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

David Tuerlinckx1, Eddy Bodart2, Maria-Grazia Garrino3

  • 1Department of Paediatrics, Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Mont-Godinne, 5530, Yvoir, Belgium. david.tuerlinckx@pedi.ucl.ac.be.

European Journal of Pediatrics
|March 26, 2003
PubMed

Insights

Early distinction between Lyme meningitis (LM) and aseptic meningitis (AM) in children is possible. Findings suggest LM may present with prolonged symptoms, low fever, and specific cerebrospinal fluid profiles, aiding diagnosis before serologic testing.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • Aseptic meningitis (AM) and Lyme meningitis (LM) are common pediatric neurological conditions.
  • Early differentiation between AM and LM is crucial for appropriate treatment and management.
  • Distinguishing between these conditions can be challenging based solely on initial clinical presentation.

Purpose of the Study:

  • To characterize Lyme meningitis (LM) in a Belgian pediatric population.
  • To identify clinical and laboratory findings for early distinction between LM and aseptic meningitis (AM).

Main Methods:

  • Retrospective review of medical records for pediatric patients diagnosed with LM (n=14) or AM (n=16) between 1993 and 2000.
  • Kruskal-Wallis test used for statistical comparison of patient data.
  • Analysis of clinical symptoms, duration of illness, and cerebrospinal fluid (CSF) parameters.

Main Results:

  • Patients with AM exhibited more pronounced meningitis symptoms (fever, headache, neck stiffness) and a shorter symptom duration (1.6 vs 15 days) before admission compared to LM.
  • CSF analysis revealed a higher neutrophilic component (mean 56% vs 2.4%) and lower protein levels (mean 0.39 vs 1.12 g/l) in AM patients versus LM patients.
  • In LM cases, association with peripheral facial palsy correlated with shorter symptom duration and lower CSF protein levels compared to isolated LM.

Conclusions:

  • Clinical data and laboratory findings can aid physicians in diagnosing LM versus AM before serologic test completion.
  • LM should be suspected in meningitis cases with very low CSF neutrophil counts and high protein levels, coupled with prolonged symptoms, low-grade fever, and absence of pronounced meningitis signs.

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