Lyme disease

Borrelia burgdorferi sensu lato bacteremia in Slovenian children with solitary and multiple erythema migrans

To establish the frequency and characteristics of Borrelia burgdorferi sensu lato bacteremia in Slovenian children with solitary and multiple erythema migrans, 1164 patients were included in this prospective study. Bacteremia was established in 11.4% of all patients, 15.8% of patients with multiple erythema migrans, and in 7.6% of patients with solitary erythema migrans. Bacteremia can be detected in children, with untreated erythema migrans, up to 39 days after the onset of skin rash.

Southern Tick-Associated Rash Illness (STARI) in the North: STARI following a tick bite in Long Island, New York

The most common clinical manifestation of Lyme disease is the characteristic rash, erythema migrans (EM). In the 1980s EM-like eruptions were reported in Missouri and other southeastern states. The EM-like eruptions, which were of unknown etiology, often followed the bite of the Lone Star tick (Amblyomma americanum) and the rash is called STARI (southern tick-associated rash illness). Although the Lone Star tick is found in the Lyme disease-endemic areas of New England and Mid-Atlantic regions of the United States, STARI has been reported only once from the Northeast and Mid-Atlantic regions. We report a child from Connecticut who visited Long Island, New York, and developed a rash that was thought to be EM. Because the patient failed to respond to antibiotics used to treat Lyme disease, an investigation ensued, and the diagnosis of STARI was established.

Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome

BACKGROUND

Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.

MATERIAL/METHODS

Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).

RESULTS

Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.

CONCLUSIONS

Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.

[Lyme disease: prophylaxis after tick bite]

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted by infected ticks. The transmission depends on several factors, especially on the duration of the tick's presence in the host body (the nymph which is smaller than the adults and thus less visible, is in this case the most frequently involved) and on whether the tick is infected or not. The interpretation of results in the few available studies is made difficult by the lack of information obtained (due to difficulty to collect information and examination costs). The comparison is made even more difficult by the difference between Borrelia ticks species in various regions. Today, the best methods are preventive: protective clothing, tick repellents, checking and removal of ticks after a journey in an endemic zone, and in case of tick bite, regular examination of the bite site during the following weeks in order to initiate an early curative treatment if ECM is diagnosed. The currently available data seems to be insufficient to suggest systematic antimicrobial prophylaxis in case of tick bite.

Electrocardiographic findings in children with erythema migrans

OBJECTIVE

To assess electrocardiographic findings in children with erythema migrans and to compare them with findings obtained in a healthy control group of comparable age and with a similar proportion of boys and girls.

METHODS

Electrocardiograms were carried out in 147 children under the age of 15 years before treatment with antibiotics for erythema migrans (solitary 68 patients, multiple 79 patients) and in the control group of 148 healthy children.

RESULTS

Abnormal electrocardiographic findings were detected more often in healthy children than in patients (14% versus 5%; P = 0.0303) and among patients more often in boys than in girls (10% versus 0%; P = 0.0107). Electrocardiographic abnormalities characteristic for Lyme borreliosis, such as atrioventricular blocks, were rare: in patients with erythema migrans only one child had first-degree atrioventricular block; in the control group one child had first-degree and another had second-degree atrioventricular block. Patients with erythema migrans had shorter PR and RR intervals and lower R and S wave voltages in V1 than the healthy children. Comparison among patients with solitary and multiple erythema migrans did not reveal significant electrocardiographic differences. The frequency of electrocardiographic abnormalities in patients with erythema migrans was not associated with the presence of systemic symptoms, or with the presence of meningitis or the isolation of Borrelia burgdorferi sensu lato from the blood.

CONCLUSIONS

Electrocardiographic abnormalities in children with erythema migrans are mild, nonspecific and rare. The presence of clinical signs and symptoms indicative or suggestive of disseminated Lyme borreliosis is not associated with higher frequency of such abnormalities. Comparison of findings in patients with erythema migrans and healthy children revealed several distinctions, some of which might have been interpreted as a result of altered activity of the autonomic nervous system.

Training room management of medical conditions: infectious diseases

Management of infectious diseases in athletes encompasses a wide range of pathogens, clinical presentations, and treatment options. Certain athletic activities and training regimens may predispose athletes to increased risk of contracting infectious diseases, some of which may limit athletic participation and pose the threat of significant morbidity. The sports medicine physician plays an important role as a first line of defense in preventing, recognizing, and appropriately treating infectious diseases in athletes.

Clinical data and cerebrospinal fluid findings in Lyme meningitis versus aseptic meningitis

The purpose of this study was to characterise Lyme meningitis (LM) in a Belgian paediatric population and to suggest findings that could allow early distinction from aseptic meningitis (AM). The medical records of patients hospitalised between 1993 and 2000 and with a discharge diagnosis of LM (n=14) or AM (n=16) were retrospectively reviewed. The Kruskal-Wallis test was used to compare data. Of the patients, 16 were identified with AM and 14 with LM, amongst which 7 presented with isolated LM and 7 with associated peripheral facial palsy (PFP). Patients with AM, when compared with LM, complained of more pronounced signs and symptoms of meningitis (fever, headaches, and neck stiffness); they statistically displayed a shorter period of symptoms before admission (1.6 vs 15 days), higher neutrophilic component (mean 56% vs 2.4%), and lower protein levels (mean 0.39 vs 1.12 g/l) on cerebrospinal fluid analysis. In the neuroborreliosis group, the duration of symptoms was shorter and the cerebrospinal protein level was lower in cases of LM associated with PFP compared to isolated LM (mean 1.3 vs 15 days; mean 0.55 g/l vs 1.12 g/l). Conclusions. Our results suggest that some clinical data and laboratory findings may help the physician to diagnose aseptic or Lyme meningitis before completion of serologic testing. LM should be suspected in cases of meningitis with very low CSF neutrophilic counts and high protein levels associated with prolonged duration of symptoms, low grade fever, and absence of pronounced signs of meningitis.

Successful treatment of neuroborreliosis with ten day regimens

BACKGROUND

There have been few large reports of the treatment and outcome of neuroborreliosis in children.

METHODS

All 203 children with symptoms, cerebrospinal fluid and serologic findings compatible with neuroborreliosis and treated at one of the four pediatric hospitals in Stockholm from 1994 through 1996 were included. Children were treated with intravenous beta-lactam antibiotics or oral doxycycline for 10 days and followed until the resolution of symptoms.

RESULTS

At the end of treatment 58% and after 2 months 92% of the children had no symptoms. Cerebrospinal fluid findings had no statistically significant influence on the outcome. Facial paralysis persisted longer than other symptoms.

CONCLUSIONS

The prognosis of neuroborreliosis in children 2 months after treatment seems to be excellent with 10-day treatment regimens.

Effective retrieval of Lyme disease information on the Web

The spirochetal infection Lyme disease, although now usually easily diagnosed and treated, has acquired an aura of ambiguity for many laypersons and medical professionals. The existence of controversy makes it difficult for infectious diseases physicians and scientists to readily obtain accurate information on Lyme disease by casually browsing the World Wide Web. Informative and current Web sites on the diagnosis, epidemiology, treatment, and prevention of Lyme disease can be found on-line, as can clear images of its clinical variants and of ticks. There are a handful of on-line resources on the biology of Borrelia and ticks, which can be tapped by the research community. These Web sites are described in the present article.

Lyme disease in central Europe

Lyme borreliosis is a fascinating disease, the aetiopathology of which is not yet completely known. Different subspecies of Borrelia burgdorferi sensu lato are responsible for the variable clinical course of the disease. Some new cutaneous (alopecia) and ocular (photophobia and retinal vasculitis) manisfestations have been described and the largest prospective study on erythema migrans during pregnancy was published during the last year. Optimal therapy of Lyme borreliosis is still lacking, but doxycycline, amoxicillin, penicillin, and ceftriaxone are recommended most frequently.

Lyme disease

Lyme disease (LD) is the most common tick-borne disease in the US. The overall trend has been an average annual increase in cases since surveillance was initiated by the Centers for Disease Control and Prevention in 1982. To date, 10 different Borrelia species have been described within the Borrelia burgdorferi sensu lato complex, although only Borrelia burgdorferi sensu strico, Borrelia garinii, and Borrelia afzelii have been associated with human disease. Ixodes ticks often carry more than one potential pathogen, and co-infection with B. burgdorferi and other organisms have been reported. Recent findings suggested that maintenance cycles of other tick-borne pathogens may be different than those for B. burgdorferi. A better understanding of the pathogenesis of Lyme arthritis has provided clues about the mechanisms responsible for variation in clinical expression of the disease. Results of therapeutic trials in Lyme neuroborreliosis are likely to have an impact upon treatment recommendations. A long term follow-up study of children treated for LD indicated that the prognosis is excellent in most cases. A safe vaccine for the prevention of LD has been approved in adults. Preliminary data suggested that the vaccine is safe and immunogenic in children.