Clinical manifestations of Lyme neuroborreliosis in children: a review

Bruinsma, R A; Zomer, Tizza P.; Skogman, Barbro H.; Hensbroek, Michaël Boele van; Hovius, Joppe W.

doi:10.1007/s00431-023-04811-w

Cited by 6 publications

(7 citation statements)

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“…Half of the patients in Paper I were children and their clinical characteristics are compared to the adults (Paper I) in Table 9. The different symptoms of children and adults show that radiculitis is more common in adults while children with LNB have, to a greater extent headache and fever, as previously reported [20,21]. Symptoms may also differ between children and adults, since adults may have a tendency to report some symptoms more frequently, such as vertigo and concentration difficulties.…”

Section: Ethical Considerationsmentioning

confidence: 59%

“…The age distribution for borreliosis is typical bimodal, with two peaks -in children between 5-9 years and in adults, with a raising incidence after 50 years of age [3,15,20]. Tick bites are often located at the lower extremities and trunk in adults and at the head or neck in children [15,21]. Bites closer to the head are believed to raise the risk of spreading the infection towards the neurological system, and children are more prone to have facial nerve palsies (FNP) compared to adults [15,21].…”

Section: Epidemiology Of Lyme Borreliosismentioning

confidence: 99%

“…Tick bites are often located at the lower extremities and trunk in adults and at the head or neck in children [15,21]. Bites closer to the head are believed to raise the risk of spreading the infection towards the neurological system, and children are more prone to have facial nerve palsies (FNP) compared to adults [15,21].…”

Section: Epidemiology Of Lyme Borreliosismentioning

confidence: 99%

“…In children, LNB more often presents with FNP or headache, which can be accompanied with a low-grade fever, loss of appetite, and fatigue [10,20]. If the child has an EM present in the head or neck, the FNP usually involves the ipsilateral side, and bilateral FNP in children is almost always caused by LNB [21]. Neck stiffness is uncommon, and most often described in children [20].…”

Section: Lyme Neuroborreliosismentioning

confidence: 99%

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Tick-borne diseases and the central nervous system : clinical and immunological aspects

Gyllemark

2023

Linköping University Medical Dissertations

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Lyme neuroborreliosis (LNB) is the dominating form of disseminated infection by the tick-borne bacteria Borrelia (B.) burgdorferi in Sweden as well as in Europe. The diagnosis of the manifestation is based on typical symptoms, together with elevated mononuclear cell count in the cerebrospinal fluid (CSF) and elevated levels of Borrelia-specific antibodies in the CSF. The diagnostic arsenal has, in recent years, been complemented by analysis of the chemokine CXCL13 in the CSF, with increasing levels in the early phase of the disease, even before antibodies can be detected in the CSF. Most patients recover within a couple of months after antibiotic treatment, but a few can suffer from residual symptoms. The mechanisms behind this are still puzzling, but there are indications that the host´s immune response may play a role. Prognostic markers would be desirable and increased understanding of pathogenetic mechanisms may provide a basis for development of new treatment strategies. Other agents besides B. burgdorferi have, however, also been detected in ticks collected in Sweden, but the knowledge of their impact on human health and their ability to invade the central nervous system (CNS) is limited.The aims of this thesis were to investigate a set of cytokines and chemokines associated with Th1 (CXCL10), Th2 (CCL22), Th17 (IL-17A, CXCL1, CCL20) and B cell (APRIL, BAFF, CXCL13) -related immunity and its association with recovery in patients with LNB included both retrospectively and prospectively. The chemokine CXCL13 was further analysed, comparing the performance of two different diagnostic methods. In a large cohort of patients investigated for LNB we investigated signs of other tick-borne diseases by analysing serum and CSF using both molecular and serological techniques.In the retrospective cytokine/chemokine study, all investigated cytokines and chemokines; namely, APRIL, BAFF, CXCL13, IL-17A, CXCL1, and CCL20 could be detected at elevated levels in patients with LNB compared to controls. Patients with recovery > 3 months had higher levels of APRIL, BAFF, and IL-17A. In the prospective study, patients with short recovery (< 1 month) had lower levels of CCL20 and patients with prolonged recovery (> 6 months) had higher levels of IL-17A. The analysis of the chemokine CXCL13 with both an enzyme-linked immunosorbent assay (ELISA) with a best-performanced cut-off of 56 pg/mL and bead-based (Luminex) method with a best-performance cut-off of 158 pg/mL (both assays with 100% sensitivity and specificity) displayed the importance of different cut-offs depending on which method that is used.In 600 patients, we analysed serum and CSF with PCR for the different tick-borne agents Anaplasma phagocytophilum, B. burgdorfer spp. (including B. miyamotoi), Neoehrlichia (N.) mikurensis, Rickettsia spp., Babesia spp. and tick-borne encephalitis virus. N. mikurensis and B. burgdorferi could be detected by PCR in sera from two patients. Neither PCR, nor serological analysis could detect any potential co-infections.In conclusion, we ca...

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Section: Ethical Considerationsmentioning

confidence: 59%

Section: Epidemiology Of Lyme Borreliosismentioning

confidence: 99%

Section: Epidemiology Of Lyme Borreliosismentioning

confidence: 99%

Section: Lyme Neuroborreliosismentioning

confidence: 99%

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Tick-borne diseases and the central nervous system : clinical and immunological aspects

Gyllemark

2023

Linköping University Medical Dissertations

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“…In children, the most common manifestations of neuroborreliosis include facial nerve palsy and aseptic meningitis. The variations in symptoms observed in different geographical regions and age groups are likely due to differences in the types of Borrelia species [3][4][5][6][7][8][9]. This case of Lyme neuroborreliosis in a non-endemic area emphasizes the need to stay alert and consider Lyme disease in regions not typically linked with the disease.…”

Section: Introductionmentioning

confidence: 99%

Rare Presentation of Pediatric Nervous System Lyme Disease: A Case Report

Khurtsilava,

kanjaradze,

Tsirdava

et al. 2024

Cureus

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Lyme disease is a multisystem infectious disease. It is caused by the dissemination of Borrelia spirochetes after a tick bite. It has various manifestations across different age groups. Commonly involved organs are the skin, joints, and nervous system. Nervous system Lyme disease has a wide spectrum of manifestations. While facial nerve palsy and subacute meningitis are commonly observed in the pediatric population, our case report reveals an uncommon manifestation of the nervous system Lyme disease. A four-year-old patient exhibited mood changes, behavioral issues, and generalized tonic-clonic seizures. Extensive diagnostic workup initially yielded no clear cause until positive IgM and IgG serology for Borrelia suggested Lyme neuroborreliosis. This differs from the usual symptoms seen in pediatric cases. The patient responded positively to antibiotic treatment, but persistent post-treatment behavioral issues raised questions about potential long-term effects. This case underscores the importance of considering Lyme disease in atypical presentations, even in non-endemic areas, necessitating an adaptable diagnostic approach for improved outcomes, especially in pediatric patients. Continued research into the comprehensive understanding of Lyme disease in pediatric patients is crucial.

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