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The long-term course of Lyme arthritis in children
I S Szer1, E Taylor, A C Steere
1Department of Pediatrics, Floating Hospital for Infants and Children, New England Medical Center, Tufts University School of Medicine, Boston.
Insights
Untreated Lyme disease in children can lead to long-term arthritis, eye inflammation (keratitis), and neurological issues (encephalopathy). Some children experience persistent joint pain and fatigue years after initial infection.
Area of Science:
- Pediatric infectious diseases
- Rheumatology
- Neurology
Background:
- The natural history of Lyme disease, particularly Lyme arthritis in children, is not fully understood.
- Long-term outcomes of untreated Lyme disease require further investigation.
Purpose of the Study:
- To investigate the long-term course of Lyme arthritis in children who did not receive antibiotic treatment for at least the first four years of illness.
Main Methods:
- A cohort of 46 children diagnosed with Lyme arthritis between 1976 and 1979 was studied.
- Participants received no antibiotic therapy for the initial four years of their illness.
- Long-term follow-up data was collected, including clinical manifestations and serological responses to Borrelia burgdorferi.
Main Results:
- Initial symptoms included erythema migrans (72%), influenza-like symptoms (15%), and migratory joint pain (13%).
- Recurrent arthritis attacks, primarily affecting the knee, decreased over time, but some children experienced joint pain and fatigue even after 10 years.
- Late complications included keratitis (4%) and subtle encephalopathy in a small percentage of children. Positive IgG antibody responses to Borrelia burgdorferi were observed throughout the illness and follow-up.
Conclusions:
- Untreated Lyme disease in children can progress through acute infection, recurrent arthritis, and potentially lead to late-onset complications like keratitis, chronic joint pain, or encephalopathy.
- The study highlights the variable and potentially long-lasting effects of Lyme disease in children without early antibiotic intervention.
Background And Methods:
The natural history of Lyme disease is not completely known. We studied the long-term course of Lyme arthritis in 46 children in whom the onset of the disease occurred between 1976 and 1979 and who received no antibiotic therapy for at least the first four years of the illness.
Results:
Of the 46 children (age range, 2 to 15 years), 33 (72 percent) initially had erythema migrans, 7 (15 percent) had influenza-like symptoms, and 6 (13 percent) had migratory joint pain. These manifestations were followed by brief attacks of arthritis, particularly affecting the knee. The percentage of children with recurrent episodes of arthritis declined each year. By year 4, only 10 children still had a mean of two episodes of arthritis per year; the duration of arthritis was generally longer in older children (P less than 0.05). During the sixth year of illness, two children (4 percent) had keratitis, and more than 10 years after the onset of disease, a subtle encephalopathy developed in two other children. Of the 39 children whom we were able to contact in 1988-1989, 12 (31 percent) still had occasional brief episodes of joint pain and 1 (3 percent) had marked fatigue. All 46 children had positive IgG antibody responses to Borrelia burgdorferi throughout the illness and on long-term follow-up. As compared with those who became asymptomatic, the children with recurrent symptoms more often had IgM responses to the spirochete and had significantly higher IgG titers (P less than 0.05).
Conclusions:
The course of initially untreated Lyme disease in children may include acute infection followed by attacks of arthritis and then by keratitis, subtle joint pain, or chronic encephalopathy.