Lyme Neuroborreliosis in Children

Abstract

Background: Information on the etiology of Lyme neuroborreliosis (LNB) in children in Europe and the influence of Borrelia burgdorferi sensu lato species isolated from cerebrospinal fluid (CSF) on clinical presentation of LNB in children are limited. Methods: The study was monocentric. During its 17-year period, children younger than 15 years with presentation suggestive of LNB or confirmed Lyme borreliosis that had B. burgdorferi sensu lato isolated from CSF and had species of B. burgdorferi sensu lato identified by pulsed-field gel electrophoresis were included. Demographic and medical data were compared for children infected with Borrelia garinii to those infected with Borrelia afzelii. Results: One hundred and fifty-three children had B. burgdorferi sensu lato isolated from CSF. In 71/113 (62.8%) and 42/113 (37.2%) patients, B. garinii and B. afzelii, respectively, were identified. Patients infected with B. garinii did not report symptoms suggestive of central nervous system (CNS) involvement or any other symptoms more often than patients infected with B. afzelii. Compared with children infected with B. afzelii, children infected with B. garinii had erythema migrans less often (18.3% vs. 45.2%) but had positive meningeal signs (69.0% vs. 38.1%), CSF lymphocytic predominance (97.1% vs. 75.0%), and elevated albumin CSF/serum quotient (80.6% vs. 50.0%) more often. Conclusions: In Slovenia, LNB in children is more often caused by B. garinii, followed by B. afzelii. The clinical picture of LNB in children caused by B. garinii is not more often suggestive of CNS involvement, but CNS inflammation is more pronounced in children infected with B. garinii, compared with children infected with B. afzelii.

Bannwarth Syndrome

“…11 Table 1 lists the pediatric studies and case reports of BWS or if "radiculopathy" was one of the presenting symptoms. 7,[11][12][13][14][15][16][17] BWS have not been reported in other pediatric studies. [6][7][8][9][10]18 In a study of 77 adults with BWS in Europe, the most frequent signs and symptoms included radicular pain (100%), EM (59.7%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesias (32.5%), FNP (36.4%), meningeal signs (19.5%) and paresis (7.8%).…”

“…7,[11][12][13][14][15][16][17] BWS have not been reported in other pediatric studies. [6][7][8][9][10]18 In a study of 77 adults with BWS in Europe, the most frequent signs and symptoms included radicular pain (100%), EM (59.7%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesias (32.5%), FNP (36.4%), meningeal signs (19.5%) and paresis (7.8%). 19 CSF analyses in these patients revealed pleocytosis with a lymphocytic or monocytic predominance, elevated CSF protein concentration, increased CSF anti-Borrelial IgM/IGG levels.…”

“…5,6 Erythema migrans (EM) is present in 13%-16% of European children presenting with LNB. 7,8 LNB was shown to be present in 12.5% of patients in the United States with confirmed LB in a surveillance data from the CDC. 9 One-fourth of the reported cases of LB occurred in children less than 14 years of age.…”

Diagnostic Precision in Lyme borreliosis: Assessing VlsE and C6 Antigens in a Pediatric Cohort

“…In Europe, where B. afzelii and B. garinii are dominant in LNB and in the United States, where B. burgdorferi sensu stricto is dominant, the results in monitoring treatment may differ. This suggests that the specific Borrelia species present in the region can influence the sensitivity of the test and subsequently impact the diagnosis and monitoring of treatment efficacy [3,57,58].…”

Characteristics of spirochetemic patients with a solitary erythema migrans skin lesion in Europe

“…The low sensitivity of borrelia blood cultures is probably an important reason that data on characteristics of patients with culture-confirmed hematogenous dissemination of borreliae in Europe are limited. Indeed, according to a PubMed literature search performed in November 2020 (and using the key words "borrelia" OR "Borrelia afzelii" OR "Borrelia garinii" AND "blood"), several studies on the isolation of B. afzelii or B. garinii from skin or cerebrospinal fluid with corresponding clinical data have been published [10][11][12][13][14][15][16][17][18]. However, no information on the pre-treatment characteristics or the post-treatment outcome of LB for patients with isolation of B. afzelii or B. garinii from blood has been reported.…”