Children and Lyme Disease

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Sun 11 Apr 2010 12:36

Expert Rev Anti Infect Ther. 2010 Apr;8(4):455-63.

Lyme neuroborreliosis in children.

Tuerlinckx D, Glupczynski Y.

Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Département de Pédiatrie, Yvoir, Belgium. david.tuerlinckx@uclouvain.be

Abstract

Lyme neuroborreliosis (LNB) represents the second most frequent manifestation of Lyme disease (LD) in Europe after cutaneous involvement. In the USA, LNB represents the third most frequent manifestation of LD after cutaneous involvement and arthritis. The scope of this article is, in the light of recent publications, to review the specific manifestations of LNB in children including predictive models, and to discuss diagnosis criteria, new diagnostic tools and new therapeutic options. Differences in disease patterns between the USA and Europe are also highlighted.

PMID: 20377339
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Wed 28 Apr 2010 14:13

HNO. 2010 Apr 25. [Epub ahead of print]

Ambiguous swelling of the earlobe.

[Article in German]

Knopf A, Becker K, Rasch C.

Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland, a.knopf@lrz.tum.de.

Abstract
A 2-year-old girl presented with a reddish swelling of the left earlobe which had been present for over 6 months. Because of the unspecific previous medical history and the unclear clinical symptoms a biopsy of the swelling was carried out. The histological investigation revealed a lymphocyte-infested infiltration with lymph follicles corresponding to cutaneous lymphoid hyperplasia, which is a rare but typical skin manifestation of stage II Lyme borreliosis. The infection could be successfully treated with antibiotics.
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Thu 13 May 2010 20:27

https://www.thieme-connect.com/DOI/DOI? ... 30-1249091

Neuroborreliose: Ätiologie und Diagnostik der peripheren Fazialisparese in Tirol
Abstract
Background: Lyme neuroborreliosis (LNB) is the second most common manifestation of Borrelia burgdorferi sensu lato (s. l.) infection in Europe. LNB is difficult to differentiate from other aetiologies of aseptic meningitis. Diagnostic criteria for LNB in children are not established. Therfore, based on the epidemiology of LNB in children from Tyrol, the aim of our study was to point out the necessity of a clear definition of pediatric LNB to avoid underdiagnosis and overtreatment.

Patients and Methods: All medical charts of patients presented with acute peripheral facial palsy from January 2002 to December 2005 were reviewed. The patients were rediagnosed according to the criteria of the German Society of Neurology (DGN).

Results: We identified 66 patients with peripheral facial palsy. 30 children were handled as B. burgdorferi s. l. infection. 5 patients were overtreated with antibiotic therapy. After reevaluation according to the DGN criteria 7 cases were reclassified as possible, 16 cases as probable and 7 cases as confirmed LNB.

Conclusions: Utilization of the established DGN criteria for pediatric LNB might help to elucidate the propability of LNB. Prospective studies are required to establish a classification system. A diagnostic tool, based on laboratory and clinical data, should avoid overtreatment of pediatric LNB.
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Mon 21 Jun 2010 9:41

https://www.thieme-connect.com/ejournal ... 006-974121

Clinical manifestations and neuroimaging in neuroborreliosis - an unexpectedly high portion of patients with cerebral arteriopathy
Neuroborreliosis often presents with cranial nerve palsy, aseptic meningitis or meningoencephalitis. Cerebral arteriopathy has rarely been reported as single cases. Here we present a retrospective analysis from 1997 to 2005 in the Berlin area. In this period neuroborreliosis was confirmed in 47 children through the finding of specific antibodies against Borrelia burgdorferi in CSF.


22 (47%) suffered from facial palsy as a presenting symptome, in one of them the palsy was bilateral. Four children (9%) had palsies of other cranial nerves, and four patients (9%) presented with paresis of an arm, hemiparesis, or spastic paraparesis. 16 children (34%) reported headache on admission, 15 (32%) presented with myalgia and/or arthralgia. Two patients (4%) had paraesthesia, another two (4%) were atactic. Ten (21%) had unspecific symptoms such as fever, fatigue, loss of appetite, or nausea. Other symptoms included general slowdown, sensoric or motoric aphasia, agitation, confusion, incomplete Horner's syndrome, and mucosa haemorrhage, each in one patient.


In 19 patients (40%) cerebral imaging was performed. 13 (68%) were found to be normal, or rather revealed typical lesions in a patient with an underlying neurofribromatosis type 1. In one child with hemiparesis, and in one with multiple cranial nerve palsies, arterial subtraction angiography (DAS) confirmed multifocal vasculitis and dissection of the left Aa. vertebralis and basilaris, respectively. In one girl with hemiplegia, MRI revealed an infarction of the according internal capsule. Although angiography was not done this finding is suspicious of focal arteriopathy. The girl also had a homozygous mutation of factor V Leiden.


In our patients with confirmed neuroborreliosis, cranial nerve palsies and unspecific symptoms of aseptic meningoencephalitis - as expected - were the most frequent clinical pictures. However, an unexpectedly large number of patients presented with focal deficits. We conclude that infectious - because treatable - causes should be ruled out in patients presenting with focal deficits.
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Wed 30 Jun 2010 16:15

Arch Dis Child. 2010 Jun 28. [Epub ahead of print]

Clinical presentation of childhood neuroborreliosis; neurological examination may be normal.

Broekhuijsen-van Henten DM, Braun KP, Wolfs TF.

Department of Paediatrics, Isala Clinics, Zwolle, The Netherlands.

Abstract
Objective Neuroborreliosis has its highest incidence in children and the older people. Signs and symptoms are different between the different age groups. The aim of this study was to describe the clinical spectrum of neuroborreliosis in children. Design The Dutch Paediatric Surveillance system registered cases of childhood neuroborreliosis during 2 years. All Dutch paediatric hospitals took part in this surveillance.

Criteria for reporting cases were strictly defined. Results 89 cases of neuroborreliosis were reported; in 66 cases diagnosis was confirmed. Facial weakness was one of the presenting symptoms in 47 cases (71%) and the only symptom in nine children (14%). The five complaints most frequently reported were: malaise, headache, fatigue, fever and neck pain. 52 children (79%) had one or more objective neurological signs at presentation, of which facial nerve palsy, other cranial nerve abnormalities and meningeal signs were most frequent. 14 patients (21%), however, had no neurological signs at physical examination. In these patients, the number of subjective complaints was higher, and the time interval to diagnosis was longer compared with those with objective neurological abnormalities.

Conclusions In this study, 79% of paediatric neuroborreliosis patients presented with neurological signs, most often facial nerve palsy. 21% presented in an atypical way without neurological signs. A thorough neurological examination is essential once neuroborreliosis is considered in children. Even in the absence of neurological signs, neuroborreliosis may be suspected in children with typical antecedents and multiple symptoms. Cerebrospinal fluid investigations are then required to confirm the diagnosis.

PMID: 20584849
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Wed 21 Jul 2010 15:35

Arch Pediatr. 2010 Jun 21. [Epub ahead of print]

Borrelia-associated lymphocytoma cutis.

[Article in French]

Palmen C, Jamblin P, Florkin B, Hoyoux C.

Faculté de médecine, Ulg, Liège, Belgique.

Abstract
We describe a 6-year-old boy who developed Borrelia burgdorferi-associated lymphocytoma cutis on the ear. Lymphocytoma is a benign polyclonal B-cell lymphoproliferative process; it is defined as a subacute manifestation of early disseminated borrelial infection. Clinical history, physical examination, and serodiagnosis tests are often sufficient to establish diagnosis, but sometimes, histopathologic analysis is needed to exclude malignant cutaneous lymphomas. The outcome is always favorable but after antibiotic therapy, the lesion disappears promptly.
Copyright © 2010. Published by Elsevier SAS.

PMID: 20573489
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Yvonne
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Re: Children and Lyme Disease

Post by Yvonne » Fri 13 Aug 2010 12:06

Arch Dis Child. 2010 Aug 10. [Epub ahead of print]

Seroprevalence of Borrelia IgG antibodies among young Swedish children in relation to reported tick bites, symptoms and previous treatment for Lyme borreliosis: a population-based survey.

Skogman BH, Ekerfelt C, Ludvigsson J, Forsberg P.

Department of Pediatrics, Falun General Hospital, Falun, Sweden.

Abstract
Background Lyme borreliosis (LB) is the most common tickborne infection in Sweden and the seroprevalence of Borrelia immunoglobulin G (IgG) antibodies varies between 2% and 26%. The seroprevalence in young Swedish children is unknown and the relation to clinical data has not been previously studied. Objective To determine the seroprevalence of Borrelia IgG antibodies in serum of young Swedish children and to relate it to gender, geographical location, reported tick bites, symptoms and previous treatment for LB. Methods 2000 healthy 5-year-old children (n=2000) were randomly selected from among participants of a larger prospective population-based study, the ABIS (All Babies in Southeast Sweden) study. Serum samples were collected and a Borrelia specific ELISA test (Dako) were performed for IgG antibody detection. Clinical data were collected from questionnaires completed by the parents. Results The seroprevalence of Borrelia IgG antibodies was 3.2% (64/2000). Previous tick bite had been noted in 66% of these seropositive children but the majority (94%) had not previously been treated for LB. In addition, another 55 children reported a history of LB but were negative to Borrelia IgG antibodies in serum. Many of these seronegative children had received treatment for erythema migrans (n=24), which is a clinical diagnosis. Whether children were correctly treated or overtreated for LB is however unknown. No differences in gender, geographical location or reported tick bites were found when comparing Borrelia-seropositive children (n=64) and seronegative children with previous LB (n=55). Conclusion This population-based study demonstrates a Borrelia IgG antibody seroprevalence of 3.2% in young Swedish children. Very few of these seropositive children report previous symptoms or treatment for LB. Thus the findings suggest that exposure to the Borrelia spirochaete (with subsequent antibody response in serum) does occur in young children, mostly without giving rise to clinical LB. Future studies on cell-mediated immune responses are needed to investigate explanatory immunological mechanisms.

PMID: 20702388
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