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Lyme borreliosis in children. A controlled clinical study based on ELISA values
M Millner1, M G Schimek, D Spork
1Abteilung Neuropädiatrie, Universitäts-Kinderklinik, Auenbruggerplatz, Graz, Austria.
Insights
Early diagnosis of Lyme borreliosis in children is crucial. Even with negative initial cerebrospinal fluid (CSF) tests, persistent symptoms warrant further investigation for neuroborreliosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Lyme borreliosis is a tick-borne illness that can affect the central nervous system (CNS).
- Diagnosing neuroborreliosis in children can be challenging, especially when initial tests are inconclusive.
Purpose of the Study:
- To evaluate the diagnostic utility of serological tests and cerebrospinal fluid (CSF) analysis in children with suspected Lyme borreliosis.
- To highlight the importance of considering neuroborreliosis in children with neurological symptoms, even with initially negative CSF findings.
Main Methods:
- Retrospective analysis of 27 children with clinical symptoms of Lyme borreliosis.
- Assessment of serological status (ELISA IgG) and CSF analysis for Borrelia burgdorferi antibodies.
- Evaluation of treatment response to antibiotic therapy.
Main Results:
- 21 out of 27 children were seropositive for Lyme borreliosis.
- CNS symptoms were present in 81% of seropositive children.
- Three children with Bell's palsy or aseptic meningitis initially had negative CSF but later developed positive CSF titres, indicating delayed antibody production.
Conclusions:
- Elevated ELISA IgG titres are indicative of Lyme borreliosis in children.
- Neuroborreliosis should be suspected in seropositive children with aseptic meningitis and neurological symptoms, even if the initial CSF analysis is negative.
- Prompt antibiotic treatment, such as Sodium penicillin, leads to clinical recovery in most cases, though residual effects like hypoacusis can occur.
Abstract:
A total of 27 children with clinical symptoms indicative of Lyme borreliosis are described, 21 of which were seropositive. CNS symptoms were found in 17 of the seropositive children (81%). Of these 21, 7 were CSF negative. Another 3 (with Bell's palsy and/or aseptic meningitis) were initially CSF negative but developed specific CSF titres 80, 65 and 120 days after the first lumbar puncture, respectively. Thus, seropositive children with aseptic meningitis and without initial signs of an infectious aetiology should be checked for a neuroborreliosis even when CSF negative in the first lumbar puncture. Antibiotic therapy undertaken in 26 children showed clinical recovery (Sodium penicillin, 300,000-500,000 units/kg per day for 14 days). One developed residual hypoacusis. Comparison of enzyme-linked immunosorbent assay (ELISA) IgG values from 27 cases with those of 30 healthy controls showed that elevated ELISA titres are a good indication of the disease. However, Lyme borreliosis can only be diagnosed correctly if the clinical symptoms conform with specific titres.