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Early differentiation of Lyme from enteroviral meningitis

Samir S Shah1, Theoklis E Zaoutis, Jacob Turnquist

  • 1Divisions of Infectious Diseases, The Children's Hospital of Philadelphia, PA, USA.

The Pediatric Infectious Disease Journal
|June 4, 2005
PubMed
Abstract

Insights

Differentiating Lyme meningitis from enteroviral meningitis is crucial. Key indicators like cranial neuropathy and rash suggest Lyme meningitis, aiding early diagnosis and treatment.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurology
  • Clinical Diagnostics

Background:

  • Distinguishing Lyme meningitis from enteroviral meningitis is challenging due to similar seasonal incidence.
  • Accurate differentiation is vital as only Lyme meningitis necessitates parenteral antibiotic therapy.

Purpose of the Study:

  • To identify clinical and laboratory features differentiating Lyme meningitis from enteroviral meningitis in children.
  • To aid clinicians in making timely diagnostic and therapeutic decisions.

Main Methods:

  • A cross-sectional study comparing pediatric patients diagnosed with Lyme or enteroviral meningitis.
  • Data collected from a large children's hospital between 1999 and 2002.

Main Results:

  • Lyme meningitis patients were older (median 10.5 vs 5.5 years) with longer symptom duration (12 vs 1 day).
  • Cranial neuropathy, erythema migrans rash, or papilledema occurred in 88% of Lyme meningitis cases, versus none in enteroviral meningitis.
  • Cerebrospinal fluid neutrophil percentage >10% strongly predicted against Lyme meningitis (NPV 99%).

Conclusions:

  • Clinical and laboratory findings can facilitate early differentiation between Lyme and enteroviral meningitis.
  • These findings support informed decisions on further testing and empirical antibiotic treatment.

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