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Characterization of Lyme meningitis and comparison with viral meningitis in children
S C Eppes1, D K Nelson, L L Lewis
1Division of Infectious Diseases, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. seppes@nemours.org
Objectives:
The objectives of this study were to characterize Lyme meningitis (LM) in the pediatric population; to compare LM with viral meningitis (VM) with respect to epidemiology, history and physical examination, and laboratory data; and to provide means of early distinction of Lyme neuroborreliosis from other forms of aseptic meningitis.
Methods:
This retrospective analysis involved children admitted to Alfred I. duPont Hospital for Children between 1990 and 1996 whose discharge diagnoses indicated viral or aseptic meningitis or Lyme disease. LM was defined as the presence of cerebrospinal fluid (CSF) pleocytosis with positive Lyme serology and/or erythema migrans. Patients were considered to have VM if they exhibited CSF pleocytosis and had a positive viral culture. Demographic, clinical, and laboratory data were collected for each patient, and patients with LM were compared with age-matched patients with VM.
Results:
Of 179 patient records, 12 patients with LM and 10 patients with VM (all, >2 years old) were identified by using the above criteria. In comparing LM patients with VM patients, we noted no differences among demographic variables. Children with LM had significantly lower temperatures at the time of presentation. The presence of headache, neck pain, and malaise was similar for the two groups, but the duration of these symptoms was significantly longer among LM patients. Five children with LM had cranial neuropathies. All but 1 LM patient exhibited either papilledema, erythema migrans, or cranial neuropathy. These three findings were absent in the VM group. On CSF analysis, LM patients had fewer white blood cells (mean, 80/mm3 versus 301/mm3) and a significantly greater percentage of mononuclear cells than the VM patients.
Conclusions:
In this study, in a Lyme-endemic area, LM was about as common as VM in older children who were hospitalized with aseptic meningitis. Attention to pertinent epidemiologic and historical data, along with physical and CSF findings, allows early differentiation of LM from VM.
Insights
Lyme meningitis (LM) in children often presents with longer-lasting symptoms and specific signs like cranial neuropathies, differentiating it from viral meningitis (VM). Early identification of these pediatric Lyme neuroborreliosis indicators is key.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroborreliosis Research
Background:
- Lyme meningitis (LM) requires differentiation from viral meningitis (VM) in pediatric cases.
- Understanding distinct clinical and laboratory features aids in early diagnosis.
Purpose of the Study:
- Characterize pediatric Lyme meningitis (LM).
- Compare LM with viral meningitis (VM) in children.
- Identify early diagnostic markers for Lyme neuroborreliosis.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with meningitis.
- Defined LM by CSF pleocytosis with positive Lyme serology/erythema migrans.
- Defined VM by CSF pleocytosis and positive viral culture.
- Compared demographic, clinical, and laboratory data between LM and VM groups.
Main Results:
- Children with LM presented with lower temperatures and longer symptom duration than VM patients.
- Cranial neuropathies, papilledema, or erythema migrans were present in most LM cases, absent in VM.
- LM patients showed fewer white blood cells but a higher percentage of mononuclear cells in CSF compared to VM patients.
Conclusions:
- Lyme meningitis is as common as viral meningitis in hospitalized older children in endemic areas.
- Epidemiological data, history, physical exam findings, and CSF analysis facilitate early differentiation of LM from VM.