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.
| Published in | American Journal of Pediatrics (Volume 5, Issue 4) |
| DOI | 10.11648/j.ajp.20190504.24 |
| Page(s) | 246-253 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Lyme Meningitis, Children, Lyme Borreliosis, Diagnosis
| [1] | Stanek G, Wormser GP, Gray J, Strle F (2012). Lyme borreliosis. Lancet 397, 461–473. |
| [2] | Stanek G, Strle F (2018). Lyme borreliosis–from tick bite to diagnosis and treatment. FEMS Microbiol Rev 42, 233–258. |
| [3] | Steere AC, Strle F, Wormser GP, Hu LT, Branda JA, Hovius JWR, et al (2017). Lyme borreliosis. Nat Rev Dis Primers.; 2: 16090. doi: 10.1038/nrdp.2016.90. |
| [4] | Sood SK (2015). Lyme disease in children. Infect Dis Clin N Am 29, 281–294. |
| [5] | Shapiro E (2018). Lyme borreliosis in 2018. What is new (and what is not). JAMA 320, 635–636. |
| [6] | Avery RA, Frank G, Glutting JJ, Eppes SC (2006). Prediction of Lyme meningitis in children from Lyme disease-endemic region: a logistic-regression model using history, physical, and laboratory findings. Pediatrics 117, e1–e7. |
| [7] | Esposito S, Bosis S, Sabatini C, Tagliaferri L, Principi N (2013). Borrelia burgdorferi infection and Lyme disease in children. Intern J Infect Dis 17, e153–e158. |
| [8] | Sanchez E, Vannier E, Wormser GP, Hu LT (2016). Diagnosis, treatment, and prevention of Lyme disease, Human granulocytic anaplasmosis, and Babesiosis. JAMA 315, 1767–1777. |
| [9] | Barstad B, Quarsten H, Tveitnes D, Noraas S, Ask IS, Saeed M, et al (2018). Direct molecular detection and genotyping of Borrelia burgdorferi sensu lato in cerebrospinal fluid of children with Lyme neuroborreliosis. J Clin Microbiol 56: e01868-17. https://doi.org/10.1128/JCM.01868-17. |
| [10] | Rothbart HA (1995). Enteroviral infections of the central nervous system. Clin Infect Dis 20, 971–981. |
| [11] | Garro AC, Rutman M, Simonsen K, Jaeger JL, Chapin K, Lockhart G (2009). Prospective validation of a clinical prediction model of Lyme meningitis in children. Pediatrics 123, e829–e834. |
| [12] | Arnež M, Pleterski-Rigler D, Ahčan J, Ružić-Sabljić E, Strle F (2001). Demographic features, clinical characteristics and laboratory findings in children with multiple erythema migrans in Slovenia. Wien Klin Wochenschr 113, 98–101. |
| [13] | Reiber H, Peter JB (2001). Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs. J Neurol Sci 184, 101–122. |
| [14] | Wilske B, Schierz G, Preac-Mursic V, Weber K, Pfister HW, Einhaupl K (1984). Serological diagnosis of erythema migrans disease and related diseases. Infection 5, 331–335. |
| [15] | Preac-Mursic V, Wilske B, Schierz G (1986). European Borrelia burgdorfei isolation from humans and ticks culture conditions and antibiotic susceptibility. Zentralbl Bakteriol Mikrobiol Hyg A 263, 112–118. |
| [16] | Ružić-Sabljić E, Arnež M, Logar M, Maraspin V, Lotrič-Furlan S, Cimperman J, et al (2005). Comparison of Borrelia burgdorferi sensu lato strains isolation from specimens obtained simultaneously from two different sites of infection in individual patients. J clin Microbiol 43, 2194–2200. |
| [17] | Postic D, Assous MV, Grimont PA, Baranton G (1994). Diversity of Borrelia burgdorferi sensu lato evidenced by restriction fragment length polymorphism of rrf (5S)-rrl (23S) intergenic spacer amplicon. Int J Syst Bacteriol 44, 743–752. |
| [18] | Arnež M, Lužnik-Bufon T, Avšič-Županc T, Ružić-Sabljić E, Petrovec M, Lotrič-Furlan S, et al (2003). Causes of febrile illnesses after a tick-bite in Slovenian children. Pediatr Infect Dis J 22, 1078–1083. |
| [19] | Shah SS, Zaoutis TE, Turnquist J, Hodinka RL, Coffin SE (2005). Early differentiation of Lyme from enteroviral meningitis. Pediatr Infect Dis J 24, 542–545. |
| [20] | Halperin JJ (2015). Nervous system Lyme disease. Infect Dis Clin N Am 29, 241–253. |
| [21] | Garro AC, Rutman MS, Simonsen K, Jaeger JL, Chapin K, Lockhart G (2011). Prevalence of Lyme meningitis in children with aseptic meningitis in a Lyme disease-endemic region. Pediatr Infect Dis J 30, 990–992. |
| [22] | Øymar R, Tveitnes D (2009). Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe. Scand J Infect Dis 41, 88–94. |
| [23] | Dayan NE, Rubin LG, Di John DD, Sood SK (2004). Hypoglycorrachia in Lyme meningitis. Pediatr Infect Dis J 23, 370–371. |
| [24] | Broekhuijsen-van Henten D, Braun KP, Wolfs TFW (2010). Clinical presentation of childhood neuroborreliosis; neurological examination may be normal. Arch Dis Child 95, 910–914. |
| [25] | Eppes SC, Nelson DK, Lewis L, Klein JD (1999). Characterization of Lyme meningitis and comparison with viral meningitis in children. Pediatrics 103, 957–960. |
| [26] | Tuerlinckx D, Bodart E, Garrino MG, de Bilderling G (2003). Clinical data and cerebrospinal fluid findings in Lyme meningitis versus aseptic meningitis. Eur J Pediatr 162, 150–153. |
| [27] | Porwancher R (2006). Predictive model of Lyme meningitis. Pediatrics 118, 438–439. |
| [28] | Tveitnes D, Natås OB, Skadberg Ø, Øymar K (2012). Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study. Arch Dis Child 97, 215–220. |
| [29] | Cohn KA, Thompson AD, Shah SS, Hines EM, Lyons TW, Welsh EJ, et al (2012). Validation of clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics 129, e46–e53. |
| [30] | Tuerlinckx D, Bodart E, Jamart J, Glupczynski Y (2009). Prediction of Lyme meningitis based on a logistic regression model using clinical and cerebrospinal fluid analysis. Pediatr Infect Dis J 28, 394–397. |
| [31] | Waespe N, Steffen I, Heininger U (2010). Etiology of aseptic meningitis, peripheral facial nerve palsy, and a combination of both in children. Pediatr Infect Dis J 29, 453–456. |
| [32] | Wilske B, Fingerle V, Schulte-Spechtel V (2007). Microbiological and serological diagnosis of Lyme borreliosis. FEMS Immunol Med Microbiol 49, 13–21. |
| [33] | Cerar T, Ruzic-Sabljic E, Cimperman J, Stle F (2006). Comparison of immunofluorescence assay (IFA) and LIAISON® in patients with different clinical manifestations of Lyme borreliosis. Wien Klin Wochenschr 118, 686–690. |
| [34] | Theel ES, Aguero-Rosenfeld ME, Pritt B, Adem PV, Wormser GP (2019). Limitations and confusing aspects of diagnostic testing for neurologic Lyme disease in the United States. J Clin Microbiol 57: e01406-18. https://doi.org/10.1128/JCM.01406-18. |
| [35] | Christen HJ (1996). Lyme neuroborreliosis in children. Ann Med 28, 235–40. |
| [36] | Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP (2005). Diagnosis of Lyme borreliosis. Clin Microbiol Rev 18, 484–509. |
| [37] | Schutzer SE, Body BA, Boyle J, Branson BM, Dattwyler RJ, Fikrig E, et al (2019). Direct diagnostic tests for Lyme disease. Clin Infect Dis 68, 1052–1057. |
| [38] | Halperin JJ (2002). Nervous system Lyme disease. Vector Borne Zoonotic Dis 2, 241–247. |
APA Style
Mojca Rozic, Andra Leskovec, Eva Ruzic-Sabljic, Maja Arnez. (2019). Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation. American Journal of Pediatrics, 5(4), 246-253. https://doi.org/10.11648/j.ajp.20190504.24
ACS Style
Mojca Rozic; Andra Leskovec; Eva Ruzic-Sabljic; Maja Arnez. Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation. Am. J. Pediatr. 2019, 5(4), 246-253. doi: 10.11648/j.ajp.20190504.24
AMA Style
Mojca Rozic, Andra Leskovec, Eva Ruzic-Sabljic, Maja Arnez. Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation. Am J Pediatr. 2019;5(4):246-253. doi: 10.11648/j.ajp.20190504.24
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ajp.20190504.24,
author = {Mojca Rozic and Andra Leskovec and Eva Ruzic-Sabljic and Maja Arnez},
title = {Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation},
journal = {American Journal of Pediatrics},
volume = {5},
number = {4},
pages = {246-253},
doi = {10.11648/j.ajp.20190504.24},
url = {https://doi.org/10.11648/j.ajp.20190504.24},
eprint = {https://article.sciencepublishinggroup.com/pdf/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 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.},
year = {2019}
}
TY - JOUR T1 - Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation AU - Mojca Rozic AU - Andra Leskovec AU - Eva Ruzic-Sabljic AU - Maja Arnez Y1 - 2019/11/11 PY - 2019 N1 - https://doi.org/10.11648/j.ajp.20190504.24 DO - 10.11648/j.ajp.20190504.24 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 246 EP - 253 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20190504.24 AB - 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 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. VL - 5 IS - 4 ER -
Information
Email: