Epidemiology and Clinical Manifestations of Lyme Borreliosis in Childhood

Abstract

. Lyme borreliosis is a tick‐borne infection caused by the spirochete Borrelia burgdorferi, whose discovery in 1982 solved an aetiological mystery involving a variety of dcrmatological and neurological disorders and explained their association with Lyme disease. Lyme borreliosis occurs frequently and is readily treatable with antibiotics. Along with its discovery, however, came the realization that it is difficult to diagnose accurately, especially antibody diagnosis. False‐positive antibody results in particular led to gradual widening of the clinical spectrum, and differential diagnosis became increasingly difficult. This prospective, multicentre study presents a systematic description of Lyme borreliosis in childhood, emphasizing epidemiological and clinical issues. Because, predominantly, inpatients were examined, Lyme neuroborreliosis was the focus of the study, with the chief concern being to minimize false‐positive results. To this end, we chose to narrow the diagnostic criteria, using the presence of specific antibodies in the cerebrospinal fluid as the determining factor. The epidemiological investigation was focused on the incidence of Lyme neuroborreliosis in childhood in southern Lower Saxony as well as on the prevalence of Lyme neuroborreliosis among acute‐inflammatory neurological illnesses in children. The clinical part of the study aimed at establishing criteria for differential diagnosis in addition to the detection of specific antibodies. The detection of specific IgM antibodies using an IgM capture ELISA confirmed the presence of acute Lyme borreliosis. The study examined 208 children with Lyme borreliosis, of whom 169 had Lyme neuroborreliosis, from mid‐1986 until the end of 1989. The yearly incidence of Lyme neuroborreliosis in Lower Saxony was 5.8 cases/100,000 children aged 1 to 13. The manifestation index was 0.16, or one case of Lyme neuroborreliosis per 620 infected children, compared with the presence of specific antibodies against B. burgdorferi for children in the same age group and region. Both the seasonal distribution of Lyme borreliosis, which peaked in summer and autumn, as well as the information about when the tick bites took place point to an incubation period of a few weeks. The most frequent manifestation of Lyme neuroborreliosis in childhood was acute peripheral facial palsy, found in 55% of all cases (n = 93). Lyme borreliosis proved to be the most frequently verifiable cause of acute peripheral facial palsy in children, causing every second case of this disorder in summer and autumn. Bilateral facial palsy was, without exception, found to be caused by Lyme borreliosis; thus it can be considered a specific neurological sign of this infection. The second most common manifestation of Lyme neuroborreliosis in childhood was aseptic meningitis (27.2%, n = 46). Lyme borreliosis was the third most common cause of aseptic meningitis in childhood (11.8%). Meningoradiculoneuritis with peripheral nerve involvement (Bannwarth syndrome) was diagnosed in only 3.6% of the childr...

Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis

“…In some cases, the AIs were ≥1.5 while in serum BB -specific antibodies were below the cut-off of the ELISA [19]. This phenomenon was found in 9 patients in our study.…”

“…These patients were either in the very early stage of the disease or were immunosuppressed individuals or were children with an isolated facial palsy [19]. In our study, all patients had CSF lymphopleocytosis, and we have not seen such a case in adults during our clinical practise.…”

Bilateral sensorineural hearing loss and spastic paraparesis in Lyme disease

“…The absence of a tick bite or a cutaneous eruption is not unusual because the tick is small and a rash may not appear. 1,3 The unique feature in this case was the bilateral sensorineural hearing loss, which appeared concomitantly with the paraparesis. There are few studies associating Lyme disease and hearing loss.…”

Pseudotumor cerebri bei Neuroborreliose

“…Nach einer Studie von Christen et al [2] aus den Jahren 1986-1989 lag deren Inzidenz in Niedersachsen bei 5,8/100.000 Kindern im Alter von 1-13 Jahren [1,2].…”