Children and Lyme Disease

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
Post Reply
User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:02

Przegl Lek. 2007;64 Suppl 3:38-40.

CNS Lyme disease manifestation in children.

Kaciński M, Zajac A, Skowronek-Bała B, Kroczka S, Gergont A, Kubik A.
Department of Pediatric Neurology, Jagiellonian University, Krakow, Poland. neupedkr@cm-uj.krakow.pl

BACKGROUND: Neurological symptoms develop in 10-20% of children with borreliosis. AIM OF THE STUDY: It was a presentation of clinical manifestation of neuroborreliosis in children. MATERIAL AND METHODS: Children with neuroborreliosis and other neurological diseases were admitted to the University Hospital during 2005-2006 without any selection. Of these 9 patients, there were seven males and two females, ranging in age between 3-17 years. Neurological diagnostic was performed using ELISA Biomedica kit and western blot bands. A 2-6 week sequential treatment with either i.v. ceftazidime or amoxicillin and oral doxycycline or amoxicillin was provided. Children were monitored regularly during the next 4-24 months. RESULTS: The 9 children with borreliosis constitute 0.53% of the pediatric neurology department's patients. The clinical manifestation of LD were usual and unusual from patient to patient. They included three cases of facial nerve paralysis (with bilateral paralysis in one case). In two cases, they included transverse myelitis and in a single case, hemiparesis, meningitis and acute ataxia. Typically, other patients with early stage borreliosis first manifest focal seizures, raising the suspicion that borreliosis could be responsible for triggering seizures. The antibiotic treatment was successful in 7 patients and only partially effective in 2 children with facial nerve paralysis. CONCLUSIONS: The most common symptom of neuroborreliosis in children is motor dysfunction. Acute ataxia may be a clinical presentation of neuroborreliosis. It is probable that borreliosis_triggers seizures in children with EEG abnormalities.

PMID: 18431910
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:03

Ned Tijdschr Geneeskd. 1997 Mar 8;141(10):482-4.Links

Borrelia lymphocytoma ('winter ears') in children

[Article in Dutch]


Obihara CC, de Geer DB, van Diemen-Steenvoorde JA, de Jongh BM.
Afd. Kindergeneeskunde, St. Antonius Ziekenhuis, Nieuwegein.

Two cases of Borrelia lymphocytoma are reported. The skin lesions were located on the ear margin or lobe. They were swollen, red and painful on touching. Serum titres of antibodies to Borrelia burgdorferi were elevated in both cases. Spirochaetal cultures from skin biopsies taken from the lesions were unsuccessful. Both patients responded very well to antibiotic treatment.

PMID: 9173289
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:05

A 5-year-old Child Who Has Facial Palsy and Rash

A 5-year-old girl who has a history of eczema and seasonal allergic rhinitis presents to the pediatric emergency department with the complaints of an enlarging rash and right-sided facial weakness. The patient was seen by her pediatrician 5 days ago and was diagnosed with a flulike illness. Her pediatrician recommended ibuprofen for relief of her symptoms. Two days ago, her mother noticed a rash on the girl's right leg that has expanded in size. On awakening this morning, she was unable to move the right side of her face. No other family members are ill.

Physical examination reveals a well-appearing child in no acute distress. Her weight is normal for age, and vital signs are within normal limits. Facial asymmetry is evident, with right-sided facial weakness and a droop in the right corner of her mouth (Figure). She cannot wrinkle her forehead or close her eye completely on the affected side. There is no nuchal rigidity, and Kernig and Brudzinkski signs are normal. A 5-cm round, symmetric, blanching erythematous rash with central clearing that is slightly warm is apparent on her right anterior thigh. There are no other rashes, and the remainder of the physical examination findings are normal. A brief video of her general examination is provided (http://www.pedialink.org/media/pir/12_0 ... isease.mov)

A complete blood count demonstrates a hematocrit of 38% (0.38) and a white blood cell count of 5.6x103/mcL (5.6x109/L) with 45% neutrophils, 27% lymphocytes, and 14% monocytes. The platelet count is 274x103/mcL (274x109/L). Serum electrolyte, alanine transaminase, and aspartate transaminase values are normal. The erythrocyte sedimentation rate is 24 mm/hr. Additional serum testing further supports the diagnosis after consideration of the child's environmental exposures and season of year

Diagnosis: Lyme Disease With Erythema Migrans and Bell Palsy

http://pedsinreview.aappublications.org ... /28/12/465
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:15

Prediction of Lyme meningitis in children from a Lyme disease-endemic region: a logistic-regression model using history, physical, and laboratory findings.

Avery RA, Frank G, Glutting JJ, Eppes SC.

Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. averyr@email.chop.edu

BACKGROUND: Differentiating Lyme meningitis (LM) from other forms of aseptic meningitis (AM) in children is a common diagnostic dilemma in Lyme disease-endemic regions. Prior studies have compared clinical characteristics of patients with LM versus patients with documented enteroviral infections. No large studies have compared patients with LM to all patients presenting with AM and attempted to define a clinical prediction model. OBJECTIVE: To create a statistical model to predict LM versus AM in children based on history, physical, and laboratory findings during the initial presentation of meningitis. METHODS: Children older than 2 years presenting to the Alfred I. duPont Hospital for Children between October 1999 and September 2004 were identified if both Lyme serology and cerebrospinal fluid (CSF) were collected during the same hospital encounter. Patients were considered to have Lyme disease only if they met Centers for Disease Control and Prevention criteria (documented erythema migrans and/or positive Lyme serology). Patients were eligible for study inclusion if they had documented meningitis (CSF white blood cell count: >8 per mm3). Retrospective chart review abstracted duration of headache and cranial neuritis (papilledema or cranial nerve palsy) on physical examination and percent CSF mononuclear cells. Using logistic-regression analysis, the type of meningitis (LM versus AM) was simultaneously regressed on these 3 variables. The Hosmer-Lemeshow test was performed and the area under the receiver operating characteristic curve was calculated. RESULTS: A total of 175 children with meningitis were included in the final statistical model. Logistic-regression analysis included 27 patients with LM and 148 patients classified as having AM. Duration of headache, cranial neuritis, and percent CSF mononuclear cells independently predicted LM. The Hosmer-Lemeshow test revealed a good fit for the model, and the Nagelkerke R2 effect size demonstrated good predictive efficacy. Odds ratios based on the logistic-regression results were calculated for these variables. The final model was transformed into a clinical prediction model that allows practitioners to calculate the probability of a child having LM. CONCLUSIONS: Longer duration of headache, presence of cranial neuritis, and predominance of CSF mononuclear cells are predictive of LM in children presenting with meningitis in a Lyme disease-endemic region. The clinical prediction model can help guide the clinician about the need for parenteral antibiotics while awaiting serology results.

PMID: 16396843


DISCUSSION

This is the largest cohort of North American children studied during the initial evaluation of suspected LM. We included all patients who were evaluated for LM (as indicated by ordered Lyme-serology testing) in hopes of representing the population with which the clinician is faced during the initial presentation of meningitis. We defined a clinical prediction model using history, physical, and laboratory findings that are immediately available to all clinicians and can help guide management decisions until diagnostic results are received. Because neither AM nor LM are true medical emergencies, our prediction model could reduce unnecessary parenteral antibiotic use while awaiting serology results. Additionally, Lyme-serology results may not be definitive when patients initially present with central nervous system Lyme disease, again supporting the need for clinical predictors of LM.

Our clinical prediction model will be most helpful in children who do not have erythema migrans at presentation. The largest prospective study of Lyme disease in children reported that 84% of all children presenting with early disseminated Lyme disease were found to have erythema migrans on physical examination.3 However, children in our study (18 of 27 [66.7%]) and others did not seem to have erythema migrans as frequently during LM.5,7,13,14 The absence of erythema migrans in children with AM should not deter the clinician from obtaining Lyme serology, especially in Lyme-endemic regions.

Longer duration of headache was found to be a significant predictor of LM in our study. Although headache is frequently reported as the predominant or most frequent symptom in both AM15,16 and LM,7,13,17,18 a previous study found that patients with LM reported a longer duration of headache at presentation when compared with those with enterovirus meningitis.7 Unlike patients with LM, patients with enterovirus meningitis typically have a rapid onset of headache and fever and are likely to present, on average, within 2 days of onset of symptoms.16 In a large study of children with acute disseminated encephalomyelitis, less than half of the patients presented with a complaint of headache.19 Admittedly, the assessment of headache and headache duration in young children can be difficult and potentially unreliable.

The presence of a cranial nerve palsy (typically the facial nerve) is not pathognomonic for LM, yet it occurred frequently in our patients with LM as well as in other studies of Lyme disease in children.5,7,13,14,20–23 The etiology of a peripheral facial nerve palsy in children without Lyme disease includes a variety of infectious, neoplastic, structural, and idiopathic causes, most of which do not typically present with meningitis.24–27 The only patient with AM in our study who had a cranial nerve palsy was found to have an abducens nerve palsy, which is also known to occur in Lyme disease, and was eventually diagnosed with multiple sclerosis.13,17,21,28 Both peripheral facial nerve and abducens nerve palsy have been reported in children with Lyme disease who do not have a CSF pleocytosis or symptoms suggestive of meningitis.14,20,28 Lyme serology should be obtained in these patients, especially if other systemic symptoms suggestive of Lyme disease are present.29

Raucher et al first described the association between Lyme disease and papilledema.30 Since then, numerous investigators have reported this finding in children diagnosed with Lyme disease with and without a CSF pleocytosis.7,13,21,28,31 In our study, papilledema was found in 9 patients with LM and 4 patients classified as having AM (acute disseminated encephalomyelitis: n = 1; confirmed enterovirus: n = 1; and AM with no known etiology: n = 2). To our knowledge, papilledema has been reported previously in only 1 patient with enterovirus meningitis.32 We are unaware of any studies describing an association between papilledema and acute disseminated encephalomyelitis.

The first studies of LM in children described a CSF mononuclear cell predominance.6,23 Two reports have recommended that a CSF lymphocytic or mononuclear predominance (or a paucity of percent CSF neutrophils) can help clinicians distinguish between LM and AM.5,7 Our study extends this observation by demonstrating an increasing predicted probability and OR of having LM as the percent of CSF mononuclear cells increase even after controlling for the influence of cranial neuritis and duration of headache. Our regression model calculates that patients with 90% CSF mononuclear cells have an OR of 3.4 for LM, whereas the OR is only 2.0 for patients with 40% CSF mononuclear cells. When calculating our model-derived predicted probability and ORs, the clinician should consider that it is exceedingly rare for patients with LM to have <50% CSF mononuclear cells. AM is known to have a predominant percentage of CSF polymorphonuclear neutrophils early in the disease course, with later shift to a lymphocyte predominance. We found that 6 of the 7 patients diagnosed with acute disseminated encephalomyelitis in our study had >86% CSF mononuclear cells. Despite a large percentage of CSF mononuclear cells found in LM, this finding is not specific to LM and further supports the need to rely on other factors (eg, cranial neuritis and duration of headache) when attempting to predict LM. The presence of weakness, ataxia, and MRI findings readily differentiates LM from acute disseminated encephalomyelitis.19

One limitation of our study is that we collected our data retrospectively, and thus our clinical prediction model would be considered "level 4" evidence.33 Before our prediction model can be used to make clinical decisions, our findings need to be validated in a large, prospective study. Another limitation is that our model does not address the small, albeit significant, possibility of classifying a child as having AM when he or she ultimately has bacterial meningitis. However, many excellent clinical prediction models exist to predict bacterial meningitis and could be used in conjunction with our model.34–40 Although Lyme serology is obtained for most children presenting with nonbacterial meningitis at our hospital, it is possible that Lyme serology was not collected for all of these children, potentially creating a selection bias in our population of patients with AM. However, we excluded those patients without Lyme serology because we felt that their inclusion might result in misclassification of some patients with LM as having AM, with greater consequences for the validity of the results. It is also possible that some patients who were included in the LM group might have had Lyme disease in the past with persistent antibodies irrelevant to the current CSF pleocytosis, resulting in misclassification of AM as LM. However, with the background seroprevalence in our region, that would be unlikely. Finally, it is unclear whether the presence of prolonged headache, cranial neuritis, or CSF mononuclear predominance in a child with meningitis would have the same predictive value in regions with a low incidence of Lyme disease.

http://pediatrics.aappublications.org/c ... l/117/1/e1
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:16

Arch Pediatr. 1999 Dec

Ischemic stroke caused by neuroborreliosis

[Article in French]


Laroche C, Lienhardt A, Boulesteix J.
Service de pédiatrie II, CHU Dupuytren, Limoges, France.

Ischemic stroke in children is rare and its etiology is frequently unknown. CASE REPORT: We report the case of a nine-year-old boy who presented a right ischemic lenticular stroke due to neuroborreliosis, with a good outcome after antibiotic treatment. CONCLUSION: We suggest that it is important to search for neuroborreliosis in case of an ischemic stroke in children; the study of cerebral spinal fluid is a good diagnostic marker.

PMID: 10627902
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:17

Ann Med. 1996 Jun;28(3):235-40. Links

Lyme neuroborreliosis in children.

Christen HJ.
Department of Pediatrics, University Hospital, Goettingen, Germany.

Children are more likely than adults to be bitten by ticks and thus more likely to be infected by Borrelia burgdorferi. In a serosurvey the infection rate measured by immunoglobulin G (IgG) antibodies was 2.6%. In a prospective hospital-based multicentre study 169 children with Lyme neuroborreliosis were examined; the infection was diagnosed by detection of specific immunoglobulin M (IgM) antibodies in the cerebrospinal fluid (CSF) using an IgM capture ELISA. The yearly incidence of Lyme neuroborreliosis was 5.8 cases per 100,000 children aged 1-13. Facial palsy and lymphocytic meningitis account for nearly 90% of all cases with neuroborreliosis indicating striking differences in the clinical spectrum between children and adults. Lyme borreliosis proves to be the most frequently verifiable cause of acute peripheral facial palsy in children, causing every second case of this disorder in the summer and autumn. In cases of facial palsy, nearly all patients with a positive history of tick bite or erythema migrans in the head and neck region show ipsilateral subsequent facial nerve palsy, suggesting a direct invasion via the affected nerve by Borrelia burgdorferi. Lyme borreliosis is the third most frequent cause of lymphocytic meningitis in childhood. Inflammatory changes of the cerebrospinal fluid along with the presence of specific antibodies are mandatory for the diagnosis of Lyme neuroborreliosis. High-dose intravenous penicillin G as well as third-generation cephalosporins prove to be effective in paediatric Lyme neuroborreliosis.

PMID: 8811167
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:18

Neuropediatrics. 2005 Dec;36(6):386-8. Links

Autoantibodies to human manganese superoxide dismutase (MnSOD) in children with facial palsy due to neuroborreliosis.

Eiffert H, Karsten A, Ritter K, Ohlenbusch A, Schlott T, Laskawi R, Christen HJ.
Department of Medical Microbiology, University Hospital, Gottingen, Germany.

AIM: Acute peripheral facial palsy due to neuroborreliosis is associated with a distal neuritis. In patients with Lyme disease the activity of antioxidant enzymes is decreased. With respect to the pathogenesis of neuroborreliosis, sera of children with acute peripheral facial palsy were investigated for autoantibodies against human manganese superoxide dismutase (MnSOD), which were suspected of raising the oxidative injury of infected tissues. METHODS: Sera of 20 children with acute peripheral palsy with neuroborreliosis, sera of 20 children with facial palsy without reference to Lyme disease and sera of 14 blood donors were tested for antibodies against human MnSOD using an ELISA. RESULTS: The concentrations of IgM autoantibodies to MnSOD of the children with neuroborreliosis were significantly increased, compared with the two control groups. CONCLUSIONS: We propose that the antibodies detected block the protective effects of MnSOD resulting in an increased oxidative inflammation.

PMID: 16429379 [PubMed - indexed for MEDLINE]


Neuropediatrics. 2004 Oct;35(5):267-73. Links

Acute peripheral facial palsy in Lyme disease -- a distal neuritis at the infection site.

Eiffert H, Karsten A, Schlott T, Ohlenbusch A, Laskawi R, Hoppert M, Christen HJ.
Department of Bacteriology University of Göttingen, Germany.

AIM: Children with acute peripheral facial palsy have often suffered tick bites and/or erythema migrans in the head/neck region on the same side. With respect to the pathogenesis of neuroborreliosis this topographical association was investigated in an animal model. METHODS: A Borrelia garinii strain, isolated from the CSF of a child with acute facial palsy, was injected in 9 rats intracutaneously in the right subauricular region. Infected rats were examined for clinical symptoms of Lyme disease, the spread of the spirochetes was investigated by PCR of necropsies (facial nerves, trigeminus nerves, heart, brain, skin) up to 47 days after infection. The nerve tissues were investigated by histology, immunohistochemistry and electron microscopy. RESULTS: None of the rats developed a facial palsy or other symptoms of Lyme disease. Borrelia DNA was found in the heart after 5 days and in the brain after 7 days of infection up to the end of investigation (47 days), as well as in the ipsilateral peripheral nerves after 7 to 33 days. Borrelia was detected by electron microscopy near endoneural vessels of the facial nerve. Peri-, epi-, and endoneural infiltrations of macrophages, plasma cells and B cells characterized an inflammation of the facial and trigeminus nerves ipsilateral to the infection site. CONCLUSION: An infection with Borrelia garinii in the subauricular region induces an ipsilateral neuritis of peripheral nerves. The particular vulnerability of the human facial nerve may be a result of its long intraosseus course. Thus, an inflammatory edema may injure the nerve in the canalis facialis.

PMID: 15534758
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:20

Correlation of Seroreactivity with Response to Antibiotics in Pediatric Lyme Borreliosis

PAUL T. FAWCETT,1,2* CARLOS D. ROSE´,2,3 KATHLEEN M. GIBNEY,4 AND ROBERT A. DOUGHTY2,5
Immunology Laboratory, Department of Clinical Science,1 Division of Rheumatology,3 and Immunology Research
Programs,4 Alfred I. duPont Institute,5 Wilmington, Delaware, and Department of Pediatrics,
Thomas Jefferson University, Philadelphia, Pennsylvania2
Received 31 July 1996/Returned for modification 24 September 1996/Accepted 7 October 1996

Response to treatment with antibiotics was compared with serologic reactivity and clinical symptoms in a pediatric population with presumptive diagnoses of Lyme borreliosis. The population analyzed for this study
consisted of a subset of a larger Lyme clinic population being monitored as part of a prospective study on
pediatric Lyme borreliosis. All patients resided in an area in which Ixodes scapularis and Borrelia burgdorferi
are considered endemic. Serum from patients was tested by enzyme-linked immunosorbent assay and Western blotting. Response to antibiotics was evaluated by members of a pediatric Lyme clinic. Results showed that positive serologic test results correlate with a favorable response to antibiotics, as does the presence of erythema migrans (EM), regardless of serologic status. Seronegative patients without EM had chronic fatigue and arthralgia and/or myalgia as primary symptoms and did not respond to antibiotics, even when multiple courses of treatment were given. These results indicate that serologic tests designed to have high specificity can reliably rule out Lyme borreliosis in patients with chronic symptoms, thus preventing unnecessary treatment with antibiotics.

http://cvi.asm.org/cgi/reprint/4/1/85.pdf
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:22

Schweiz Rundsch Med Prax. 2007 May 16;96(20):815-7. Links

Lymphadenopathy and absences

[Article in German]


Staub E, Strozzi S, Aebi C.
Medizinische Poliklinik, Universitätskinderklinik, Inselspital Bern.

A 6-year-old boy presented with deterioration of general well-being during several weeks, headache and swelling of lymph nodes in the neck. In addition, the parents reported brief episodes resembling typical absence seizures. Serological tests and the examination of cerebrospinal fluid revealed neuroborreliosis. At the same time, electroencephalography showed characteristic patterns of absence epilepsy. The boy's condition improved rapidly during a 2-week course of intravenous ceftriaxone and after initiation of antiepileptic therapy. To our knowledge, absence epilepsy has not previously been reported in association with neuroborreliosis. We consider the two conditions to be coincidental.

PMID: 17566418
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Children and Lyme Disease

Post by Yvonne » Sun 27 Apr 2008 12:24

Tick inoculation in an eyelid region

Summary:

Purpose: To determine the frequency and dependence of Lyme borreliosis after tick infes­tation in the eyelid region.

Material and methods: Five patients after tick inoculation were investigated by immuno­fluorescence assays for IgM and IgG antibodies to Borrelia burgdorferi. One positive test was followed with an enzyme immunoassay and immunoblot (a two step system). Ophthalmologic evaluation of myositis was supported with MRI, laboratory, and internal clinical investi­gations.

Results: Four children showed negative Borrelia serology after a bite from a tick. In one case the left abducens nerve palsy was found, which was diagnosed in MRI as a thickened left lateral rectus muscle. The diagnosis of myositis with positive Borrelia burgdorferi serology was consistent with Lyme borreliosis. Other laboratory examinations were negative. The symptoms were reduced after treatment with ceftriaxon.

Conclusions: Lyme borreliosis was found in one in five patients after tick infestation in the eyelid region. Antibiotic prophylaxis against Lyme borreliosis with ampicillin is recommended for children after a tick bite

Material and methods

We have treated 5 patients from tick bite in eyelid area since 1989. Four of them were children of between 3 to 10 year-old. After application of the local anesthetic ointment with 2,5% lidocain and 2,5% prilocain (Emla Astra® Zeneca), ticks were removed. In case 3 the head of a tick was removed with a sterile needle. Case 5 comprised a 78 year-old man, who removed a big tick by himself and we removed the holdover of the head. All children took the prophylactic treatment for three weeks after the tick bite with antibiotics: amoxicillin 50 mg/kg weight/per day. Serological tests for Borrelia burgdorferi with the immunofluorescence assay (IFA) for IgM (1:48 normal titer range) and IgG antibodies (1:32 normal titer range), were carried out for cases 1-3 one and six months after tick bites. In cases 4 and 5, an additional, more sensitive and specific enzyme immunoassay (EIA) for Borreliosis (with a normal titer range for the IgG antibody at 1:160) was also carried out. We have used a “two step system” (6) that included EIA and immunoblot for IgG antibody (positive by recognition minimum of two of five proteins 20, 24, 35, 39, 88 kDa) in the positive EIA test in case 5. All immunological investigations were carried out in the same laboratory in Bremen (6). Standard ophthalmological tests were performed for all patients. Additionally, an MRI, internal, neurological examinations, and a Hess screen investigation for paretic strabismus were carried out for patient 5, with the diagnosed orbital myositis. This patient was cured after the daily intravenous 2 g ceftriaxon (Rocephin®, Roche) for 3 weeks and with 60 mg prednison/day for a week.

Conclusions

Tick infestation in the eyelid region is found mostly in children, and the tick should be removed as soon as possible. While the response of the cellular immunity system (erythema migrans) to Bb is manifested after few days till weeks, we feel that an appropriate antibiotic prophylaxis should be undertaken, before specific IgG antibodies will be found in 3 or more months

http://www.okulistyka.com.pl/klinika/06_nr_46_art18.htm
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

Post Reply