Cutaneous Manifestations of Lyme Borreliosis in Children—A Case Series and Review

Abstract

The occurrence of skin lesions is the earliest symptom of Lyme disease, and the diagnosis of these lesions and appropriate treatment may prevent complications of the disease, which are mainly neurological. The cutaneous presentation in borreliosis is heterogeneous. There are typical lesions that constitute the basis for the diagnosis of Lyme disease, and atypical ones, which cause significant diagnostic difficulties especially when the patient does not remember the tick bite. This study aims to describe the heterogeneous skin symptoms of Lyme borreliosis, as well as offer a practical approach for the recognition of the disease. Based on pediatric cases from clinical practice, rare cutaneous presentations of Lyme disease at various stages of illness and therapy are presented. Diagnostic recommendations for recognizing individual forms are discussed.

Neuroborreliosis and Post-Treatment Lyme Disease Syndrome: Focus on Children

“…Performing multiple lumbar punctures to obtain CSF for monitoring the course of NB in a child raises ethical concerns as it is a traumatic procedure for the patient. In addition, currently used tests, including intrathecal production of antibodies and serological tests, are not the basis of cure assessment [12]. Published in 2005 by the Swiss Society of Infectious Diseases, a case definition for PTLSD does not differentiate between adults and children.…”

“…The early localized phase (calculated up to 8 weeks from the moment of infection) is most often associated with the occurrence of a primary lesion, i.e., a characteristic erythema migrans (EM), as a pathognomonic symptom. Another form of the early local phase is borrelial lymphocytoma, which manifests as a blue-red nodule on the earlobe, scrotum, or nipple [12,13]. In the early disseminated stage of the disease (from 6 to 26 weeks from the moment of infection), various organs are involved as a result of the dissemination of the spirochetes through the blood and lymph vessels in the body.…”

“…This form is less common in children [6]. The early disseminated phase also includes multiple erythema migrans (MEM), where it takes on multiple forms occurring simultaneously on different parts of the body [12,13]. The late phase of LB in children occurs several months, sometimes even several years, after infection in the form of Lyme arthritis (mono-, oligo-, or polyarthritis), acrodermatitis chronica athrophicans, and neuroborreliosis (NB) [18].…”