Electrocardiograph Abnormalities in Children With Lyme Meningitis
Elizabeth J Welsh1, Keri A Cohn2, Lise E Nigrovic3
1Department of Pediatrics, and Divisions of.
Insights
Electrocardiographic (ECG) abnormalities are common in children with Lyme meningitis, affecting one-third of patients. Older age and prolonged fever increase the risk of these changes.
Area of Science:
- Pediatric infectious diseases
- Cardiology
- Epidemiology
Background:
- Lyme meningitis is a serious infection in children.
- Electrocardiographic (ECG) changes can occur in early-disseminated Lyme infection.
- The prevalence and risk factors for ECG changes in pediatric Lyme meningitis are not well-established.
Purpose of the Study:
- To estimate the prevalence of ECG abnormalities in children diagnosed with Lyme meningitis.
- To identify risk factors associated with ECG changes in this pediatric population.
Main Methods:
- Cross-sectional study conducted in three urban pediatric tertiary care centers.
- Included children diagnosed with Lyme meningitis who underwent ECG testing.
- Multivariable logistic regression analysis used to identify independent risk factors for ECG abnormalities.
Main Results:
- ECG abnormalities were present in 33% of 103 children with Lyme meningitis.
- Common abnormalities included atrioventricular block (16%), ST-T wave changes (14%), and prolonged QT interval (11%).
- Independent risk factors for ECG abnormalities were age ≥13 years and fever lasting ≥5 days.
Conclusions:
- Electrocardiographic abnormalities are frequent in pediatric Lyme meningitis.
- Older children (≥13 years) with prolonged fever (≥5 days) have the highest likelihood of ECG abnormalities.
- The clinical significance of asymptomatic ECG changes in pediatric Lyme meningitis requires further investigation.
Objective:
The objective of the study was to estimate the prevalence of and identify risk factors for electrocardiographic (ECG) changes in children presenting with Lyme meningitis.
Design:
This was a cross-sectional study.
Setting:
The study was set in three large urban pediatric tertiary care centers.
Participants:
Children who were diagnosed with Lyme meningitis and underwent ECG testing were included.
Outcome Measure:
The presence of an ECG abnormality associated with early-disseminated Lyme infection was the outcome measure.
Results:
Multivariable logistic regression was used to identify factors independently associated with ECG abnormalities. ECG testing was performed in 103 (66%) of 157 children with Lyme meningitis. The median age of these children was 10.8 years; 68% were male. ECG abnormalities, identified in 34 (33%) subjects, included one or more of the following: atrioventricular block (n = 16; 16%), ST-T wave changes (n = 14; 14%), and prolongation of the corrected QT interval (n = 11; 11%). In multivariate analysis, age ≥13 years and fever for ≥5 days were independently associated with ECG abnormalities. The probability of ECG abnormalities was greater than 50% in those with fever for ≥5 days or age ≥13 years, and if a subject fulfilled both criteria, the probability of ECG abnormalities was 83% (95% confidence interval: 50%-96%).
Conclusions:
Electrocardiographic abnormalities occur commonly in children with Lyme meningitis. While older children with prolonged fever were most likely to have such abnormalities, the clinical consequences of asymptomatic ECG abnormalities in children with Lyme meningitis are not known.
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