of Lyme borreliosis against the background of the absence of a verified fact of tick bite.Material and methods. Confirmation of the diagnosis by ELISA and immunoblot analysis.Research results. A clinical case of borrelial lymphocytoma caused by a combination of three Borrelia species (Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii) in a 6-year-old girl is presented. The disease manifested as multiple migratory erythema in the area of the child's face, which was mistaken for allergic dermatitis. According to the parents, the child had no history of a tick bite. The diagnosis was confirmed by ELISA and immunoblot analysis. The patient was prescribed doxycycline treatment for 21 days at 50 mg twice a day. Three weeks after the start of antibiotic therapy, a complete regression of the lymphocytoma was observed.Conclusions. Doctors of various specialties have difficulties in diagnosing Lyme disease in its various stages, especially in children with a heavy allergic history. With the presented clinical case, we want to emphasize the importance of early and timely diagnosis of Lyme borreliosis, in particular, in the absence of an episode of tick bite in the anamnesis.

FEATURES OF THE ALGORITHM OF CLINICAL AND LABORATORY DIAGNOSIS OF LYME BORRELIOSIS IN CHILDREN

The aim of the study – to improve the algorithm of clinical and laboratory diagnosis of Lyme borreliosis in children. Materials and Methods. The search and analysis of available literature sources of the PubMed database is carried out, using a combination of keywords "Lyme disease in children", " Clinical and Laboratory diagnostic". A group of children (62) aged 1 to 17 years was observed to identify pathogens of haemotransmissible infections among children. C-reactive protein (CRP) was determined, which is a protein and reagent of the acute phase. To confirm the diagnosis of PM, determine the form of the lesion and identify the antigens of the pathogen, a routine two-step method of blood analysis was used. Results and Discussion. The algorithm for the diagnosis of Lyme borreliosis in children has been developed for use in making a diagnosis. Clinical: complaints – malaise, fatigue, headache, arthralgia, myalgia, subfebrile body temperature; anamnesis – tick bites, location of bites, time of appearance of symptoms after the bite; objective – lymphadenopathy, arthritis, pain syndrome, intoxication syndrome; laboratory and instrumental diagnostics: biochemical blood analysis (increased level of C-reactive protein, rheumatoid factor is rarely detected), ultrasound of joints, immunological examination (immunofluorescence analysis and blot test), detection of Borrelia by PCR method in synovial fluid. Conclusions. Proposed algorithm for diagnosing the Lyme disease in children.

Рідкісні форми ураження очей при хворобі Лайма в дітей

Lyme disease (LD) is a multisystem disease caused by Borrelia burgdorferi and other similar tick-borne borrelia. Purpose - to analyse and present clinical cases of eye lesions in children with suspected LD for differential diagnosis and treatment refinement. We present 2 clinical cases with ocular lesions in children of infectious genesis with suspected LD. Basic examinations, ophthalmoscopy, optical coherence tomography with angiography, clinical and immunological tests, including ELISA and immunoblot, were performed. Serological results were compared in children with different forms of eye lesions of infectious genesis. Conclusions. The diagnosis of LD should be confirmed by laboratory tests (ELISA and western blot serological tests), indicating the presence of specific anti Borrelia burgdorferi IgM/IgG antibodies, and confirming the clinical manifestations of the disease. Paediatricians should be alert to LD, especially in residents of endemic areas. The need for prophylactic treatment of LD in children exposed to tick bites has been proven. The diagnosis of LB in children should be laboratory confirmed by a two-step method (ELISA serological tests and western blot), which confirms the clinical manifestations of the disease. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and child was obtained for the study. No conflict of interests was declared by the authors.

Racial Differences in the Diagnosis of Lyme Disease in Children.

The Pediatric Infectious Disease Journal ():10.1097/INF.0000000000003991, June 05, 2023. | DOI: 10.1097/INF.0000000000003991

Racial Differences in the Diagnosis of Lyme Disease in Children.

Black children with Lyme disease compared with children of other races were less likely to have an erythema migrans lesion diagnosed (adjusted odds ratio, 0.34; 95% confidence interval, .14-.79) but more likely to have a swollen joint (adjusted odds ratio, 3.68; 95% confidence interval, 2.13-6.36) after adjustment for age and local Lyme incidence.

Особенности течения болезни Лайма у детей

В статье представлены литературные данные и результаты собственных наблюдений особенностей болезни Лайма у детей на современном этапе. Рассмотрены вопросы диагностики, лечения и профилактики болезни Лайма у детей.

Lyme Borreliosis Associated with Ramsay-Hunt Syndrome: A Case Presentation of Bilateral Facial Nerve Palsy in a 14-Year-Old Patient

Background: In children, facial neuropathy is the most common disease that occurs due to the damage of the cranial nerves. Facial nerve palsy (FNP) in children can be congenital or acquired. Congenital FNP may occur at birth due to the trauma and with certain genetic syndromes. Acquired FNP can be caused by HSV types 1,2, HHV-6, cytomegalovirus, EBV, VZV, bacterium B. burgdorferi or can result from inflammatory diseases, trauma and tumors. Unilateral or bilateral FNP is the most common complication of Lyme disease in children. The study that was conducted by Furuta Y. et al. indicates that reactivation of VZV infection is an important cause of acute peripheral FNP in children aged 6-15 years. Case Report: We have described a rare clinical case of bilateral peripheral FNP in a 14-year-old child with a confirmed diagnosis of Lyme disease and reactivation of VZV infection. Conclusions: Prescribed therapy with doxycycline for 21 days and valaciclovir for 7 days made it possible to achieve functional recovery of nerve on both sides.

Seasonality of Acute Lyme Disease in Children.

Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.

Pediatric Lyme Disease Biobank, United States, 2015-2020.

In 2015, we founded Pedi Lyme Net, a pediatric Lyme disease research network comprising 8 emergency departments in the United States. Of 2,497 children evaluated at 1 of these sites for Lyme disease, 515 (20.6%) were infected. This network is a unique resource for evaluating new approaches for diagnosing Lyme disease in children.

The clinical presentation, treatment and outcome of serologically confirmed paediatric Lyme disease in the Republic of Ireland over a 5-year period: a retrospective cohort study.

Lyme disease (LD) is the most common tick-borne illness in Europe. Population-based studies in European children are few. This study aimed to assess the incidence, clinical presentation, treatment and outcome of serologically confirmed paediatric LD in the Republic of Ireland over a 5-year period. A retrospective review of records from accredited laboratories performing Borrelia burgdorferi serological testing was undertaken. Proformas were distributed to clinicians of children and adolescents with positive Lyme serology. Data were requested regarding clinical presentation, treatment and outcome. Updated NICE guidelines were used to classify clinical cases. Serology testing for B. burgdorferi was performed on 2908 samples. Sixty-three (2.2%) children were two-tier positive, generating a crude annual incidence rate of 1.15/100,000. Proformas were returned for 55 (87%) and 47 met clinical and laboratory criteria for LD. Twenty-seven (57%) presented with non-focal symptoms (erythema migrans and/or influenza-like symptoms), and 20 (43%) with focal symptoms (cranial nerve involvement, 11; CNS involvement, 8; arthritis, 1). Median age at presentation was 8.2 (2.5-17.9) years. Seventeen (36%) acquired LD overseas. Twenty-five (83%) of the remaining 30 children acquired infection in the West/Northwest of Ireland. Full resolution of symptoms was reported in 97% of those with available data. Serologically confirmed LD in children is relatively rare in the Republic of Ireland. Ninety-eight percent of children tested were seronegative. Of the seropositive cases, 40% could have been diagnosed based on clinical findings alone. Neurological presentations (40%) were common. Full resolution of symptoms occurred in almost all (97%) where data were available.

Практичні аспекти хвороби Лайма у дітей

Lyme disease is especially important in the spring–autumn period, despite the fact that its clinical manifestations may be throughout the year. Awareness of general practitioners with this problem is insufficient, it requires additional knowledge about diagnosis and treatment. In pediatric practice, the fact of a child being bitten by an Ixodes mite that carries the causative agent of Lyme borreliosis, in addition to babesiosis, anaplasmosis, often goes unnoticed. Therefore, parents seek medical help only when various problems arise, often the thought of Lyme disease does not even arise. Lyme disease has a wide polymorphism of clinical symptoms, is characterized by multisystem lesions, cyclical course — all this complicates the diagnostic search. The difficulty also lies in the fact that there are no domestic clinical recommendations. This publication presents approaches to the diagnosis, treatment, prevention of Lyme disease based on the experience of experts from different countries. Modern approaches to two-stage laboratory diagnostics, tactics of patient management from the moment of bite, treatment at different stages of Lyme borreliosis are analyzed. Attention is paid to the need for epidemiological research in Ukraine and the beginning of educational programs to prevent the disease. The differentiated approach to the treatment of Lyme disease in children due to age aspects, concomitant pathology, safety of long_term antibacterial therapy should be studied more. No conflict of interest was declared by the authors. Key words: Lyme disease, children, diagnosis, treatment, prevention.

18 Lyme disease as an emerging cause of Seventh Cranial Nerve Palsy (“Bell’s palsy”) in Nova Scotia

Abstract Introduction/Background Lyme disease, a tick-borne zoonosis caused by the bacterium Borrelia burgdorferi, has emerged in Nova Scotia (NS) as a common illness. Since 2002 when Lyme disease was first diagnosed in NS, &amp;gt;1000 cases have been reported. Seventh cranial nerve palsy (CNP-7) is said to be the most common presentation of early disseminated Lyme disease in children in endemic areas. Objectives We aimed to determine the frequency of CNP-7 in NS and if physicians are considering Lyme disease as an etiology. Design/Methods A retrospective review of health records of children seen at the IWK Health Centre from 2000-2018 who were ≤18 years of age with an ICD-9 or 10 diagnosis of Bell’s palsy (CNP-7) was conducted. CNP-7 due to local infection, trauma, malignancy, or systemic neurologic disease was excluded. Results Of 237 ICD “Bell’s palsy” diagnoses, 66 cases were eligible, of which 60.6 % (n=40) were female. The median age was 10 years (range 0-16). Five cases of Lyme disease-associated CNP-7 were recognized (7.6%), all since 2013. No bilateral CNP-7 occurred; 59.1% of cases were on the left. Most children presented within 3 days of symptom onset (84.8%) to the emergency department (95.4%), and 56.1% subsequently saw a pediatric neurologist. The most common associated symptom with CNP-7 was headache (22.7%). Lyme disease was considered in the differential diagnosis in 34.8 % (n=23) of cases, and only since 2012. Systemic steroids were prescribed to 51.5 % (34/66) of children in the emergency department, for durations varying from 1 to 10 days. The most common steroid course length was 5 days. Antimicrobials were prescribed for 18 (27.3%) children including acyclovir, beta lactams and tetracyclines. Resolution of the facial palsy findings was documented in 45 children, of whom 36 (54.5%) had complete resolution and 9 (13.6%) had partial resolution. Four children with Lyme disease associated CNP-7 had complete resolution, and one had partial resolution. Conclusion There does not appear to be a standard approach to diagnosis and management of CNP-7 in this pediatric health centre. Lyme disease is not regularly considered in the differential diagnosis, which is surprising given the high incidence of Lyme disease in NS. These findings will be shared with health care providers most likely to see CNP-7 in order to develop a standard algorithm to the initial presentation of 7th cranial nerve palsy in children.

Challenges and new methods in the diagnosis of Lyme disease in children.

Despite the constant development of biotechnology, laboratory diagnostics of Lyme disease in children still poses a significant challenge. The aim of this article is to present the current methods of Lyme disease diagnosis and its future perspectives. A serological test is often the first step in supporting clinical diagnosis of Lyme disease in children. Recently, a new generation of enzyme-linked immunosorbent assays has been created. These assays use recombinant proteins or synthetic peptides in their antigenic spectrum. It is postulated that these tests may replace the classic immunoblot as the second step in the Lyme disease diagnostic protocol. Direct detection methods based on bacterial culture techniques or using the polymerase chain reaction (PCR) have inadequate sensitivity, which prevents their widespread use in clinical practice. Recently, a number of other tools have been developed that are of supportive importance. Among them, measuring of the CXCL13 chemokine concentration in the cerebrospinal fluid has the potential to become a routine procedure in the diagnosis of Lyme disease in children. Future diagnostic strategies of Lyme disease might include: innovative immunological tests using new antigens, combining serology with direct methods in order to increase sensitivity, standardization of selected unconventional tests, identification of host response biochemical metabolic markers or linking clinical symptoms reported by patients with appropriate test panels. In the absence a vaccine which protects against the disease, the preventive recommendations given to parents to prevent tick bites in children remain valid.

Lyme disease in children: Data from the Canadian Paediatric Surveillance Program

BackgroundLyme disease (LD) is an infectious disease that is emerging in eastern and central Canada associated with the spread of the tick vector Ixodes scapularis. National surveillance shows that children are an at-risk age group. ObjectivesTo study the epidemiology of LD in Canadian children using the Canadian Paediatric Surveillance Program (CPSP) to better understand exposure history, clinical manifestations, diagnosis and treatment of paediatric LD cases in Canada. MethodsA structured questionnaire was completed by paediatricians for each LD case reported as part of the Canadian Paediatric Surveillance Program from 2014 to 2017. ResultsThere were 95 cases that met inclusion criteria as confirmed or probable cases. The median age was 7 years; 38 % were 5–9 years and 35 % were 10−15 years of age. Most cases were acquired in known Canadian endemic locations; 5 were acquired during travel to the US. Most cases were reported from Nova Scotia and Ontario (46 % and 38 % respectively). The most common clinical presentation was arthritis (59 % of all cases), which is a manifestation of the late disseminated stage of LD. Late disseminated disease presented through the year, whereas early LD (Erythema migrans) and early disseminated LD presented during the summer and fall. Antibiotic choice and duration of therapy generally followed accepted guidelines. ConclusionThis study of the clinical spectrum of LD in Canadian children underlines the need for preventive measures to protect children in Canada from emerging LD, and the need for health care provider awareness.

Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children.

Conventional two-tiered testing (CTTT) for Lyme disease includes a first-tier enzyme immunoassay (EIA) followed by a supplemental immunoblot, and modified two-tiered testing (MTTT) relies on two different sequential EIAs without the inclusion of an immunoblot. MTTT has shown promising results as an alternative strategy for the diagnosis of Lyme disease in adults but has not yet been evaluated in children. We performed a cross-sectional study of children and adolescents ≤21 years of age undergoing clinical investigation for suspected Lyme disease. Serum specimens were analyzed with both a whole-cell sonicate (WCS) and a C6 EIA, with a supplemental immunoblot if either EIA was positive or equivocal. We compared CTTT (WCS EIA followed by supplemental immunoblot) to MTTT (WCS EIA followed by C6 EIA) using McNemar's test to evaluate for agreement beyond chance alone. We then used a kappa statistic to measure level of the agreement between testing strategies. We included 1,066 serum specimens, of which 156 (14.6%) had a positive CTTT and 165 (15.5%) had a positive MTTT. There were no significant differences between MTTT and CTTT (P = 0.16). Although the overall agreement between MTTT and CTTT was high (kappa, 0.88; 95% confidence interval, 0.84 to 0.92), 33 children had discordant test results. In a cohort of children and adolescents undergoing investigation for suspected Lyme disease, CTTT and MTTT results agreed in most cases. Since immunoblots are time-consuming, laborious, and challenging to interpret, MTTT provides a promising alternate Lyme disease testing strategy for children.

1760. Interferon Gamma Release Assay for Diagnosis of Lyme disease

BackgroundThe sensitivity of current antibody detection assays against Borrelia burgdorferi in the early stage of Lyme disease is very low. In children especially, who commonly have febrile viral illnesses, manifestations of early Lyme disease can be misdiagnosed. We previously demonstrated that IFNγ secretion could be detected in whole blood collected from Lyme disease patients at first clinical presentation following overnight incubation of the blood with peptides derived from B. burgdorferi. In the present study, we further evaluated the utility of IFNγ release for the laboratory diagnosis of Lyme disease in children with varying stages of the illness.MethodsChildren ages 2–18 years with no prior history of Lyme disease and with manifestations of Lyme disease at any stage were enrolled in the study. Sick and healthy controls were enrolled for comparison. We collected history and physical examination data and blood samples at the time of enrollment, at 1 month, and at 6 months. Standard 2-tier testing with ELISA (whole cell sonicate [WCS] and C6) and western blot were run in parallel to the IFNγ release assay for all blood samples. Sensitivity and specificity of the study assay were determined for presentation at all stages of Lyme disease. Clinical data were summarized.ResultsBlood samples from 22 patients with Lyme disease and 7 controls (4 sick, 3 healthy) were obtained at the first visit. The IFNγ release assay detected early and early disseminated Lyme disease with 78% sensitivity compared with 59% sensitivity of 2-tier testing in our study. For patients presenting with a single erythema migrans (EM) lesion, the IFNγ release assay detected Lyme disease with 63% sensitivity compared with 14% sensitivity with 2-tier testing. The IFNγ release assay had only 25% sensitivity for detecting late disease. A single control patient was positive for both the IFNγ release assay and 2-tier serology.ConclusionA novel IFNγ release assay demonstrated significantly increased sensitivity when compared with 2-tier testing in the laboratory diagnosis of Lyme disease in patients presenting with a single EM lesion. Future study is needed to determine its utility in detecting early Lyme disease in patients with nonspecific febrile illness in the absence of erythema migrans.Disclosures R. Dattwyler, Qiagen: Collaborator, Research support. P. Arnaboldi, Qiagen: Collaborator, research materials.

Profil pacjenta diagnozowanego w kierunku boreliozy na przykładzie pacjentów szpitala pediatrycznego Warszawskiego Uniwersytetu Medycznego w latach 2013-2015

Introduction. Lyme borreliosis is the most frequent tick-borne disease in Europe and North America. It is a chronic, multi-organ disease, with phasic course. The diagnosis is based on clinical symptoms and serologic findings at the patient bitten by the tick. Aim. Aim of this study was to analyze the recommendations for the tests towards the Lyme disease at patients of the Pediatric Hospital of Medical University of Warsaw. Material and methods. We conducted a retrospective analysis of medical data of children hospitalized at the Pediatric Hospital in the period from January 2013 to the end of February 2015, who had performed diagnostic tests for Borrelia burgdorferi infection. Results. In the period from 1st January 2013 to 28th February 2015 tests forantibodies to Borrelia burgdorferi were ordered in 226 patients, including 119 girls and 107 boys. The ELISA test was performed in 219 patients, Western blot test was performed in 25 patients, and the presence of antibodies in the cerebrospinal fluid was examined in 2 patients. Diagnosed patients presented various symptoms. Patients from the two largest groups reported with articular complaints and heart symptoms. The group of patients diagnosed with fever, headache and facial nerve paralysis was less numerous. A small group of patients had a history of tick bite and presented with erythema. Conclusions. Patients of the Pediatric Hospital of the Medical University of Warsaw, who were ordered to perform tests for Lyme disease, presented symptoms from various organs and systems. These symptoms overlap with ailments and symptoms described in people who have been diagnosed with Lyme disease in both the early and late stages of the disease. The serological tests in connection with the medical history and physical examination are an important element in the diagnostics of Lyme disease in children.

Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department.

To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease. We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease. We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease. Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis.